Discharge from Hospital
For many elderly people the pathway into care follows a hospital discharge. This is a time of stress for any family concerned, and sometimes family members are put under pressure to sign discharge forms. The most important advice is be very careful and sign nothing until you fully understand what you are signing and its implications.
A typical scenario is that an elderly relative is living at home and has a fall and is taken to hospital as an emergency. Once there is no medical reason to keep them in hospital, they will be declared fit for discharge. You believe it is not safe for them to return home and raise this with the hospital. At this point your relative may be offered a few weeks of ‘rehab’ in a separate location – often a care home.
You need to be aware of the following:
- If there is any doubt about mental capacity – ie. to understand, retain and weigh up information, a mental capacity assessment (MCA) must be made before anything else is done.
- If the MCA finds lack of capacity a “best interests meeting” has to be held unless there is a registered LPA for Health & Welfare in force.
- If you are asked to sign a form make sure you understand exactly what its purpose is.
- No-one can be discharged until a comprehensive assessment of their health and social care needs has been made. Everyone must be assessed to see if they require a full assessment from Continuing Health Care (CHC) but hospital staff can sometimes pay lip service to this requirement and families are not even aware it has occurred.
- Remember a CHC assessment can only take place once needs have stabilised.
- What can happen is the NHS pay for a number of weeks care in a care home to free up a hospital bed and then just stop paying after six weeks. This does not negate their obligation to carry out a CHC assessment.
- Only when the ward has complied with CHC legislation can they make a referral to Social Services. Adult Social Care must make a full assessment and must not discuss finances before assessing needs.
- They are not allowed to step away from this because the patient is a self-funder. Social Services also have to fund intermediate care of six weeks while assessing needs to see if they can restore a person’s functional ability. Ask for a copy of their intermediate care policy. This is available for all patients, including self-funders.