What are the care options following hospital discharge?

When your older relative is leaving hospital, it can be a very worrying time to ensure that they have the right level of care on hospital discharge. We consider the views of the patient, relatives and nursing staff and provide top tips for managing the process to provide the best possible care for your older relative.

A possible patient’s viewpoint

Your name is Albert and you’re in your 90s. You have been seriously ill and now you have just about recovered, even though you still have some aches and pains. For 70 of your 90 years, you have lived in your own home, you’ve survived the Second World War…. you’ve always been independent.  But now someone is telling you it’s time to leave hospital after your illness and things feel rather different. Your confidence is shattered, your friends are mostly long gone and your family possibly doesn’t live anywhere nearby. It’s terrifying and they may even start to talk about moving you to a care home, rather than you being able to return home. Where do you turn?

A possible nursing perspective

The discharge sister is charged with emptying hospital beds. She has a tough job on her hands. They’re queuing up downstairs in A&E, and there are no beds available.She knows that there are three possible discharges tomorrow on ward 6G. That should help. So she goes to see what is happening on Ward 6G. Albert on Ward 6G is medically fit, but his family live in Manchester and this is Surrey. They came down last week and have found a care home they like for him, but it’s full. The rest of the homes are just not right. The family is lovely and they are really worried about their Dad / Great-Grandfather. They don’t want him to linger in hospital, but their hands are tied …it’s all so difficult.

A possible relative’s perspective

Any discussion about the long term care of a loved one is bound to be a challenge, ever more so when the loved one has had a spell in hospital and have suddenly found long standing arrangements are not going to work.

Nobody wants to keep someone in hospital for a minute longer than necessary. But the decision of where to go next, made in a hurry by families who are often living and working some way away, possibly also being called on to help their own grown up children with child care, can lead to more problems in the long term.

It seems that a breathing space is needed where the loved one and the family can look at all the options carefully and adjust to the new circumstances in a calm and measured manner.

What are the options?

It is said that good discharge planning starts from day one of admission. However, in practice, it is not usually considered until the patient is deemed “medically fit for discharge” when families will be asked to either take their loved one home or to find alternative arrangements.

The problem which also needs to be addressed in discharge teams is finding the right sort of person to help in the many tricky administrative issues which can crop up on discharge. Where discharge from hospital works well, there is usually a dynamic co-coordinator who knows her around the system, helping resolve the small but important problems which hold up hospital discharge.

Very often, a breathing space is all that is needed to take the pressure out of the situation, so that a proper assessment can be made of the long term needs of the older person. Any assessment made from a hospital bed is going to differ from one made calmly.

At this stage, the options available are:

• Home with home-care by the hour (the hospital social service team will advise on this, irrespective of whether you will pay for your care or not.)
• Respite care (Short term) in a care home (the discharge sisters will have the names of homes which offer respite facilities) or
• 24-hour live-in care at the patient’s own home
• 24-hour live-in care at a relative’s home

24 hour care can be a viable option on hospital discharge

This model of care is becoming increasingly popular with families and their loved ones; however, as it is new, it is little understood by many discharge teams and it is worth looking at the various excellent companies that provide such care. For Albert, it would mean that he would be cared for safely in his home, at a cost which may well be less than many good care homes.

However, some hospital nursing staff not know about the live-in care option and many are not prepared to take the perceived risk in helping someone like Albert to return to his own home.

Some great live-in care services exist, but they need to be linked to the NHS and social services in order to make them a viable option for when people are discharged from hospital.

What you can do to help

If your older relative is about to be discharged form hospital, talk to the discharge sister about the options they recommend.

If you’d like to consider 24-hour live-in care, ring some local providers and ring them to ask for an assessment. You must also consider the following few top tips in selecting your 24-hour live-in care provider company:

1. Check that the provider is registered with the Care Quality Commission (CQC) – this is vitally important, as it will mean that all staff are properly checked and trained.
2. Ask if the provider employs their own staff, or do they act solely as an introductory agency. (both arrangements can work well, but is it is slightly riskier if the staff are self-employed)
3. Find out what arrangements are in place to supervise the live-in care services. Are the supervisors trained to at least NVQ level 3 or are they registered nurses? Also does the provider supervisor make regular visits to the client’s home?
4. Ask if the provider is prepared to offer you a short, 2 to 4 week contract, so that you can keep your long term options open
5. Ask if the provider is able to provide cover if the carer is ill or unable to work
6. Ask to talk to other people who have received services from the provider company to ensure you get proper references.

For further advice and information, please contact Christina Sell at Arbour Companions & Care on 0845 8381090 or  07484 160261