Returning home after a stay in hospital will doubtless be a welcome relief, but also a time of anxiety, particularly for an elderly patient who lives alone or needs after-care and support. Their safety and wellbeing are at the heart of the hospital discharge process.
When the time comes for your elderly parent or relative to be discharged from hospital you will need to know how the discharge process works, what to prepare and what happens after they leave hospital.
How discharging elderly patients from hospital works
Almost as soon as someone goes into hospital the staff, which may include a discharge co-ordinator, will start planning for a return to their home (or a care home). When doctors decide that the patient no longer needs to receive treatment in hospital, there should already be a plan in place for their swift and safe discharge.
A hospital’s aims are that:
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1.
The elderly patient is ready to leave
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2.
They will be safe where they are going
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3.
That any further support is put in place
“Discharge to Assess” (D2A), or “Home First”, is now the standard procedure for patient discharge. If the patient is deemed fit to be discharged, but likely to have long-term care needs, the local authority is no longer required to carry out a care needs assessment prior to discharge from hospital. This will take place once the patient has returned to their residence.
The NHS is obliged to include carers and family members in the discharge planning process. You therefore have the right to be included in the discussions about hospital discharge for an elderly parent or relative.
The hospital discharge process
The first step is a discharge assessment which will determine whether more care is needed after leaving hospital. This is made in collaboration with the patient and with their family or carers.
If the patient needs little or no care it is call a “minimal discharge”. If further care is needed, it is a “complex discharge” and a care plan will be put in place.
The discharge process begins well before the day of discharge, with hospital staff and co-ordinators constantly reassessing someone’s needs for when they are discharged. The aim is for everything to be in place so that they can be discharged when a doctor gives the medical go ahead.
Discharge planning for elderly patients
It is the hospital staff and the discharge co-ordinator’s responsibility to make sure that the patient is ready, that it is safe and that the patient will have everything they need when they get home. While it is the hospital’s responsibility, they will do this with the patient and their family, so there is some preparation you may need to do before your parent or relative is finally discharged.
How the hospital will prepare for the discharge of an elderly patient
While every situation might be slightly different, these considerations will be given to most of the following for the patient to be discharged from hospital:
- Do they have somewhere to go home to and do they have access to it (e.g. keys)?
- Is their home is suitable for them to return to – does it need adaptations first?
- Do they have suitable clothes to wear?
- Do they have a safe method of getting home (e.g. a pre-booked taxi, or a lift)?
- Do they have enough money to satisfy short term needs?
- Do they have a supply of medication and do they, or their carer, know about any new ones?
- Do they have the ability to comfortably and confidently use any new equipment or living aids?
- Has their GP has been informed?
- Is there an understanding of local services to help with things like shopping?
- Do they have an understanding of next steps in their treatment plan or a follow up appointment?
Your hospital discharge checklist
In addition to helping the hospital organise the items above, there are some simple things that you and your family can do to help make the discharge process easier for elderly relatives.
- Bring in some comfortable, easy to put on, warm clothes for them to wear when leaving.
- If driving, park close to the exit or move to the pick-up zone.
- Ask questions and make notes about everything you need to know on the condition they have been treated for.
- Make sure the hospital have up-to-date contact details.
- Organise carer support if needed.
- Look into and consider further care options (e.g. live-in care or personal alarms).
- Think about food – what will they eat at home? Consider a meal delivery service so that there is no preparation involved.
- Find out more about local charity services and funding options.
- Plan for the care plan assessment that will take place the day or the next after discharge.
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Why a meal delivery service might be a good idea
With a meal delivery service you can get pre-made, nutritious and variable meals delivered for the week ahead. This means no preparation needed to ensure your relative eats well, which is super important after returning from hospital for their recovery. If you aren’t going to be able to have time to cook their meals, or not having a carer who can, then a meal delivery service is a simple way to not worry about food for them.
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The benefits of a personal alarm after hospital discharge
Many families decide to invest in a personal alarm system for their elderly parent after being in hospital as they can be at greater risk of having a fall. A personal alarm provides a level of security and reassurance for families so that should an elderly parent fall, a 24/7 monitoring team will be able to quickly assess the situation and get help to them. You can get personal alarms with built in fall detection, GPS capabilities, or ones with a simple emergency button.
Care for elderly patients after hospital discharge
After an elderly patient has been discharged from hospital, and it is determined that they may need further help when they get home, a care and support plan can be made.
This is done by a member of social services. There may be a delay currently in this taking place due to a backlog of assessments post-pandemic, but it should be done usually a day or two after discharge from hospital. This can include a care needs assessment and a carers assessment for a primary carer, which is particularly helpful if that is an elderly spouse or partner. Your relative might also be assessed for NHS continuing healthcare.
It may well be a good idea for a family member who is not necessarily the primary carer to be present when a care plan assessment is done to be able to contribute, ask and answer questions, and to understand the results.
FAQs for discharging elderly patients from hospital
What is Discharge to Assess?
Discharge to Assess is a strategy employed by NHS England, especially when dealing with older patients who may need further care and support after being discharged from hospital. The idea is to continue the assessment process after discharge, instead of delaying hospital discharge in order to assess.
What is the criteria for discharge from hospital?
The criteria for hospital discharge will vary between hospitals (each has their own discharge protocols and processes), conditions and where the elderly patient would be discharged to. It is the hospital's upmost priority to make sure that they don't require any further primary care from the hospital and that they are being released into a safe environment.
Can you discharge a family member from hospital?
No. It is the hospital's decision to discharge a patient, unless the patient wishes to self-discharge. Throughout your elderly relative's stay in hospital it is advised to be involved in discharge discussions so that you can understand the reasons why someone is or isn't being discharged from hospital.
Can you self-discharge from hospital?
Although not advised, you can discharge yourself from hospital at any point.
Who discharges you from hospital?
Once a doctor has determined that it is medically safe to discharge an elderly patient from hospital, it is the job of discharge coordinators, and potentially social care staff, to make sure that they are being discharged into a safe environment and that they can be assessed for further support if needed, once being discharged.
Can a hospital discharge you if you have nowhere to go?
If an elderly relative is unable to be discharged home for whatever reason, there are other options that a hospital will consider for discharge. Community hospital wards or care homes might be considered, especially if there are further needs that will require attention following hospital discharge.
What are the different types of hospital discharge?
There are two types of hospital discharge, minimal and complex, that are determined after an initial assessment. A minimal discharge means that little or no support will be needed after discharge. A complex discharge recognises that further support will be required.
When can a COVID patient be discharged from hospital?
Whenever a doctor determines they are medically safe to do so. Having COVID does not change a patients ability to be discharged, but will be kept in mind for example if they were to be discharged into a care home, does the care home have the ability to properly isolate them from other residents?
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