Coming Out Of Hospital

You or your carer should be consulted and informed at all stages of your care, including discharge. As with other care matters, you have the right to make informed choices about your options. If you are not happy with your discharge arrangements, you must let a member of Health and Social Care (HSC) staff who is dealing with your care and treatment know.

Plans for hospital discharge should not happen at the last minute. Planning for discharge should begin on admission to hospital with one member of staff being responsible for coordinating arrangements. Having a discharge coordinator can help you feel safe and secure about their arrangements and you should be told their name. However, all staff involved in a person’s care should have an input into the process.

All hospitals should have a hospital discharge procedure to ensure patients leave with the help and support that they need. Information about these procedures should be available to patients.

Hospital discharge procedures will vary depending on your needs and whether you are being discharged to your home or going to live in a care home. You may just require basic help such as a letter to your doctor or advice about medication. Otherwise, you may need transport home or require a lot of support, assistance and preparation.

As well discharge rights considered above and aftercare, the following discharge arrangements should be followed:

• You should be given adequate notice of the precise date and time you will be leaving hospital, and contingency plans should be put in place where necessary
• Appropriate transport should be in place with an escort if necessary
• You should be provided with an emergency contact number in case of medical difficulties after discharge
• Written discharge information should be sent to your GP within 24 hours of discharge
• Advice about medication, diet, rest, and follow up appointments should be provided

If you are returning to your own home after a hospital stay, there are a variety of practical issues which should be considered before you are discharged. For some people, friends or family members may be able to arrange these, whereas others may require their discharge coordinator to make arrangements for them, for example, through social services.

It is important to remember that hospitals have a duty to make these arrangements and ensure everything is in place before you home.

Preparing your home

Your home should be properly prepared for your return. This could involve turning on heating, having basic food supplies ready, and making up a bed. If you have been assessed as needing special equipment such as a shower seat or a stair lift, for example, these should be supplied and fitted before your discharge. In fact, you or your carer, if you have one, should be trained on how to use the equipment and instructions provided.

Services in the community

Community care services, such as home help or meals on wheels, should be in place and ready to start as soon as you are discharged. If you received these services before going into hospital and they need to be resumed, Health and Social Care (HSC) Trusts need to be informed that you are being discharged and tou need the services again.

Benefits

Any benefits that are affected by your hospital stay can be reinstated when you are discharged, as long as you continue to meet the eligibility criteria. You will need to inform the benefits office promptly when you go into and leave hospital.

Essential Items

You will need items such as your clothes, shoes, a front-door key and cash returned for your journey home.

Medication and Follow-Up Appointments

If you are given medicine to take home with you, it is important that you are provided with information such as what the medicine is for and how often and for how long it needs to be taken. It is also important for you to ensure that you can open the medication. For example, if it is in a child-proof bottle, you should check that you can open it yourself.

If you require a follow-up appointment, full details of this should be provided before you are discharged.

A care assessment may have to be carried out by social services to determine what level of care you need.

If you require a high level of support, you may have the choice of receiving this care in your own home.

If a care plan is arranged while you are in hospital, it should be reviewed within 2 weeks of your discharge. You should never feel you have to leave a hospital until your care plan has been agreed with you and all services needed are in place.

In some cases you may require more time to recover or a spell of rehabilitation. Therefore, it may be best if you move into a care home until you are back to normal and can cope in your own home.

It is important to note that there is usually a charge for care home accommodation, even when moving into a care home on a temporary basis.

Indeed, you may be medically fit enough to leave hospital, but not able to manage at home even with the help of community care services. In this case, you may be offered the option of moving permanently into a care home.

Where high levels of medical care are still required you may be moved into nursing care.

Moving into a care home on a permanent basis is a big decision, so you should take time to decide. You cannot be discharged into a care home against your will, so your wishes must be taken into consideration.

Most people are discharged from hospital without any difficulties. However, in some cases hospital discharge does not go smoothly and problems may arise. Problems may occur due to:

• Hospital factors such as timing of ward rounds, waiting for test results, delay in home assessment, management of medication, and availability of transport
• Co-ordination issues such as communication problems between care managers, district nurses, occupational therapists, and GPs
• Resource issues such as lack of rehabilitation places, care home places, home care resources, and equipment
• Patient or carer issues, such as being excluded from decision making, being given limited options, or not having their wishes taken into consideration

Problems may include:

• Discharge occurs too soon and you are still ill
• You do not feel ready to be discharged
• You are discharged from hospital but cannot manage at home
• You are not offered services you think you need
• Discharge is delayed and you are kept in hospital unnecessarily
• Discharge is poorly managed from the patient/carers perspective
• You are discharged into an unsafe environment
• You feel pressured into moving into a care home

Problem-Solving

If problems arise, you should:

• Speak to staff or hospital management about your concerns
• Explain that you are aware of the hospital’s responsibility to ensure your needs are met following discharge
• Ask for a community care assessment
• Ask for current services to be reviewed
• Seek advice from the Patient Client Council or advice services
• Complain to the hospital complaints manager or the local Trust
• Challenge the decision
• Phone the local Trust (social services) and ask for help if you are in crisis
• Contact your GP
• In a medical emergency contact 999