Carer's guide to hospital discharge
A practical guide to support a family member or friend leaving hospital. With tips from experienced carers in the Mobilise community to guide us through. Including what a good discharge process should look like. Making us feel more prepared and in control of the situation.
Everything we need to know about a hospital discharge:
What does a good hospital discharge process look like?
What a hospital discharge looks like for us, or the person we care for will be different from everyone else. But there are a few things we can make sure we're aware of, and are in place before safely leaving the hospital.
“A good hospital will not discharge someone until everything is in place.”
- Unpaid Carer
“The experience of my lovely Dad moving from hospital to a Care Home was mostly good.”
- Unpaid Carer
Let’s start with the NHS helpful guide on arranging care before leaving the hospital. We may want to take a look at this first to give us a picture of what to expect in the hospital discharge process.
These include:
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Arranging any extra help such as district nurse, or paid care at home
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Any medical equipment (and how to use it)
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Any home adaptations such as grab rails, stair lifts, raised toilet seat.
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Even if the person we care for doesn’t need a formal assessment for a care and support package, we should be signposted to alternative informal support services.
We’re big on learning from other carers to get to grips with a new situation. Including what a 'good process' to leaving the hospital looks like - so that hopefully our experiences are a little smoother.
“My father-in-law had the “Rapid Response” team after his first visit to hospital. They turned up with a walking frame, commode etc. Put a plan in place for keeping him well and visited or called him daily to keep an eye on things.” - Unpaid Carer
✅ A simple checklist to make sure everything is in place
As a carer, we have the right to be involved in the planning of the hospital discharge under the Health and Care Act 2022 (Section 91). And the discharge team should be the ones to guide us along.
"From the outset people should be asked who they wish to be involved and/or informed in discussions and decisions about their hospital discharge, and appropriate consent received. This may include a person’s family members (including their next of kin), friends, or neighbours, some of whom would be considered unpaid carers." - National Government Guidelines
Still, here are some things we can prepare to make sure the discharge team has set up the right support we need at home:
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Help with organising transportation home
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Help with handling new medical equipment (ask for a demonstration)
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Information about prescribed medication (and if there’s a simple method for us to get repeat prescriptions)
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How often or frequent the follow-up appointments are - and if hospital transport can be arranged (if needed)
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If possible or suitable for us, if telephone appointments can be arranged
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If the person we care for requires more care (than when they were admitted), what other long-term care options and funding are available
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List of informal support services we can get in touch with if the person we care for does not require a care plan
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Contact with a NHS/social care crisis response team that can be easily contacted post-discharge
How is the hospital discharge process different in Scotland?
In Scotland, The Carers (Scotland) Act 2016 sets out carer's rights in relation to hospital discharge. There is also a duty to involve carers (including young carers) in hospital discharge when:
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The person being discharged is likely to require care following discharge
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The carer can be identified without delay
When do hospitals discharge patients?
A hospital will usually discharge the person we care for, when they no longer need inpatient care. Usually, the care team will also agree that it’s safe for them to go home. This is because staying in the hospital any longer than is needed may expose the person we care for to infections, reduce their independence, limit physical activity or hinder the full recovery process.
Accordingly to HealthWatch, the national discharge policy emphasises that people should not be discharged at night and they should always be informed about the next stages of their care.
Do hospitals discharge patients during the weekend?
There have been cases where people have been discharged during the weekend, but this is rarely the case. As carers, we should be kept in the loop of the discharge dates. So that it gives us enough time to arrange to ensure the discharge care package has been put in place.
How long does hospital discharge take?
How long our hospital discharge takes will also depend on whether the discharge assessment (which we have the right to be fully involved with) determines if it will be a minimal or complex discharge.
If everything is in place, a discharge can be within a few hours. Or it can take weeks - this will depend on the needs of the aftercare.
Every hospital will have a different discharge policy. We should be able to get a copy of the hospital’s policy from them, or from their Patient advice and liaison service (PALS).
In Scotland, we can get the hospital’s policy from the Patient Advice and Support Service (PASS).
PALS or PASS can help us in many ways, such as resolving any questions or concerns we may have when using the NHS service.
“They were very focused on getting the bed empty fast. Be prepared to do the leg work quickly once the decision for discharge has been made.” - Unpaid Carer
What is a hospital discharge assessment?
This is simply the assessment of whether the person we care for will require additional support, once they leave hospital.
Whilst the person we care for is in hospital, the hospital staff should arrange a discharge assessment by contacting social services. This is so that both ends know what kind of help the person we care for needs when they’re home. In some cases, this assessment will take place at the hospital or they will visit our home.
What is a minimal discharge?
A minimal discharge means that the person we care for will require little to no care after leaving the hospital. This may be because they are closer to recovery and therefore this discharge process tends to be quicker, as less further arrangements are needed to be made.
What is a complex discharge?
A complex discharge means that the person we care for will need some form of specialised care after leaving the hospital. This is likely to be topped up with a care needs assessment if our discharge assessment reveals they will require ongoing care needs. This discharge process may take longer.
If the care needs of the person we care for have increased since their hospital stay, then as carers, we are entitled to a new Carer’s Assessment or an Adult Carer Support Plan in Scotland, before we start meeting those needs.
And remember, we have the right to say we cannot or do not wish to meet those needs.
The person we care for will also receive a letter to give to their GP, which includes information about their treatment and care needs.
For some of us, this might be the starting point of our caring role. Along with tips from carers in the Mobilise community, we’ve created a guide on ‘First steps for getting help and support with caring’ to help those of us newer to caring.
We can also take a look at what help our local carers service offers as some may have different projects connected to hospital discharge.
Can a hospital discharge you if there is nowhere to go?
Before a hospital discharge can be agreed upon, the discharge team will be responsible for making sure that their basic discharge needs are met.
These basic discharge needs include having:
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Suitable clothes to wear home
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Someone picking them up (or a taxi/hospital transport is booked)
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Enough money to help them in the short-term
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Knowledge and confidence in using new medical equipment
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Incontinence supplies if needed
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Support with letting the GP know about their discharge
This means that the hospital cannot discharge the person we care for, if they have no place to go. This would be considered as an ‘unsafe, unstable discharge’. The hospital will always need to discharge to a place of safety.
Can a hospital arrange transportation home?
Yes, the hospital discharge team can arrange transportation for patients to be discharged and sent home. This can include arranging for an ambulance or other medical transport vehicle, or coordinating with a family member or friend to provide transportation.
The specifics of how transportation is arranged will depend on the hospital's policies and the patient's individual needs. The national hospital discharge guidelines state that hospital discharge teams are responsible for:
"Making arrangements to ensure there is transport for people to return home from
hospital. This should be via family/carers where appropriate/suitable, voluntary
sector, or taxi and, only as a last resort, non-emergency patient transport services
(NEPTS)"
Although, other carers tell us to be prepared for a long wait if an ambulance is required.
Make sure to also check if the hospital transport meets the person we care for’s needs. For example, if the person we care for needs to lie down, rather than sit in a wheelchair, then a different transportation may be needed.
Can we refuse discharge from hospital?
According to court cases in 2004 and 2015, hospital patients are unable to refuse hospital discharge.
But a carer (and nurse) in our community shared:
“A good hospital will not discharge someone until everything is in place. You have the option to refuse to take someone home if support is not provided quoting an ‘unsafe discharge’. There should be a delayed discharge team who are dedicated to making a smooth discharge.”
Carers tips on avoiding an unsafe hospital discharge
Unfortunately, we've seen many cases where for carers in the Mobilise Community, the person they care for was being sent home earlier than agreed in the hospital discharge plan - and in some instances were been threatened with a withdrawal of the care package if they did not accept the new date.
If we find ourselves in a similar situation, other carers have shared some nuggets of wisdom:
"Quite simply tell them that she cannot come back as accommodation will not be suitable till then. Sometimes we have to put our foot down and say no"
"Refuse and tell them you will make a safeguarding complaint against the hospital if it's not a safe discharge"
"Speak to PALS and ask for a meeting with the Clinical Manager for the ward/unit your mum is on. And ask for Occupational Therapist to visit to check if accommodation is suitable for her release. This could delay everything for you and Mum."
"Ask them if they realise that any falls or injuries sustained if they discharge her into an unsafe environment will be totally their responsibility. Worked for me, suddenly Mum was in a community nursing home instead of home alone!"
Delayed Discharge team
In Scotland, if the person we care for is clinically ready to be discharged, but the necessary care, support and accommodation requirements have not been put in place, then this becomes a delayed discharge.
What funding is there for free care after a hospital discharge?
There are various funds to support initial care when the person we care for leaves hospital:
1. Intermediate Care
If the person we care for had a short illness or less severe operation, then intermediate care (also known as re-ablement) may be arranged for the person we care for. This is up to six weeks of free care, arranged by hospital staff such as the discharge coordinator, before the person we care for leaves the hospital.
If it is not, it is best to ask about it, because once they have left the hospital, the hospital will no longer be able to arrange this for us.
2. Rapid Response Team
Some carers in our community have shared that the person they care for has been supported by the Rapid Response Team. A team that can respond within two hours, to support older people and those with complex needs to stay in their homes and out of hospital.
3. British Red Cross
The British Red Cross also offers support to get us home from the hospital. Such as arranging transportation, making sure we have enough food stocked up in the fridge or simply being there for us if we feel we would benefit from chatting to someone.
However, to set up this support, they will need a referral from our GP or a health professional.
4. Continuing Health Care Funding (CHC)
CHC is free care provided by the NHS after discharge and is not means tested. As expressed by a member of the Mobilise community, there is a complicated two stage process to access eligibility for this.
"The criteria is stringent but I now have a full package of care provided free by the NHS which meets my partner's needs and he is cared for at home."
We will have to ask the discharge team for a checklist to be completed to assess whether we can progress to the next stage of assessment carried out by a multidisciplinary team at the Clinical Commissioning Groups.
"It is very important that you are present when this checklist, and the subsequent full assessment, is carried out. Do not be put off by someone telling you your loved one will not be eligible for CHC funding, everyone is entitled to a free checklist assessment."
Seven carers' tips for a smoother hospital discharge
Seven top tips 💡 that carers in the Mobilise community have shared:
“Always worth checking on the phone, that they are talking about the right person. We did have a couple of tricky conversations with staff who were clearly talking about somebody else’s Dad!”
“Ensure all clothes are labelled especially slippers as my mum's four pairs of orthopedic slippers have walked on their own.”
“We made sure that we were there when my Mother-in-Law came home. In the first couple of days you can iron out problems and make sure care is coming in. If you don’t you will spend a lot more time in sorting out the chaos.”
“Check the medicines list, have you been given any new medicine? Do you know if any old medicines are to be stopped? and what has already been taken that day.”
“Make sure all emergency numbers are written down as well as stored in your phone.”
“Don't ever be brow beaten into accepting your loved one home, if you honestly don't feel comfortable or confident.”
“If you have Power of Attorney for Health and Welfare, make them aware and that you need to be kept in the loop.”
Take our one minute simple quiz to receive your pack
We might be at different stages in the process, whether it be preparing to leave for the hospital, in hospital, or arriving home. We’ve created helpful packs depending on your situation.
What was your experience like?
Things can quickly change and so we’re open to growing this guide, with lived carer experiences.
If you have been through hospital discharge with the person you care for, feel free to share your top tips with us, so we can share it with more carers like you.
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