Being told your relative is ready to come home is positive news. However, you might have concerns, particularly if your relative is likely to need more care than before he or she was admitted to hospital.
On this page you can find information relating to
1. When should your relative be discharged?
2. Who will manage the discharge?
3. Assessing care needs
A patient’s care shouldn’t end the minute they leave hospital. All hospitals should have plans in place to help your relative with the transition from hospital to home. Each hospital will have its own policy and arrangements for discharging patients and should provide information about this.
A hospital social worker and possibly a discharge co-ordination team are likely to be involved in planning your relative’s ongoing care. Most importantly, your relative should be told who to contact for help and support once they have returned home.
When should your relative be discharged?
Is your relative ready to go home?
Your relative has the right to discharge him- or herself from hospital at any time, but you should speak to them, and the medical team, if you feel they are doing this before they are ready. If you, or your relative, are unhappy with a suggested discharge date, raise your concerns with the hospital staff.
The professionals in charge of your relative's care should have drawn up a treatment plan in discussion with both your relative and you, which leads to your relative’s eventual discharge, within 24 hours of your relative's admission to hospital.
Your relative should only be discharged from hospital:
- when their doctors are happy that they are well enough to go home and
- when they have appropriate care in place so they can manage safely at home.
Your relative should not be discharged in the middle of the night or without adequate arrangement for transport. If you do not agree with the decision to discharge or with the discharge arrangements, speak to the nurse in charge of the team involved with your relative's care.
You should also be provided with information on how to seek a review and the NHS complaints procedure, should you need to do this. The Patient Advice and Support Service (PASS) can also help (see the Useful organisations and websites page for medical emergencies).
Who will manage the discharge?
A key worker will usually be allocated to your relative to coordinate the plans for the discharge. A key worker is a healthcare professional – often a nurse – who is the main contact and source of support during a stay in hospital.
Your relative may need ongoing care from a number of different organisations and healthcare professionals. If they do, a liaison nurse, nurse discharge coordinator or assessment officer will manage the arrangements for when they go home. This is known as a reablement team.
While your relative is in hospital, the healthcare professionals looking after them will make a plan for their discharge, often called a discharge plan. They’ll ask your relative questions so they can assess their needs and find out what support is needed for when they go home. These questions may include:
- Can you manage steps or stairs?
- How do you manage with personal care, such as bathing and washing?
- Can you prepare your own meals?
- Do you need any financial support?
It can take several days to plan a discharge, especially if a number of different services need to be arranged.
Assessing care needs
If your relative has been seriously ill, or has suffered a fall, they may require care once they return home. If this is the case, your relative should be allocated a hospital social worker or other member of staff who will assess their needs and discuss a suitable care package to help once they are discharged from hospital.
If your relative’s care needs have changed substantially, they should first have a full free needs assessment made by social services. This is important, as this assessment forms the basis of all follow-up care that your relative is deemed to be entitled to.
The hospital social worker can help to arrange the assessment, either while your relative is still in hospital or before their six weeks of intermediate care is up. Once your relative’s needs have been assessed, staff should discuss the options for meeting them and should produce a care plan detailing the assessed needs.
Your relative may have temporary care needs that can be met via intermediate care, or they might need longer-term help.
In Scotland, every NHS Board and each local council's social work department should have a special arrangement in place for the discharge of patients. In many NHS Health Board areas, the process is called a Single Shared Assessment.
Intermediate care is provided in Scotland but not always for six weeks. This can vary depending on different circumstances.
- Ongoing care and support: information about what your options are if your relative leaves hospital and requires extra help at home.
- NHS continuing healthcare: find out if your relative is eligible for free NHS-funded care if he or she requires complex care after leaving hospital.
- Care services directory: find local authority services for older people in your relative's area.
Page last reviewed: December 2015
Next review due: February 2018