Coming home from hospital: what to expect
There have been some worrying reports in the news recently about the care and support that people, particularly the elderly, receive when they come home from hospital after a short stay. These reports, such as one by the BBC, paint a poor picture of frail or vulnerable people being sent home with little after-care in place, leading to readmission or escalated problems.
These news stories come from a recent Parliamentary and Health Service Ombudsman report. This highlights four key areas where there have been notable failings in hospital discharge proceedings: patients being discharged before they are clinically ready to leave hospital; patients not being assessed or consulted properly before their discharge; relatives and carers not being told that their loved one has been discharged; and patients being discharged with no home-care plan in place or being kept in hospital due to poor co-ordination across services.
The NHS states that the findings will be taken seriously and improvements are already being made. The news is particularly worrying for those with elderly relatives, who are most likely to have a short-term hospital stay, usually as a result of a fall, illness or medical event (such as a stroke, heart attack, etc).
Coming home from hospital can be very disorientating for many reasons. The reason for the stay can have its own complications, as the person returning home may be less capable in some areas than they were before they were admitted and may have long-term, lasting problems as a result. This means that their previous care and support plans might need updating and adapting to suit a new situation. Even if they have no lasting issues from the hospital stay, it can be hard to get used to being independent again after receiving round-the-clock help in hospital, so there can be a period of adjustment to consider.
If you have a relative in hospital, then you need to know what you should expect to happen so that you can ensure that the right care and support is in place for their return home. According to the NHS, a person shouldn’t be discharged from hospital until they are medically fit (as determined by a consultant); they have had an assessment to make sure that the support is in place for a safe discharge; they have been given a written care plan that sets out the support they will get to meet their assessed needs; and that the support outlined in the care plan is in place to ensure a safe discharge.
If you are worried about a relative being discharged too early, you can start by reviewing your hospital’s discharge policy, which is different for each hospital. You can usually get a copy of this by asking the ward manager or the Patient Advice and Liaison Service (PALS). Make sure that all of your relative’s needs have been met and that you are confident that there is a suitable care plan in case – ask lots of questions to the consultant to ensure that you understand any after-care or medication that is required, and get involved in the care plan so you know what support is needed and how it will be delivered.
If your relative already has a paid carer, it might be worth getting them involved in the care plan, especially if they will be responsible for delivering the care and if they day-to-day role needs changing or if they will be required to work more hours, for example.
If your relative is going into hospital for a planned stay, such as for an operation, then you can ease post-hospital problems by getting organised in advance. At the pre-op consultation, ask what kind of issues there may be after the procedure, whether short-term care and support will be needed above and beyond what is already in place, whether there are any complications or side-effects you should be prepared for and so on.
The reports highlight the worst-case scenarios from a handful of hospitals and are certainly not reflective of the huge numbers of people that return home from hospital every day. For most, the right support is in place and the transition to home goes relatively smoothly.