Hospital to Home Discharge Guide

Published: 22/05/2019

We understand that a hospital admission can be a scary and worrying time for patients and their families. However, we know from experience that patients or their loved ones do not give much thought to what happens when the time comes to be discharged from the hospital. In this essential guide we will look at the key areas when planning for a successful discharge from hospital to home and some points for you to consider.

Hospital to Home Discharge Guide


We understand that a hospital admission can be a scary and worrying time for patients and their families. However, we know from experience that patients or their loved ones do not give much thought to what happens when the time comes to be discharged from the hospital.

Yet the way the discharge process is organised and handled is critical to the health and well-being of the patient.
Patients, their family and loved ones along with healthcare providers all play a role in upholding a patient's health after discharge.

In this essential guide we will look at the key areas when planning for a successful discharge from hospital to home and some points for you to consider.
 

In the Hospital: Planning for Discharge


To start preparing and planning for a discharge, speak to the doctor and ask how long your loved one is likely to stay in hospital for. The doctor may or may not know depending on whether the admission was planned or an emergency, however, the more time you have to prepare the discharge the more successful it will be.

When a patient no longer needs 24 hour medical attention and their condition can be managed outside of a hospital, they are ready for discharge. When a patient leaves hospital they have a few options to be discharged to:
  • Home, with no additional help needed
  • Home, with help needed from family or loved ones
  • Home, with help needed from a home care agency (read about our homecare services here)
  • A nursing or residential home (either short-term or long-term)
 

Who is on the Discharge Team?


Many different people will be involved in planning a hospital discharge and it is important to remember that it will vary with each hospital, however, these are common ‘Discharge Team’ members:
  • A doctor – he or she will approve the hospital discharge
  • A discharge nurse, matron or social worker – they will coordinate the discharge and make sure everything should happen when it should
  • Multidisciplinary teams, such as: Occupational Therapists, Physiotherapists, Speech Therapists – their involvement will be dependent on ongoing health and social care needs after discharge
  • You the family member, loved one or caregiver – likely to be the one who knows the patient the best
When are you made aware of who is on the Discharge Team it is a good idea to meet with the discharge nurse or social worker to discuss the discharge. You can use this time to talk about:
  • How much time you have available to be a caregiver (and whether you feel you can be)
  • Whether you want (or can) provide all of the care or whether you will need additional help and support
  • Whether you can continue working or will need to take time off
  • Whether you yourself have any health problems or limitations that may impact your ability to provide care
  • Whether you have additional commitments such as young children
  • Any other concerns or question you have about the discharge and potentially becoming a caregiver.
 
After these discussions and after various patient assessments, a Care Plan will be drawn up.
 

What is a Care Plan?


During the discharge planning and assessment process, a Care Plan will be drawn up. This should include details of:
  • the treatment and support the patient will get when discharged 
  • who will be responsible for providing support, and how to contact them (if applicable)
  • when, and how often, support will be provided (if applicable)
  • how the support will be reviewed and continually monitored 
  • a named contact for who is co-ordinating the care plan 
  • who to contact in an emergency or if things are not working out as they should 
  • information about any charges for ongoing care (if applicable)
 
The types of support detailed in a Care Plan will depend on the patients assessed needs and preferences.
 

On The Day of Discharge


The person coordinating the discharge should make sure that:
  • the patient and their family member or caregiver have a copy of the care plan
  • transport is arranged to get the patient home safely
  • professional care will be available if needed
  • the patients GP is notified in writing
  • any medication or other supplies needed are provided
  • you (if you are a caregiver) has been trained how to use any equipment, aids or adaptations needed
  • you (if you are a caregiver) you have appropriate clothes to wear 
  • If the patient is being discharged to a care home, the care home should also be told the date and time of the discharge, and have a copy of the care plan.
 

Complaints about Hospital Discharge


You might not be happy with the way a discharge from hospital has been or is being handled. For example, if:
  • the hospital plans a discharge before you think it’s safe
  • there isn’t enough support detailed or planned in the care plan
  • you don’t think the discharge assessment and care planning was carried out correctly
If you sadly find yourself in this situation or you have concerns about someone else who is still in hospital, it’s best to raise them straight away so that they can be addressed as soon as possible. Speak to the person who is co-ordinating the discharge, or the supervising consultant.
 
You may find it helpful to get support from the hospital’s Patient Advice and Liaison Service (PALS) or your local Independent Health Complaints Advocacy service.
 

Where Can I Find Additional Information?


For a more comprehensive guide regarding hospital discharge please take a look at AgeUK’s factsheet “Hospital discharge arrangements

To find out more about the award winning care at home we provide please click here.