What support is there when the person I look after is coming out of hospital?

It can be a very worrying time if you are thinking about caring for someone who is coming out of hospital and who can no longer care for themselves in the same way as before.

You may not have considered yourself a carer until now and so will need to come to terms with a completely new situation - perhaps, for example, bringing home an older relative who used to live alone. Or you may have been caring for someone at home but are now unsure whether you can provide the extra care they will need after their hospital stay.

Hospital staff should inform and involve carers in decisions throughout the patient's stay in hospital.  Carers have told us that sometimes this does not happen as it should. 

The information below will tell you what should happen and help you to keep informed and involved in decisions.

What should happen when the patient is first admitted?

You should be kept informed and involved in any decisions as soon as it is known that the patient will be staying in hospital. Hospital staff should always ask if the patient has a carer.

You should be introduced to a member of staff, usually a nurse, who will act as your single point of contact throughout the patient’s stay in hospital.  This person will be responsible for keeping you informed and ensuring you are given an opportunity to be involved in any decisions affecting you and the patient. 

You should be told what to do if you are unhappy with the way you or the patient has been treated or are unhappy with any decisions that have been made affecting you or the patient and given a copy of their complaints procedure.  

What do I need to think about before the patient comes out of hospital?

When a patient comes out of hospital it can sometimes have a huge impact on carers’ lives. Your employment, health and relationships may be affected. Carers need information so they can make proper choices. 

Patients can sometimes end up back in hospital if they are sent home before they are well enough and without the proper support in place. To avoid this, patients and carers should be involved in planning for the time when the patient is ready to come home.  You should be given an opportunity to talk about your needs as a carer and what help you may need to look after the patient.  It is your legal right to have your needs addressed and this is achieved by having a carer’s assessment. This is usually carried out by a social worker, but may involve other staff such as physiotherapists and occupational therapists.  It is also a good opportunity to talk to somebody about how you feel about caring.  Ask the nurse about how to get an assessment if you think it may be of benefit.

There are a range of services which might help the patient when they get home.  They include services provided by social services, the NHS and voluntary organisations. For information on how to find help in your local area click here.
When the patient is still in hospital you should be

• told about the treatment and condition of the patient. This should include medication and its possible side effects, and what is likely to be involved in caring.
• involved in any home visits by the Occupational Therapist to discuss what equipment and adaptations to your home might help you and the patient. It could be useful to talk to the physiotherapist about the patient’s care and what might help you.
• given help and had sufficient time to visit potential care homes if the patient is unable to be cared for at home.
• given information about charging for services.  If the patient is going to receive support services they may have to pay for it.
• given at least 24 hours notice that the person is coming home from hospital.

What do I need to think about on the day the patient comes out of hospital?

Coming out of hospital can be stressful for both the patient and carer.  There can be a lot to organise and it is important that you and the patient are prepared.  To make sure that everything goes as smoothly as possible, you should be given a copy of the discharge plan which sets out what support will be put in place when the patient leaves hospital.

Good hospital staff will ensure that the necessary arrangements are in place prior to the patient being discharged from hospital.  Here are some useful prompts to make the move from hospital to home go as smoothly as possible:

• Are all the services to support you and the patient in place? Has essential equipment been delivered and made ready for use?
• Has transport home been arranged?
• Has the patient’s GP been told they are coming home?
• Has the patient got enough medicines to last until they can see their GP?
• Do you have a phone number to call if you have any worries or concerns?
• Is everything ready at the patients home? Is the house warm enough, is there food in the house etc.

What is a discharge plan?

The written plan should include 

• the name of the person who is responsible for making sure the patient’s move from hospital back to their home goes safely and according to plan.
• details of the patient’s medication and treatment.

It should spell out

• who is providing treatment and when it happens.
• what to do in an emergency.
• details of any support, help and equipment that will be provided
• training for you as the carer if you have to provide medication or treatments.
• transport arrangements. For example, how the patient will get back to hospital for follow up appointments.

What should I do if I am not happy with the hospital's plans for when the patient comes out of hospital?

You should

• tell the nurse in charge
• if you aren’t satisfied with their response, see the consultant
• if you’re still not happy, make an urgent appointment with the hospital’s General Manager/Chief Executive and ask for a review of the decision to discharge the person you are caring for.
• You can refuse to look after someone when they come out of hospital and so try to force the services to make other arrangements for their care. Or you could ask for the person to stay in hospital until the help you think is needed is provided.

A patient can refuse to be discharged but they do not have the right to stay in hospital indefinitely. If this happens, they must be offered care at home instead.

If you are not happy with the care that is offered:

• ask the health authority for the area in which the patient normally lives to review the decision not to provide care at hospital. If the health authority is asked to review a decision it should give an explanation to the patient within two weeks
• if you are not satisfied with the outcome, contact the Health Service Ombudsman.

What do I need to think about when the patient is back home?

The reality of looking after someone at home can be very different from how it was anticipated when the patient was in hospital.  This is particularly the case in the first few weeks after the patient is back at home.  It is important that you have an opportunity to say how you are coping and whether you or the patient need extra help.

It may be helpful to let your GP know that you have caring responsibilities.  Your GP may be able to offer help and support. Social services should get in touch with you to see if you and the patient are coping at home and see if you need any help.  A date should be set to review whether support services are sufficient.

If you are unhappy with the care that has been put in place you may wish to complain.