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1HELP THEM HOMEThe challenges facing families of older patients

HELP THEM HOME

The challenges facing families of older patients


FOREWORDfrom Royal Voluntary Service Chief Executive, David McCullough

Cuts in social care budgets mean that many older people leaving hospital fail

to get the same level of support from the state that they once did. As a result,

when older people are discharged there is often an expectation that family

and friends will step in - and of course, this can be just what vulnerable older

people need to help their recovery.

But in modern-day Britain not everyone has this supportive circle close by. In

fact, our research has identified that 30 per cent of older people do not have

a strong family support network.

Now that formal care is in shorter supply the hospital teams overseeing

discharge need to make a realistic assessment of the strength of an

individual’s informal network for the weeks ahead, not just for the next few

days. Because in many cases the real picture is disguised by activity at ‘point

of crisis’ where family rallies round the hospital bed but then quickly return to

their own homes and busy lives.

We believe that this assessment is pivotal in ensuring a good recovery and

avoiding a rapid return to hospital.

In the absence of a strong support network, we know that there is a clear

opportunity for volunteers to provide the support that family or close friends

would if they were able and available.

To improve the patient experience; to support recovery and to help alleviate

pressure on NHS services, we believe that hospitals struggling with delayed

discharge and readmissions should include volunteers in Home from Hospital

services right across the UK.

David McCullough

Royal Voluntary Service

Chief Executive


CONTENTS

Foreword 1

Executive summary 3

Key Findings 4

Introduction 7

The NHS and social care context 8

What we already know about patient discharge 11

The experiences of family members 14

The hospital experience 14

Care and support at home 18

Looking to the future 21

Conclusion and summary 24

Recommendations 26

References 28


EXECUTIVE SUMMARY

The health and social care system in Britain is under severe pressure.

For example, in England the latest data on delayed discharges shows that

in September 2015, there were over 147,000 days of delay when patients

who were clinically fit could have left hospital, over 30% higher than five

years previously.

We know from our previous report, Going Home Alone, that hospitals and

the wider system are also under pressure to discharge prematurely, and this is

associated with a five-fold risk of readmission within three months, compared

to those who judged they were discharged appropriately.

Going Home Alone identified that the majority of patients did have some

form of support at home from friends and family, professional carers and

volunteers, and many were living with a partner or spouse at the time of

readmission. However, it did not get under the skin of this support, how

family, spouses and carers were coping, or their views on the support

received and required for their loved ones on discharge. Examining this

part of the process is critical if we are to improve outcomes and prevent the

vicious cycle of readmission with all the human and health and care system

costs that entails.

5-FOLDrisk of readmission within

three months when patients

are discharged prematurely.

147,000days of delay when patients

who were clinically fit could

have left hospital...

...this is

30%higher than five years ago.


KEY FINDINGS

The hospital experience

Most patients were visited frequently by their offspring and wider family and

friends. However, a significant minority received rare or no visits, often due to

travel or relationship problems.

For offspring, premature discharge is a much bigger problem than delayed

discharge, 19% of respondents thought their parents were discharged too

early. This is in stark contrast to the public debate on discharge, and given

the association between premature discharge and readmission, may also be

leading to preventable costs.

Although most offspring thought hospital staff had a good understanding

of the patient’s personal circumstances, 29% said that staff had not had a

conversation with them about this, or how it affected care needs.

Most significantly, those that were asked about their parent’s personal

circumstances were over twice as likely to report that their parent’s discharge

was appropriate.

Care and support at home

One in four respondents had concerns about the care received by their

parent after post-discharge, with the majority feeling there was not enough

care received, and key concerns about them also being a carer for their

spouse or partner.

Of those who had concerns about post-discharge care, almost half felt

unable to share those concerns with staff for a combination of reasons

including a perceived lack of knowledge and sense of “doctor knows best”.

Those who felt their parent was discharged prematurely were almost

eight times more likely than those that didn’t to have concerns about

post-discharge care.

Many respondents helped their parents regularly and some said their

parents didn’t require help. But one in five people felt guilty about not

being able to do more.


Looking to the future

Although the majority of respondents had strong family networks which

would help them cope with caring for older relatives without external help,

a large minority – over 30% had weak or non-existent networks to help

them do so.

Nearly a third (30%) of respondents said they would not be able to

accommodate their parents if they had to recover from a hospital episode.

In response to a question about whether they could put up older relatives in

their own homes as opposed to care homes, less than 30% responded that

either themselves or others in their family would definitely be in a position to

do so for their parents.

What does this mean?

Delayed discharge is a key issue for policy-makers, the health and care

system, patients’ and their families. Going Home Alone showed how older

patients who thought their discharge was too early, were five times more likely

to be readmitted. This new research with patient’s families, shows this is a

significant problem from their perspective too, one in five of our respondents

said the discharge was too early, far more than said the discharge was

delayed.

Clinicians need to talk directly to patients’ families about their personal

circumstances post-discharge, since we find this in itself is associated

with perceptions of appropriate discharge. Better and more consistent

communication is likely to lead to more appropriate care packages,

including the contribution of volunteers.


One in four families had concerns about the post-care discharge their

parent received, including the amount of care they could give and concerns

for parents who were carers themselves.

Looking forward, many families were worried about their ability to

offer the care needed if their parents were admitted to hospital in

future. Although many families have strong family support networks,

over 30% do not. With existing cuts and restrictions on funding going

into social care, the services of volunteers are likely to be needed more

than ever. There are important questions about how those services will

need to adapt, change and scale up to help meet that challenge.

20%of respondents thought their parents were discharged too early, potentially leading to avoidable readmissions.

30%of respondents said hospital staff had not had a conversation with them about their parents’ personal circumstances.

Over

50%of respondents had concerns about post-discharge care with many feeling unable to share those concerns.

Over

30%of respondents had weak or non-existent networks to help them care for older relatives at home.

30%of respondents wouldn’t able to accommodate their parents following a hospital stay.

1 in 3felt guilty about not being able to do more.


INTRODUCTION

Ensuring older people have good experiences in hospital and are neither

discharged prematurely or with undue delay when clinically fit is critical to

good health and wellbeing and the efficient functioning of the health and

care system.

Royal Voluntary Service, assisted by the Kings Fund, analysed the results of

research conducted with a nationally representative sample of 1,000 adults

with a parent over the age of 75 in England, Scotland and Wales who spent

time as an inpatient in the last five years. The research conducted by

PCP Market Research, which took place between 26th October and

6th November 2015, asked about the experience of the longest stay.

It sought to understand: the experience of hospital care; the relationship with,

and knowledge of, clinicians; the level of support required and needed; and

the relationships between these factors.

This paper is structured as follows. Firstly we review the current health and

social care context, with a focus on delayed discharges and the availability

of social care. Against this context we set out the core findings of our new

research with those families whose older parents have been discharged

following a significant inpatient hospital stay, their experience of discharge

and the support that is available. We follow this with a discussion and

recommendations. This analysis has been undertaken to determine measures

that can be put in place to ensure older people have a better experience of

discharge and that they have adequate support when they return home.

SECTION 1


THE NHS AND SOCIAL CARE CONTEXT

The NHS and social care are currently under severe pressure. Across Britain,

the appropriate care of older people is a priority.

Last year, the Government in Wales published a framework aimed at

delivering integrated care for older people with complex needs (Welsh

Government, 2014). The framework is focussed on preventative services and

support to maintain wellbeing, as well as on ensuring that older people have

control over their care. The aim is to strengthen community care and prevent

unnecessary hospital admissions, while ensuring that people are not delayed

unnecessarily in hospital and that they are adequately supported on their

return home.

The Scottish Government’s plan for older people is set out in Reshaping

Care for Older People, a 10-year programme for change aimed at improving

services for older people by shifting care towards anticipatory care and

prevention. The emphasis is on moving away from traditional “institutional”

care towards care at home and within the community, a shift which is being

supported by a dedicated Change Fund.

SECTION 2


There have been a plethora of policy initiatives in England with the focus on

integration of care for older people from the Better Care Fund to new models

of care as part of the Five Year Forward View (NHS England et al, 2014).

The mechanisms to take forward these policy initiatives are different, and

in that we can learn from each other (Ham et al, 2013) but across Britain

support for older people at home – either to prevent hospital admission (or

readmission) or to facilitate discharge when they are ready to leave hospital –

is a key policy objective. It is also key to patient flow within the health and care

system, and part of delivering better health and wider system objectives and

targets.

However, we know health and care systems are under pressure. For example,

Figure 1 shows the overall number of days that patients in England have been

delayed in hospital once medically fit to be discharged. In September 2015,

147,738 days were delayed, over 30% more than five years previously, and

just below the peak month over this period in January 2015.

NHS England also collects data on the stated cause of the delays (Figure

2). The biggest cause in September 2010 was “awaiting completion of

assessment” at 19.2%, by January 2015 (the month with the highest overall

level of delayed days) awaiting assessment was still accounting for 17.5% of

delays, but by then the largest cause of delay, accounting for close to 1 in 4

(24.1%) of all delays, was “awaiting further NHS non-acute assessment”.

FIGURE 1

Days of delayed discharge in England, September 2010 to September 2015

SOURCE

Analysis of NHS England (2015)

40,000

120,000

180,000

80,000

160,000

Sept

embe

r

Sept

embe

r

Sept

embe

r

Sept

embe

r

Sept

embe

r

Sept

embe

r

Janu

ary

Janu

ary

Janu

ary

Janu

ary

Janu

ary

May

May

May

May

May

Nov

embe

r

Nov

embe

r

Nov

embe

r

Nov

embe

r

Nov

embe

r

Mar

ch

Mar

ch

Mar

ch

Mar

ch

Mar

chJuly

July

July

July

July

2011-12 2012-13 2013-14 2014-15 2015-16


Over the course of this year, this has dropped back a little, in September

accounting for 18.7% of delays. The largest growth in cause of delays

between September 2010 and from the peak in January 2015 was “awaiting

care package in own home”, growing from 11% in September 2010 to 14% in

January 2015 and again to 17.7% in September.

Behind the system issues and the growing workforce and funding pressures

in acute hospitals, there are human stories (Oliver, 2015). Healthwatch

England’s recent report, Safely Home (Healthwatch England, 2015) details

the experience of patients and their families who felt that their discharge

from hospital was unsupported, premature or “marooned in acute beds

unable to move on” (Oliver, 2015). This echoes previous reports from Age

UK, the National Institute for Health Research and the Royal Voluntary

Service. It is stressful for all sides, with NHS hospital staff under pressure to

prevent hospital admissions, discharge patients sooner to free up capacity,

whilst unprecedented cuts in local government and community services

have reduced the capacity of social care to cope and support patients with

complex needs in the community.

In this context, understanding how people cope at home when older relatives

are released from hospital and helping support them in doing so is ever more

important, for their health and their relatives and the efficiency and outcomes

of the health and social care system.

FIGURE 2

Causes of delayed discharge in England, September 2010 to September 2015

20%

60%

100%

40%

80%

Sept

embe

r

Sept

embe

r

Sept

embe

r

Sept

embe

r

Sept

embe

r

Sept

embe

r

Janu

ary

Janu

ary

Janu

ary

Janu

ary

Janu

ary

May

May

May

May

May

Nov

embe

r

Nov

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Nov

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Nov

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Nov

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r

Mar

ch

Mar

ch

Mar

ch

Mar

ch

Mar

chJuly

July

July

July

July

2011-12

Awaiting public funding Awaiting further non-acute NHS care

Patient or family choiceDisputes

Awaiting residential home placement or availability

Awaiting nursing home placement or availability

Housing - patients not covered by NHS and Community Care Act

Awaiting care package in own home Awaiting community equipment and adaptations

2012-13 2013-14 2014-15 2015-16


WHAT WE ALREADY KNOW ABOUT PATIENT DISCHARGE

Last year Royal Voluntary Service published its report, Going Home Alone

(Royal Voluntary Service, 2014) which sought to understand the experiences

of hospital discharge from the perspective of older patients whether they were

discharged too early or too late, and how much and what type of support

there was at home on discharge.

The patient survey was instructive and identified a link between discharge

and future readmission to hospital. Figure 3 shows patients’ views on the

timeliness of their discharge. Over a quarter of those who were readmitted

within three months said they had not felt ready to go home at the time of

their first discharge, compared with only 5% who were not readmitted within

three months. This is a strong warning sign: some patients feel they are being

discharged too early and there may well be a link between this and high

readmission rates.

SECTION 3

FIGURE 3

Patients’ views on appropriateness of discharge and relationship with readmission within three months

Readmitted within three months

Not readmitted

I felt well enough to have been discharged

earlier

13%

57%

26%

12%

81%

I felt I was discharged at the time that

was right for me

I felt I was released before I was well enough

to go home

Don’t know/ I can’t remember

2%4%5%


Figure 4 shows patients’ views on whether there was enough support on

discharge. This suggests readmission is closely related to whether or not

individuals actually receive the support they feel they need. Amongst those

who were not readmitted, only 17% indicated they had not received all of the

support they felt they needed but of those who were readmitted, this figure

was more than double at 41%.

FIGURE 4

Patients’ views on whether there was enough support on discharge and relationship with readmission within three months

Readmitted within three months

Not readmitted

All of it

59%

8% 8%8%

83%

Most of it About half Just a little

4% 4%2%


Finally, figure 5 shows that in all eight areas of support covered by the

research, at least half those respondents who required support in these areas

felt they required it for a period of longer than six weeks. This applied to both

those who were readmitted within three months and those who were not

readmitted.

Going Home Alone was followed by a survey of nurses involved in patient

discharge to gain a better understanding of the process. These findings

are consistent with the messages from patients. In particular, almost 70%

of nurses reported that they frequently have to delay discharging patients

because there is no support in place for them once they leave hospital,

and 35% have discharged patients aged over 75 before they felt they were

ready to leave hospital in order to “free up a bed”. Finally, about 75% of

those nurses questioned think pressures on the NHS could be eased by

working alongside charities and volunteers to ease the transfer of older

people back home.

FIGURE 5

Patients’ views on duration of support required for those who were readmitted within three months

More than 6 weeks following discharge

4 - 6 weeks following discharge

2 - 4 weeks following discharge

First week following discharge

Day of discharge

Can’t remember

Getting to the shops

Preparing meals

Collecting prescriptions

Getting out to meet friends and

family

Getting to the shops - readmitted

Preparing meals -

readmitted

Collecting prescriptions - readmitted

Getting out to meet friends and

family - readmitted


THE EXPERIENCES OF FAMILY MEMBERS

The new research identified the experiences of adults with older parents over

the age of 75, in England, Scotland and Wales. Our results are based on

1,000 respondents, 600 from England and the remainder equally split from

Wales and Scotland. Our results in the section “looking into the future”

are based on all 1000, while those on “the hospital experience” and

“care and support at home” are based on the 640 for whom at least one

parent had experienced an inpatient stay within in the last five years.

We asked respondents to answer based on the specific episode with the

longest length of stay within those five years. This is likely to improve recall,

its specificity, and be a challenging and non-trivial event for the parent

and family.

THE HOSPITAL EXPERIENCE

Length of stay and visiting

Given our focus was on the longest period in hospital, it is unsurprising

that the average length of stay was just over two weeks, at 15 days.

This length of stay implies that most respondents’ parents had a serious

acute or chronic medical condition. Most patients received significant

numbers of visits, an average of 10 across the sample from respondents,

and most patients received visits from a range of people. Figure 6, shows

that seven in 10 patients received visits from between three and 10 people,

though a significant minority were visited only by one or two people

including the respondent.

SECTION 4

FIGURE 6

Number of people who visited

parent during their hospital stay

1 or 2 3 to 5 > 106 to 10 Don’t know

10%

30%

50%

20%

40%


Seven in 10 respondents felt that the visits patients received were very or

fairly regular. However, 13% of respondents stated that visits were rare

or non-existent, due mainly to travel problems including living too far away,

or poor relations between child and parent.

Delayed and premature discharge

The large majority of respondents thought that their parents were discharged

when they were well enough and in a timely manner (Figure 7). Less than five

percent thought their parents were delayed when they were well enough to

go home, this is commensurate with NHS England’s national level data which

suggests that around three percent of overall bed-days in hospital are filled by

patients well enough to leave. However, two in ten thought their parent was

discharged too early.

Moreover, we know from Going Home Alone (see Figure 3) that patients

who thought they were not well enough to be discharged were over five

times as likely to be readmitted within three months as those who thought

they were well enough to go home at discharge. Premature discharge is

therefore a big challenge to the long-term sustainability and efficient working

of the NHS and care system. Patients and their families are concerned about

leaving hospital too early and this has little known, and potentially large cost

implications for the system which are under-researched.

FIGURE 7

Level of confidence with the

timing of the hospital discharge

and its appropriateness

I believe my parent was

discharged when they were

well enough and at the

right time

I believe my parent was

discharged too early before

they were well enough

I believe my parent was well

enough to be discharged

earlier than they were

20%

60%

100%

40%

80%


The majority of respondents, 84%, thought that hospital staff had a good

or quite good understanding of their parent’s personal circumstances before

they were discharged. However, this still leaves a sizeable majority feeling that

staff were not knowledgeable. Moreover, three in 10 said that staff did not

enquire with them about their parents’ personal circumstances and how this

may affect their care needs. Those who had been asked by staff were over

twice as likely to report a good understanding of personal circumstances than

those who had not been asked.

Most significantly, there is a strong relationship between being asked about

personal circumstances and about confidence in the hospital’s decision

to discharge. In particular, those that had been asked about their parent’s

personal circumstances were almost two and a half times more likely to

think that their parent was discharged appropriately compared to those that

weren’t asked. However, they were also over three times more likely to think

that their parent was well enough to be discharged earlier than they were

compared to those that weren’t asked.


Summary of the Hospital Experience

§ Most patients were visited frequently by their offspring and wider family

and friends. However, a significant minority received rare or no visits,

often due to travel or relationship problems

§ For offspring, premature discharge is a much bigger problem than

delayed discharge, 19% of respondents thought their parents were

discharged too early. Given the association between premature discharge

and readmission, this may also be leading to preventable costs.

§ Although most offspring thought hospital staff had a good understanding

of patient’s personal circumstances, 29% said that staff had not had a

conversation with them about this, or how it affected care needs.

§ Most significantly, those that were asked about their parent’s personal

circumstances were over twice as likely to report that their parent’s

discharge was appropriate.


CARE AND SUPPORT AT HOME

In contrast to views on care received in hospital, a large minority, one in four

respondents had concerns about the level of care available at discharge.

These concerns were greatest when their parent were also carers to a spouse

or partner (half of respondents whose parents were also carers had concerns),

followed in order by those whose parents were living in a care or nursing

home, and those living with the son or daughter or living alone.

Level of care required post-discharge and views on appropriateness of discharge

For those who had concerns, the leading cause was that they felt more care

should be provided. Around one in five said that their parent would have to

provide as well as receive care, and around the same percentage didn’t feel

that they were able to cope with looking after their parent.

There was a very strong relationship between views on concerns about the

level of care available on discharge and concerns about whether parents

were discharged appropriately. Those who felt their parent was discharged

prematurely, were almost eight times more likely than those that didn’t have

such fears, to have concerns about the level of care available at home.

Although over half of respondents who had concerns about post-care

discharge voiced their concerns, almost as many didn’t, with the majority

wishing they had (Figure 8). When asked why they didn’t voice their concerns’

the majority said they didn’t feel knowledgeable enough to comment with

many also trusting what the doctors said, or thought “it would work out in

the end”.


Amount of care required and received

For those parents that required support, around six in 10 respondents helped

regularly or “a bit”, a further 15% said that their parent didn’t require help

from them. This leaves over one in five respondents saying that they weren’t

able to help (Figure 9). Further, just over one in five respondents “felt guilty

about not being able to do more”.

When asked about possible help that they or family members could provide

in the future, less than half the respondents thought that they or other family

members would be able to provide help for sure and 23% said they definitely

wouldn’t without external help.

FIGURE 9

Care availability

post-discharge from offspring

Yes, I helped regularly Yes, I helped a bit No, I wasn’t able to help They didn’t need help

10%

30%

20%

40%

FIGURE 8

Reasons why offspring did not

voice concerns about

post-discharge care

Yes No No, but I wish I had

I trusted what the

doctor said

I didn’t feel knowledgeable

enough to comment

I thought it would work

out in the end

Other - please state

10%

30%

50%

60%

20%

40%


Summary of Care and Support at Home

§ One in four respondents had concerns about the care received by their

parent post-discharge, with the majority feeling there was not enough

care received, and key concerns about them also being a carer for their

spouse or partner.

§ Over half of respondents had concerns about post-discharge care, but

many felt unable to share those concerns with staff for a combination of

reasons including a perceived lack of knowledge and sense of “doctor

knows best”.

§ Those who felt their parent was discharged prematurely were almost

eight times more likely than those that didn’t to have concerns about post-

discharge care.

§ Many respondents helped their parents regularly and some said their

parents didn’t require help. But one in five people felt guilty about not

being able to do more.


LOOKING TO THE FUTURE

Respondents were also asked about their views on where future care

responsibility would fall within the family, with most feeling this would fall

on themselves or their siblings. A minority, around 10%, felt they would need

some external assistance from beyond the family network.

Importantly previous experience of care is clearly related to future

expectations about being able to cope. People who felt they were able to

offer their parent good care on discharge, were also more confident about

not requiring external care in the future. Similarly, those that didn’t feel

their parent got enough external support for the reported experience were

more likely to say they required external support after any further hospital

admission and discharge.

Given existing cuts, rising demands and restrictions on funding going into

social care it is unlikely local authorities will be able to continue to keep up

with demands. We therefore asked respondents about the sort of care they

may be able to provide in the future (Figure 10).

Just under seven in 10 respondents said they would be able to provide some

care in their own home for their parents while they recovered from hospital.

Almost 45% said that they could do this “as long as necessary”, with a further

25% up to three months. However, 31% said they couldn’t accommodate their

parents at all.

FIGURE 10

Willingness and ability to

accommodate parents in own

home whilst they recovered

from hospital

Up to one monthUp to one week Up to six weeks Up to three months

As long as necesssary

I wouldn’t be able to accomodate

them at all

10%

30%

50%

20%

40%


Although most people’s family networks are very or fairly strong and resilient

to looking after older relatives, around one in four respondents had relatively

weak networks and some no family network at all (Figure 11).

Again, looking to a future hospital episode, respondents were asked which

statements applied to them. Many respondents either lived too far away, or

work and family commitments would make it hard for sons and daughters to

provide the care they thought their parent would need. Three in 10 worry they

will not be able to offer all the care that their parent would need.

Despite 45% of people saying that they would be willing to accommodate

their parent in their own home for “as long as necessary”, people were

more pessimistic when asked a direct question about long-term care and

whether they would consider putting up older relatives in their own homes

rather than in care homes. “Would you or someone in your family be in

a position to do this for your parent?” 34% replied no, 37% maybe, and

slightly under 30% yes.

FIGURE 11

Perceived strength of family

network in relation to caring

for an older relative

Very strong Fairly strong Not very strong Non-existent

10%

30%

20%

40%

50%


Summary of Looking to the Future

§ Although the majority of respondents had strong family networks which

would help them cope with caring for older relatives without external help,

a large minority – over 30% had weak or non-existent networks to help

them do so.

§ 30% of respondents said they would not be able to accommodate their

parents if their parent had to recover from a hospital episode.

§ In response to a question about whether families would consider putting

up older relatives in their own homes as opposed to care homes, less than

30% responded that either themselves or others in their family would

definitely be in a position to do so for a parent.

FIGURE 12

Whether families would consider

“putting up older relatives”

as a substitute for care homes

Yes Maybe No

10%

30%

20%

40%


CONCLUSION AND SUMMARY

The health and care system is under severe pressure, with restrictions on

funding going into social care. This impacts on care and means that good

transition between services and home is ever more important for the health

and wellbeing of older patients, and for the efficient running of the system.

This report finds that most families are willing and able to provide most, if not

all of their parents’ care, but a clear minority who need at least some support

to cover a gap left between rushed and pressurised health services and

reduced social care provision.

Whilst in hospital most patients are visited frequently by offspring and wider

families and friends but a significant minority are visited rarely or not at all,

often due to transport problems. We find that, many families are finding

premature discharge a problem. This reinforces the findings from Going

Home Alone, which showed that those patients who perceived they had been

discharged too early, were much more likely to go on to be readmitted to

hospital again within the next three months. This premature discharge issue is

a problem for patients, families and the system.

There is also a significant issue with communication between clinicians

and family members around discharge. Again, although most offspring

thought hospital staff had a good understanding of their parents’ personal

circumstances at home, close to a third said staff hadn’t talked to them

directly about them or how they affected needs post-discharge.

The care received post-discharge was much more likely to cause concern,

than that received in hospital. One in four respondents had such concerns,

with the top issues being about the amount of care received, and about

parents having to go back home and themselves deliver care for a spouse

or partner.

SECTION 5


This reinforces the point about premature discharge and communication

within the hospital setting about the discharge process, families that had

been asked about their parents personal circumstances were over twice as

likely to report that their parent’s discharge was timely and appropriate.

Unfortunately, around half of respondents who had concerns about post-

discharge care, had felt unable to share those concerns with staff for a

combination of reasons including a perceived lack of knowledge and sense of

“doctor knows best”.

There is also a strong link between views on premature discharge and views

on post-discharge care, those feeling their parent was discharged prematurely

were almost eight times more likely than those that didn’t to have concerns

about the post-discharge care they received – clearly some people leave

hospital too soon for families to get services and wider help in place.

Whilst most people were able to help their parents regularly following

discharge, 20% said they felt guilty about not being able to do more.

Looking to the future, the majority of respondents had strong family networks

which would help them cope with caring for older relatives without external

help, but a large minority, over 30% had weak or non-existent networks to

help them do so.


RECOMMENDATIONS

Given that many more family members, and from our earlier work Going

Home Alone, former patients, are concerned about premature discharge

compared to delayed discharge, this needs to be taken more seriously by

health and care system leaders.

Clinicians need to talk directly to patients’ families about their personal

circumstances post-discharge, since we find this in itself is associated

with perceptions of appropriate discharge. Better and more consistent

communication is likely to lead to more appropriate care packages,

including the contribution of volunteers.

One in four families had concerns about the post-care discharge their

parent received, including the amount of care they could give and

concerns for parents who were carers themselves. Volunteers can help,

offering support to families and carers, who themselves have left hospital

to go back to caring roles.

Looking forward, many families are worried about their ability to offer the

care needed if their parents are admitted to hospital in future. Although

many families have strong family support networks, over 30% do not.

With existing cuts and restrictions on social care, Home from Hospital

services are likely to be needed more than ever. There are important

questions about how those services will need to adapt, change and scale

up to help meet that challenge.


THE SIX ESSENTIALSRoyal Voluntary Service believes that no older person should have to leave hospital unaccompanied and without

support unless they choose to. We have identified the Six Essentials we believe every older person should be entitled

to experience when they leave hospital. Ensuring these are in place, will improve the discharge process and more

importantly, will help older people to get well sooner.

Every older person should be told the plan for their return home from hospital

Every older person should be accompanied home before 10pm from hospital unless their preference is different

Every older person needs to be able to collect their prescriptions and get to follow up appointments for a speedy recovery after a stay in hospital

Every older person should come home from hospital to a warm, well-lit house with someone asking how they are

Every older person should know they’ll have help to get some shopping in and won’t have to sit hungry after a stay in hospital

Every older person should have a friendly face to turn to for help after a stay in hospital

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REFERENCES

Ham et al (2013) Integrated care in Northern Ireland, Scotland and Wales: Lessons for England. London:

The King’s Fund. http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/integrated-care-in-northern-

ireland-scotland-and-wales-kingsfund-jul13.pdf

Healthwatch England (2015) Safely home: What happens when people leave hospital and care settings?

http://www.healthwatch.co.uk/sites/healthwatch.co.uk/files/170715_healthwatch_special_inquiry_2015_1.pdf

NHS England et al (2014) Five year forward view https://www.england.nhs.uk/wp-content/uploads/2014/10/

5yfv-web.pdf

NHS England (2015) Delayed Transfers of Care Data 2015-16. Available from https://www.england.nhs.uk/statistics/

statistical-work-areas/delayed-transfers-of-care/delayed-transfers-of-care-data-2015-16/

Oliver, D. (2015) Improving hospital discharge and intermediate care for older people. London: The King’s Fund

http://www.kingsfund.org.uk/blog/2015/10/improving-hospital-discharge-and-intermediate-care-older-people

Royal Voluntary Service (2014) Going Home Alone: Counting the cost to older people and the NHS

http://www.royalvoluntaryservice.org.uk/Uploads/Documents/Reports%20and%20Reviews/Going_home_alone.pdf

The Scottish Government (undated) Reshaping Care for Older People: A Programme for Change 2011-2021

http://www.gov.scot/Topics/Health/Support-Social-Care/Support/Older-People/Reshaping-Care

Welsh Government (2014) Welsh Government (2014) A Framework for Delivering Integrated Health and Social Care

For Older People with Complex Needs http://wales.gov.uk/docs/dhss/publications/140319integrationen.pdf

Royal Voluntary Service is a registered charity with charity number 1015988 & SC038924 and is a limited company registered in England and Wales with company number 2520413. Registered office Beck Court, Cardiff Gate Business Park, Cardiff CF23 8RP.

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