Before Leaving Hospital

What is a discharge plan?

As soon as people are admitted to hospital a process of planning should begin to find out what services and support they may need when they leave. By the time they leave hospital a clear discharge plan should be in place. This planning process should ensure that when people leave hospital they and, with their permission (or when appropriate) you as their carer, know about the following:

Their medical condition

This should include information on treatment, medication and future medical appointments. It should also include the names of the persons GP and consultant.

Services and support

This should include information on the services that have been agreed and that will be in place for the person returning home, for example, home care and community nursing. Contact numbers are available at the end of the folder.

How is a discharge planned?

If the person needs to be cared for and supported for the first time or if their care and support needs have changed, it is important to make sure the right support and services are put in place. The patient and, with their permission, you as their carer, should be involved in decisions and choices about their care. If services are already in place for the person, the main issues for discharge planning are to make sure that services and support will continue as before.

The following key people are usually involved in the discharge planning process:

Nurse in charge

They are the main contact person while the patient is in hospital, overseeing the care provided and plans made for leaving hospital.

The Consultant

They decide what medical care should be provided and decide when the patient is well enough to leave hospital.

Co-ordinator for carers

There is a co-ordinator for carers available at the hospital who can assist in:

assessing and meeting the individual needs of carers;
involving carers in discharge planning; and
highlighting and signposting carer organisations in the community.

Pharmacist

They provide the medication required for the patient and information on how and when it should be taken.

Listed here are some of the other people who may be involved when requested and when necessary:

Hospital social worker
Occupational therapist
Community psychiatric nurse
Physiotherapist
Speech and language therapist
Dietitian
Community Psychiatric Nurse
Chaplain

Checklist

Here is a checklist to make sure you have all the information you need.

Does the person I am caring for have a copy of the discharge letter/plan?
If not, speak to the nurse in charge or the hospital social worker if they are already involved.
Does the person I am caring for and, with their consent, do I, as their carer, have information on the services they will receive on leaving hospital?
If not, speak to the nurse in charge or hospital social worker.
The person you care for may have to pay towards the services provided. Has this been discussed?
If not, speak to the hospital social worker about a fi nancial assessment. Your local Carers Centre or Citizens Advice Bureau can also offer support.
Am I clear about what welfare benefits I, and the person I am caring for, are entitled to claim?
If not, speak to your social worker or your local Carers Centre.
Can I get a Carer Assessment?
Yes, if you are or will be providing substantial and regular care. Speak to the social worker or co-ordinator for carers.
Do I know what support is available to me as a carer?
If not, speak to the co-ordinator for carers and contact your local carers centre.