Make sure your relative is safe and properly assessed in hospital
These tips are taken from our new and updated guide, How To Get The NHS To Pay For Care, and will help you if you’re facing pressure to get your relative out of hospital and into care…
Elderly people generally fare very badly in hospital in the UK and many are discharged too soon in an attempt by the hospital to free up the bed, yet without the proper NHS Continuing Healthcare assessments having been done and without proper ongoing care arrangements having been put in place.
Hospital social workers, as part of the discharge team, often seem very quick to tell someone they’ll have to pay for their ongoing care – even though they may know that no assessment has taken place to ascertain who is responsible for paying for that ongoing care. This is established through an assessment for NHS Continuing Healthcare.
Many families are also told that their relative will be assessed ‘once they get to a care home’. Again, this could seem to be an attempt to pass someone over to the local authority for means testing before the NHS has to assume financial responsibility.
When this happens, of course, the responsibility then falls to you to challenge this and track the maladministration back to when that mistake was made.
Insist on an assessment for NHS Continuing Healthcare
Do this while your relative is still in hospital – and don’t let anyone convince you your relative ‘won’t be eligible’ until the proper assessments have been done.
Families report that hospital staff are not always aware of Continuing Healthcare or the assessment process. However, this is no reason for assessments to be overlooked.
If your relative is going into intermediate care and their ongoing health and care needs are not yet clear, the assessment process may be delayed until things are clearer. They may, for example, improve with short-term rehabilitation. Equally, they may deteriorate. The NHS can wait to do an assessment to see how effective the rehabilitation is before they assess ongoing needs. However, your relative should not be charged for intermediate care, and your relative cannot just be told to pay for their ongoing care, whether at home or in a care home. It must be clearly shown, through assessment, whether their funding is a local authority or an NHS responsibility.
Make sure the hospital knows you want to attend all Continuing Healthcare assessments for your relative, and let them know you’re fully aware of the NHS Continuing Healthcare assessment process. Once the Discharge Team is aware of your knowledge, they may stop pressurising you so much.
Section 2 notice
At the point where the hospital decides your relative is no longer NHS responsibility, the hospital will issue a ‘Section 2 notice’. This is effectively a notice to Social Services that the hospital is handing over responsibility for your relative’s care to the local authority.
What this means in practice is that the NHS is shifting budget responsibility to Social Services, who will then means test your relative. However, if your relative needs ongoing care for health reasons, this handover should only be done after a proper assessment for NHS Continuing Healthcare funding has been carried out.
The NHS of course wants people to occupy hospital beds for as short a time as possible, because of the cost, which is understandable. However, many families report that the NHS will sometimes, incorrectly, try to hand over responsibility before proper procedures and guidelines have been followed. If the hospital tells you that they need the bed and that your relative is ‘bed blocking’, remind them that it’s their problem, not yours, and that their primary concern should be the proper care and wellbeing of your relative.
Make sure you know who the hospital discharge coordinator is for your relative and let that person know you’re aware of the discharge procedures that have to be followed.
If the hospital has already issued a Section 2 notification, ask to see a copy. You are entitled to see it as your relative’s representative. Make sure that everything on the form looks up to date and correct and based on a current assessment of health needs and that your relative has been assessed for NHS Continuing Healthcare. If the form is incorrect, raise this with the hospital. They will have to withdraw the Section 2 notification and do a new one.
Don’t be pressured into a quick discharge from hospital
No one who needs any kind of ongoing care should be discharged from hospital without a proper assessment for health needs and without a full package of care in place and available to them as soon as they are discharged. There should be no gap in care.
Don’t be pressured into a quick discharge from hospital. And beware – if you sign anything from Social Services you may be opening yourself up to paying for care, or giving them the opportunity to bill you for care. So check carefully anything you sign.
Once your relative is out of hospital, it’s much harder to fight for care funding because you have less leverage. All the while the hospital is anxious to get your relative out, the urgency of the bed situation can actually help you. It’s very sad that it should be like this, but many people report this to be the case.
Since Care To Be Different was set up, we have been approached by over 1,000 families, and this specific issue is one of the most common situations we hear about.
A ‘delayed discharge’ period starts from the time your relative was originally meant to be discharged (the first Section 2 notice) until the time he/she actually is discharged – with appropriate ongoing care.
Once a new discharge date has been decided, a Section 5 Notification will be issued by the NHS to Social Services. All rules about carrying out proper assessments remain the same.
Once your relative is ready to be discharged from hospital, make sure that on the day of discharge they are still properly cared for – and not left in a Discharge Lounge without care and attention. Your relative should be properly dressed and fed, given enough drinks, and have any continence needs addressed throughout.
Your relative should only be sent home or elsewhere if ongoing care is in place and they will be safe at their destination, including if that’s likely to be a cold and empty house.
Find out more about NHS Continuing Care funding in our e-book, How To Get The NHS To Pay For Care.