Should I sign hospital discharge forms for my relative?

Should I sign hospital discharge forms for my relative?

If you’re under pressure to get a relative out of hospital, you may be asked to sign hospital discharge forms

Image of doctor and wheelchair - should you sign hospital discharge formsThere are all sorts of forms you may come under pressure to sign, such as hospital discharge forms, financial assessment forms, a care needs analysis, health needs assessment forms, a ‘needs portrayal’ form, a Continuing Healthcare assessment form – all sorts.

Our general advice is always to be careful.

Only sign hospital discharge forms if you understand what you’re signing (and not just accepting what hospital staff may tell you without further exploration), and if you’re aware of the implications of what you’re signing.

That’s easy to say, of course. When a crisis happens, you often don’t have time to find out what should and shouldn’t happen. Plus, as with most families, you’re unlikely to have faced such a situation before.

Every situation is different, but let’s look here at one typical hospital discharge scenario…

You have an older relative who is now frail, but still lives at home. However, things have been getting more difficult and dangerous for them at home. Then your relative has a fall and is taken to hospital as an emergency. After a few days, when it’s clear that there’s nothing from a medical point of view to keep them in hospital, the hospital declares them fit for discharge.

This raises alarm bells for you, because you know it’s not safe for your relative to go back home and they should not be discharged home. You raise this with the hospital.

At this point your relative may be offered a few weeks of rehab (local authority or NHS funded) in a separate location (often in a short-term care home). A member of social services or a ‘rapid response’ team may also start asking your relative questions about their care needs. Notes may be made and your relative may be asked to sign these notes.

There are several things to be aware of here:

  • If there is any doubt about your relative’s mental capacity to understand, retain and weigh up information on their care needs and risks – and communicate their decision about going back home – a Mental Capacity Assessment (MCA) should be undertaken before anything else is done.
  • If the MCA reveals that your relative does not have the mental capacity to make a decision about going home, a Best Interests Meeting may need to be held to ascertain what is best for your relative.
  • If the MCA shows that your relative does have capacity, and yet you disagree, you can challenge this. This is where having a Lasting Power of Attorney for Health and Welfare can be invaluable.
  • Your relative should not be asked to sign anything if they lack the capacity to understand what’s is going on and the implications of any decisions they make.
  • If you as their representative are asked to sign a form at this point, make sure you understand exactly what its purpose is. If it contains a few notes about your relative’s needs, be sure to add in writing on the form that this is not a full and comprehensive assessment of needs (if it’s not). Also, write down on the form what your understanding is of the actual purpose of the form.

Let’s go back to the point where you or your relative are being asked questions about care needs, and you’re asked to sign the notes/paperwork prior to your relative going into rehab…

If the sole aim of any suggested rehab care is to get your relative back home again, your signature on that paperwork could potentially be interpreted as your agreement that your relative should indeed go back home. And yet the option of rehab may have been the only option that was mentioned to you.

You may feel the hospital was backing you into a corner – just to allow them to discharge your relative.

There is, of course, another option, which is full time care. This could be either in a care home or through live-in care at home. This takes time to organise, though. In the meantime you may have to insist that there’s a delayed discharge from hospital, so your relative can stay in hospital until appropriate ongoing care has been put in place and all relevant assessments undertaken and care plans drawn up. This includes NHS Continuing Healthcare assessments.

Although this may all sound rather complicated, the golden rules in all of it are:

  • Get informed – and if you know a crisis is likely to occur, read up on the process as much as possible in advance.
  • Hold out for what you know to be right for your relative at every stage in the process.
  • No one should be asking you about money until the appropriate care needs assessments have been carried out – to ascertain who is responsible for providing the ongoing care. If it’s shown that the NHS is responsible, your relative should not have to pay for that care; it will be funding through NHS Continuing Healthcare.
  • Be careful what you sign – and if you feel things have not been explained or carried out properly, write this on the form.
  • Take one step at a time.

If ongoing full time care does seem the best option, start looking at care homes or live-in care providers as soon as you can. Don’t let the local authority push you into agreeing to their choice of care home – unless you’re happy with it. Choosing a care home needs careful thought.

If you’ve been through such a scenario, what tips and advice would you give to other families in the same boat?

20 Comments

  1. Gill 1 year ago

    I have gone through 4 years of wrangling with the NHS, Social Workers, Occupational Therapists, Rapid Response Teams, Dr’s, Discharge Nurses, Financial Assessors, Deprivation of Liberty Safeguard team etc. Mum has Alzheimers at late stage and has really bad psychosis. Eventually they have admitted her under section 2 to be assessed. I have read 100s of forums about the illegal lengths that the NHS and it’s levels of collusion. If this is an illegal practice cannot there be a Class Action brought against them for this. I feel that this is a toxic time bomb waiting to explode on the scale of PPI etc. Surely this could be challenged in a court of Law??

    • Author
      Angela Sherman 1 year ago

      Gill – many families ask the same questions; this whole issue could no doubt be challenged in a court of law, and many families feel that is the only recourse sometimes, but of course it comes at a financial cost. There may well be firms of solicitors who would be willing to pursue a class action.

  2. David 2 years ago

    Are social services or the NHS allowed to bombard relatives with telephone calls on a Saturday and Sunday asking whether relatives have found a suitable care home into which an in-patient can be discharged? Particularly when relatives have provided both social services and the NHS with updates about finding a suitable home during the course of the normal working week.

    • Author
      Angela Sherman 2 years ago

      That sounds very unreasonable on the part of the care authorities, David.

      • David 2 years ago

        Yes Angela it is unreasonable, and discourteous. And at the moment I cannot find anything, apart from decency and good manners, which makes it improper for social services or the NHS to make such telephone calls at the weekend when they have been kept up to date about progress during the course of the normal working week.

    • Linda 2 years ago

      In 2010, my mother was admitted to hospital following a fall and her second hip fracture. While she was there it was obvious that she was showing increased signs of dementia. In her notes it was recorded where she lived and that her husband was fit and well and that he would look after her. She did not live at the address she had given. It was a day centre that she attended once a week, plus her husband had been dead for 19 years. I was told that she would be non-load bearing for six weeks and then would go for intermediate care for two or three weeks. Mother lived with my sister, who had been made my mother’s nominated carer by social services. that sounds reasonable, except that my sister has Downs syndrome. My sister said that she could not cope any longer and so I started looking for a care home. My big mistake was to tell the hospital. From that point on I was asked at each visit when I would be getting my mother out of hospital and they had her out of bed and had crossed her name off the list to go for intermediate care. I was even rung at home by the doctor “caring” for my mother, asking when I would remove her. Besides mother’s confusion about where she lived and the existence of her husband, she was convinced that the wound she had was a result of being attacked. I asked for a review of her mental state and they said that they had done a scan, which showed that there was no problem.
      Fortunately, I found her a care home that met her needs at the time. She subsequently moved to a home which should have been more suited to her needs, but she was soon sectioned and admitted to a mental hospital. When I went to a meeting of the medics, it transpired that the scan that my mother had when in hospital had shown that there was a deterioration in her brain and she did have problems. It seems that the hospital was more concerned about bed blocking than addressing the issues.

      • Author
        Angela Sherman 2 years ago

        That’s appalling, Linda. It sounds as though you have several grounds to complain about the professional conduct of several people here. Also, a Mental Capacity Assessment (MCA) should have been carried out. (Note – this is not the same as a general assessment of a person’s cognitive ability. This may help: http://caretobedifferent.co.uk/mental-capacity-assessments/ If an MCA was carried out, there should be the paperwork to match. I suspect there isn’t any.

  3. Edward 2 years ago

    Hi,

    My 92 year old father is in hospital in Wales after he collapsed at home (He lives alone). He has had a variety of health problems (diabetes, low blood count, gallstones, a bacterial infection) but the hospital is planning to discharge him in a few days after he has had a procedure to remove a gallstone. However he is unable to stand, let alone walk, due to a painfully arthritic knee and hip.

    Should we be asking for a CHC assessment while he is still in hospital or is it already too late.

    The other concern we have is if we start the ball rolling with the CHC process and he is refused, could that lead to problems down the road. For example, the social services start to intrude or dictate where or how he should be cared for (at great expense!)

    I feel like a drunk about to stumble across a mine field………any guidance would be most appreciated

    • Author
      Angela Sherman 2 years ago

      Hi Edward – the information on Care To Be Different is specific to the care system in England. Although Wales is similar, you’ll need to look at the National Framework for Continuing Healthcare for Wales. This link should help you: http://gov.wales/topics/health/nhswales/healthservice/chc-framework/?lang=en There are some differences in the process – but I would nevertheless insist on an assessment for CHC before your father is discharged from hospital. He should not be asked to pay anything until is it clear (through assessment) who is actually responsible for paying. I hope that helps.

  4. Bernie Crean 2 years ago

    Hi – I have seen a number of case recently with regard to discharge processes affecting their loved ones. All were cases were a relative was seen to be a ‘self funder’ and both ward staff and Social Services felt they could fund their ongoing care needs and were being pushed to discharge and free up the bed. Without knowing the legal requirements that should be applied they felt something wasn’t as it should be.

    They were correct to be concerned and to seek an opinion form someone that knew what the ward and Social Services were legally required to do prior to discharge. In every case there was complete disregard to CHC guidance and legislation that dictates what should happen and it was clear that they were being treated differently because they could pay for their own care.

    In summary, no one can be discharged until a full comprehensive assessment of their ongoing health & social care needs have been assessed. This can only happen when that persons health has stabilised and on going care is known. Everyone must be assessed to see if they require a full assessment for CHC. This must be done by using a CHC checklist and the patient ( or their POA/Family/Advocate if they don’t have mental capacity to do so) must be informed of this process and they must consent to it taking place and to be allowed to be fully involved in the process and to be given a copy of the checklist. If the patient does not have capacity to consent then a formal best interest process must occur and the family/care/POA/advocate must be involved in this process.

    Checklist’s if they happen at all can frequently be done in secret by ward staff to pay lip service to this requirement and to speed up discharge and frequently families are not aware it has occurred and have not been given a copy. Also remember that well managed needs must not be marginalised when scoring a checklist and that the threshold is set deliberately low. If the checklist is ‘positive’ , this this indicates there is a need for a full assessment for CHC funding and a MDT must be set up with social services involvement and a DST must be completed. There is a requirement for this full assessment to be person centred and with full involvement and inclusion of the patient/care/POA/advocate. The law is very clear a discharge cannot take place until a determination on eligibility for CHC has been made. Wards cannot refer to Social services until a CHC process has occurred. This is why ward staff are averse to fully complying with the CHC process, as it delays discharge.

    If need be the patient can be discharged from hospital whilst awaiting an assessment for CHC. This may be because needs are not known and to allow for a more comprehensive assessment of needs, or for rehab or recuperation. Remember only when needs are stable can a CHC checklist/full assessment occur. If this happens then funding responsibility for all care remains with the NHS until a determination on CHC is known. In every one of the cases I picked up they were trying to get the family to pay for care whilst a CHC process could occur or hadn’t taken place. Each discharge was stopped following my intervention to ensure full compliance with legislation.

    What can also happen is that the ward do pay for care in a residential or nursing home for a period of weeks to enable the bed to be cleared and to discharge a patient. This does not negate the need for full compliance with the legislation on discharge and need to comply with undertaking a CHC assessment via a checklist. I have case were the NHS paid for 6 weeks post discharge care then just ended funding without complying with the legislation on discharge and assessing for CHC. Just because they have been in a care home does not mean the law and guidance can be avoided, they are NHS patients and they need a discharge to occur in line with legislation. I can’t tell you how many times I had this argument with the NHS when they tried to refer someone to my Adult Social Care team at the end of a period of funding.

    If the ward do fully comply with CHC legislation and do everything by the book, then and only then must they make a referral to Social Services and advise them that they have a patient with ongoing care needs. Social Services must then undertake a formal assessment within 48 hours to identify what care they require. This does not always happen when a patient is seen as a self funder and Social Services will either not take the referral or the ward don’t refer to them. The new Care Act is very clear on what must happen. Social Services must assess and must not discuss finances before assessing a patient. If needs are complex then Social Services must do a full comprehensive assessment and not offer what they would like to do which is a simplistic assessment. We then go back to the legal duties under the Care Act, which states that in every assessment of care they must consider if the care needs are above being a social care need and the assessor must be competent and trained to know how to do this. So if the ward have or have not complied fully with assessing for CHC the Social Worker must also consider if needs are beyond being social care and can assist you to challenge the view of NHS staff. Sad fact is that many Social Services staff are not trained on CHC, do not know the LA limits or are not assertive enough to stand up to ward staff.

    Do not agree to a discharge until a CHC checklist has been done and that you are fully involved in this. If one hasn’t taken place then advise the ward of the legal need to do so. If Social Services try to step away because the patient is a self funder, advise them of what the Care Act states. Never agree to fund ongoing care if a CHC process has not been done or you are awaiting the outcome of a CHC assessment. All Health Trusts have funds to pay for ongoing care until CHC eligibility is known and have various names: interim funding, rehab fund, complex assessment beds, intermediate beds etc.

    Social Services also have a duty to fund intermediate care of 6 weeks whilst assessing needs and to see if they can restore a persons functional ability. Ask them for a copy of the intermediate care policy, this is available for all clients including self funders.

    For further info look at these links;

    http://www.ageuk.org.uk/documents/en-gb/factsheets/fs37_hospital_discharge_arrangements_fcs.pdf?dtrk=true

    http://www.disabilityrightsuk.org/how-we-can-help/independent-living/care-act-resource-page

    http://www.nhs.uk/choiceintheNHS/Rightsandpledges/Waitingtimes/Documents/nhs-england-and-ccg-regulations.pdf

    http://www.legislation.gov.uk/uksi/2014/2823/regulation/5/made

    Good luck…..

    • Author
      Angela Sherman 2 years ago

      Thanks very much for your comment, Bernie. That’s very informative.

  5. annie gonzalez 2 years ago

    Great Article. Thanks for the info, super helpful. Does anyone know where I can find a blank “Hospital Discharge Form” to fill out?

    • Author
      Angela Sherman 2 years ago

      Thank you for your feedback Annie – appreciated. As a family member, it wouldn’t normally be you who fills in a hospital discharge form; it would be the discharge team. But as your relative’s representative you should be fully involved in the process – and be able to object if you feel the discharge plans are incorrect, unsafe, inappropriate, etc.

  6. Madeline 3 years ago

    My cousin had a brain heamorage and suffered a stroke after it. She in unable to mobilise and has her medication through a peg. She can eat now orally but will need 24 hr care. She needs turning frequently throughout the day and is doubly incontinent. She has been an inpatient since april 2014. I demanded a CHC referal and she has passed the Checklist. However after looking at the domains in the assesment she doesn’t meet a ‘priority or severe’. We had a discharge meeting today and we have been advised that a report will be drawn up for the next meeting. The assesment one. My cousin wants to live independantly in her own home with the 24 hr care. The NHS social worker is adament that my cousin will only get 4 calls a day funded and unless the family provide the care. They suggest she will be better off in a nursing home. We dont understand this because it will cost more to pay for her in the nursing home. My cousin is devasteted she is only 52 and worked all her life in healthcare. she doesnt want to be institutionalised. Can we as a family refuse for her to be discharged until she gets the care package she needs? She wants to live as independantly as she can with care in her home. They are saying its very unlikely this is gonna happen We dont know what to do.

  7. Melanie Tudor 3 years ago

    My father is poorly and crippled. Hes had three months CHC. Just been told £667 PWEEK and the rest is a lifestyle top up. How can this be, I thought nhs funding should fund the lot or have I got that wrong. They are saying that a next of kin signs contract not dad. What are the implications as I cannot afford 1230 per month for dads fees. I’m seriously worried here.

    • Angela 3 years ago

      Melanie – CHC cannot me topped up, and there is no cap on the weekly CHC payment. Sounds like the NHS is trying to get away with paying less than they have to. If the care home is charging the top up for care that is part of your father’s required care, this is completely wrong. CHC is 100% funding for all assessed care needs.

  8. Jill Honeybun 4 years ago

    I’ve made it clear that my mum, currently in a hospital rehab. ward, won’t be going anywhere until things have been done properly. In theory, she has had two “checklists”. Neither mentioned really significant health problems – like a shoulder which has crumbled away completely. It should have been replaced 10 years ago but was too high risk. As a result, she has very little strength in her hands, she can’t even push a straw into a drinks carton, or brush her own hair. Nevertheless, she was given a self propelled wheelchair! She is tall like me, with a knee replacement, and arthritis in the other knee. The checklist recorded bilaterial TKR (total knee replacement) but it’s three replacements in one knee. No one noticed she only had scars on one knee?! As a result of her knee problems, she hasn’t been able to get out of a low chair for many years – they were concerned that she couldn’t get up from a low commode! I have said repeatedly that I have both types of Power of Attorney, still not recorded. It’s a complete and utter shambles in my view. Nothing to do with patient needs, or a statutory duty to care for the most vulnerable in society. Everything to do with budgets.

  9. Susan Evans 4 years ago

    Oh, how my heart goes out to you. I have been in the same place for four months. Ignored emails, no communication between the agencies, a service that made me ashamed of my country. I was summonsed to a meeting two months ago. The ward sister even contacted my place of work to ensure I had left work to attend! When I got there the Matron of the hospital was sitting, arms defiantly folded and he began to discuss bed blocking and immediate discharge. I listend patiently and then replied simply with the law… while I am attempting to appeal against a legally flawed DST assessment my mother could not be moved. He immediately asked where I was getting my information from. I assured him I had been given enough time to learn all I needed to know that I could write a dissertation on CHC. Knowing your rights can move mountains. His hands were ringing wet at the end of the meeting.
    Sadly my mum passed away in hospital last week before the situation was resolved. Now my dad has been diagnosed with the onset of dementia and I am ready for yet another fight in the future. DO NOT GIVE UP. It is exhausting but necessary. God bless you .xx

  10. Linda 4 years ago

    I am now into our 11th month and continue the fight for my Mum to receive continuing health care funding. I could not possibly have foreseen what has happened and the lengths the NHS will go to in order to protect their budget. Your information has been invaluable, without it I would not have had the strength to carry on although it has taken its toll on my own health. To date I have had a fatally flawed initial assessment, had to wait 6 months for another DST to be conducted, despite continued correspondence with CCG. This was again fatally flawed. I have been pressurised, intimidated by various NHS staff, a social worker that does not give a damn in my opinion and who consistently coerces with the NHS. I have asked numerous questions, in writing and sent emails to the relevant authorities, to no avail. Which confirms they have something to hide. Mum has been in a hospital enviroment for 11 months to date. A ‘best interests’ meeting was recently held, I was advised by the social worker during the meeting that they would be speaking to their legal team in regards to the Court of Protection! All because I am continuing to ensure justice is done and will not back down. Needless to say nothing surprises me now. I am currently awaiting a response from IRP, they have not confirmed to me if they will take on my Mum’s case, I have contacted them asking for confirmation of this, I still await a response, apparently they have been liaising with social services yet I have heard nothing. I have no trust or faith in anybody associated with NHS or Social Services the very two governing bodies who should provide support for my Mum. I do not have Power of Attorney, hindsight is a wonderful thing! My Mum has various medical conditions and problems associated with them, Alzheimer’s, Vascular Dementia, double incontenence and no mobility, she has a primary healthcare need not a social need! I will not allow them to discharge my Mum from hospital until the appeal process has been exhausted, I WILL CONTINUE TO BE A THORN IN THEIR SIDE UNTIL JUSTICE IS DONE. Good luck to everybody who has the courage to fight this gross miscarriage of justice.

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