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