If someone you care for has been admitted to hospital, it can be a very challenging experience for you, bringing up all sorts of difficult emotions and practical concerns.
When the person you care for is ready to leave the hospital, this can mark an important step in their recovery, but may also come with its own set of responsibilities and worries. You might wonder how you will cope with their needs when they come out, especially if this is the first time you have had to think of yourself as a carer or if the needs of the person you care for have changed.
Understanding the hospital discharge process and the support you can expect as a carer can help you feel more confident and prepared for whatever happens. Our practical guide walks you through the key aspects of the discharge process, offering practical advice on how to support yourself and the person you care for during this time of transition.
The hospital discharge process is the series of steps that healthcare professionals take to ensure that someone is ready to leave hospital and return home or move to another care setting, such as a rehabilitation centre or a nursing home. Every hospital in the UK will have its own discharge process, but they will all be very similar as they are based on strict government guidelines. Each hospital has a specific discharge policy and you can ask for that from the ward manager, the Carer Liaison officer, the discharge coordinator, or through the hospital Patient Advice and Liaison Service (PALS).
The Health and Care Act of 2022 means that all NHS hospital trusts in England now have a duty to ensure that unpaid carers are involved as soon as possible when plans for discharge are being made, with each hospital discharge policy emphasising the need to identify any carers, including family members and young carers, at the point of admission. In practice, this means that if the person you care for has capacity and has consented to share information with you, or if they lack capacity but you have Lasting Power of Attorney (LPA), the hospital teams can keep you updated, listen to your concerns and answer any questions you might have so you feel as empowered and informed as possible at every stage.
As a carer you should feel included in discharge planning meetings, ward rounds and discussions. You should feel involved in conversations about what you might be expected to offer when the person you care for is discharged, and what support you might need in order to fulfil your role safely and confidently.
Planning for discharge starts as soon as someone has been admitted to hospital and involves a multidisciplinary team (you might hear the phrase ‘MDT’) of doctors, nurses, social workers, and therapists. As a carer, you are an important part of this team and should feel invited to contribute and share your knowledge as a discharge plan is drawn up to meet the ongoing needs of the person you care for.
Sometimes carers can feel overlooked in the busy environment of a hospital or feel daunted at having to introduce themselves, but it is important to highlight your role as a carer as soon as the person you care for is admitted. Our article on Identifying yourself as a carer when supporting someone who is in hospital goes into more depth on this here. If you are looking after a child who has been admitted to hospital, our article here may also be helpful.
The person you care for will be assessed by the medical team, and this assessment will cover every aspect of their physical and mental health, their mobility, and ability to perform daily activities. The person you care for may need further assessment in another ward or another hospital, and our article on assessment wards and assessment beds goes into more detail here.
Once it has been decided they are well enough to go home, a discharge assessment will take place that covers the needs of the person you care for, and the needs of you as their carer, when they leave hospital. If the patient needs little or no care this is called a 'minimal discharge'. If further care is needed, it is called a 'complex discharge'; this is when the assessment team will decide if extra support needs to be put in place, like specialist equipment for your home, or if short-term intermediate care or reablement package might be required.
Reablement support can include occupational therapy (OT), nursing or physiotherapy, and this takes place at home or in a residential care setting, usually for up to 6 weeks. If this type of care package is required it will usually be free, and the hospital will have a discharge team that will make sure these arrangements are put in place. If the person you care for has significant healthcare needs, the health and social care teams may also make an assessment for NHS Continuing Healthcare (CHC). This is care for people with significant ongoing care needs that is funded by the NHS in England but provided outside of hospital.
If you feel you can take on the caring role at home, a carer’s assessment may then be carried out to make sure you also have the right support in place in order to feel confident enough to fulfil your role. A discharge plan or care support plan should then be written up and shared with the person you care for and with you as their carer. This covers how the support you both need will be provided, who will provide it, and when it will be put in place.
The discharge plan, or care and support plan, is an important document that outlines the support the person you care for will need after leaving hospital. Both you and the person you care for will be given a copy of this plan when you leave the hospital, and it is a separate document to the support plan you may receive as a carer. A good discharge plan reduces the risk of a ‘failed discharge’, with the person you care for needing to be readmitted to hospital. A good discharge plan ensures that you are given plenty of notice so that you feel prepared, as well as ensuring that the person you care for can continue their recovery at home as independently as possible.
A discharge plan should include a brief medical summary of the diagnosis and treatment the person you care for received whilst in hospital, any ongoing medical conditions they may have, and any treatment they will need after being discharge. The discharge plan will also include a list of all necessary medications, including dosages, timing, and any special instructions you and the person you care for need to be aware of. Our article on Administering Medications might be a useful read here. The discharge plan may also contain guidance on particular care needs, such as wound care, dietary restrictions, or specific exercises to aid recovery. The plan will also list details of any follow-up appointments that will be necessary, and will include the dates, times, and locations of these, plus important details of your care coordinator, specific medical teams and the community care support professionals you may be in contact with.
The hospital discharge coordinator should go through the discharge plan with you and the person you care for, and that is a great time to ask questions or request additional information if anything is unclear.
Sometimes it might not feel right to you to take on the role of carer at home. Perhaps the person you care for now has additional needs, or their condition has deteriorated, and you feel unsure that you will be able to cope. It is very important that you listen to your own feelings if taking on the responsibility for being the main carer feels unmanageable to you right now. It can take courage to admit this to yourself and then share your concerns with others, but it really is in everyone’s best interests long term.
Speaking with the hospital carer liaison officer or one of the medical professionals involved about your worries is a good first step, and you will then be able to look at the other options available. Our article on self-advocacy for carers is a great resource to support you in feeling more confident to speak up at a time that might already feel very stressful for you.
One aspect of the hospital discharge process that can be reassuring to carers who have concerns about their ability to care, is the possibility of the 6-week reablement care package. This extra professional support that takes place in the home can often provide a helpful transition between hospital and home, whilst Needs Assessments for both you as the carer and the person you care for would be carried out.
Other support can often make things easier too, like adaptations to your home or specialist equipment, and the hospital discharge team can look into arranging these things for you. Our articles on home adaptations have more details on what is available here. It’s also important to acknowledge that even thinking about making these changes to your home can naturally bring up all sorts of difficult emotions.
When the person you care for is in hospital it can often feel like there isn’t much time to process all the change and new information you have to take in and this too can feel overwhelming. Expressing how you feel and looking after yourself will be important if you ever find it difficult to cope or feel you will be unable to care for someone after they come home from hospital. There may be a carers group within the hospital itself, and the discharge team will be able to give you details of groups local to you where you can receive valuable advice and where you can connect with others who will understand what you are going through.
You should be informed in advance of the day and expected time of discharge, and if you need transport to get home, that should have been arranged for you. Care support plans will be given to you if a carers assessment has taken place, and to the person you care for, along with any medication or special equipment needed and any useful contact details that might be important to you. The GP of the person you care for will be informed of their hospital stay usually within 24 hours and will also be aware if they are going to receive any extra care at home or in the community. Any support that is required will be put in place immediately.
Support doesn’t end when you leave the hospital and you should be contacted to make sure things are going well and asked if there are any changes to your needs or the needs of the person you care for that you feel should be addressed. You don’t need to wait to be contacted however, and should feel welcome to call your GP, care coordinator or other relevant professional if you have any concerns or questions at all.
If the person you care for is admitted to hospital, it can be a very stressful and demanding time for you, and looking after your own wellbeing will be key to you feeling stronger and more able to manage when the person you care for is discharged. Our resources on managing difficult emotions and the importance of self-care for carers can be found here.
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