This month I was asked this question and thought I would post my response. This is something that is increasingly going to crop up over the next few weeks and months during the winter pressure on hospital beds.
It is a common scenario, particularly now that a new directive has come into place called “discharge to assess”. The hospital is suggesting that an elderly man with a terminal illness be sent home to his equally elderly wife. She is already struggling under the strain of dealing with the emotional and practical issues. Of course she would love to have him home and he wants to be at home, but realistically even with family support it may not be possible.
I advised that the family must start talking to the discharge team now and say that with the existing circumstances at home they will not accept the discharge. That they feel it would be an “unsafe discharge”.
He has a terminal illness, so they should ask for an assessment of eligibility for Continuing Health Care Funding (CHC). If found eligible, for a Fast Track decision for funding (if not eligible for CHC he may be eligible for Funded Nursing Care (FNC)) but this only paid if the recipient is in a nursing home on top of the standard fees. A full Care Needs Assessment should be carried out so that a Care Plan of his needs can be costed and put in place before discharge.
A Carer’s Assessment should also be undertaken for his wife. This is often missed, as most people are not aware of it or that it should be undertaken for the main carer. It is particularly important if the carer themselves can be considered “vulnerable”.
Remember you can appeal against the refusal to asses for or pay CHC or FNC and we can help with that.
I also strongly recommended that they politely refuse to discuss any financial details of the person being assessed at this stage. The national guidance is clear that care needs and nursing needs are assessed first with no account to be taken of who is to fund at this stage. Some options may depend on whether the gentleman will be classed as a “self-funder”, in other words if he has assets of £23,250 or more, or substantial income, whether the care will be provided by Social Services or the NHS. But the principles are the same.
Recent guidance advises that assessments can be done after discharge when the person is home. As you might imagine, this makes no logical sense to anyone, and I recommend to my families that they resist this where it is clear that the needs of the person cannot be managed even in the short term..
When the assessments have been undertaken and decisions reached on what is needed, where is the best place to provide this care and the time frame to get things in place,then discharge can be considered.
Also, remember, if the person is to be funded by either the NHS for Continuing Health Care or Social Services through a Personal Budget, the person can have these as Direct Payments into their bank account, so they choose who will care for them.
If you would like to know more about how we can help you in the circumstances mentioned above then please do get in touch here