Hospital care/leaving hospital
People want to stay in their own home, or in a homely setting for as long as possible, and receiving long-term care in a hospital should be the last resort.
As far as possible, hospitals should not be places where people live - even those with on-going clinical needs. They are places to go for short-term episodes of treatment that cannot be provided in the community.
Spending too long in hospital can lead to:
- a sense of disconnection from family, friends and usual social networks leading to boredom, loneliness and loss of confidence
- risk of healthcare associated infection, and delirium
- distress for family and carers who have to spend time and money on regular visits to a hospital that may be some distance from home
Local authorities and NHS Boards have been working together over the last few years to develop services that support this, including Intermediate Care services, like reablement, hospital at home and more intensive home care services.
Hospital based complex clinical care
Assessment for long-term complex clinical care is based around a single eligibility question: Can the individual’s care needs be properly met in any setting other than a hospital?
If an individual does not meet the eligibility question above they will be discharged from NHS care to a suitable community setting – home with support, a care home or supported accommodation.
The assessment
The assessment will be carried out by the responsible consultant or equivalent specialist, informed by the Multi-Disciplinary Team. The assessment should be carried out in partnership with the patient, family or carer, and their views and wishes should be taken into account.
The assessment will help establish the best place for the person to have their clinical healthcare needs met. All options should be considered and the outcome of the process explained to the individual, their family and carer.
Cost of care
If a person is discharged from hospital, at this point the local authority's charging policies will apply, and the individual may have to contribute towards the cost of their care.
The local authority will carry out a financial assessment, to work out how much someone needs to contribute towards care costs. Find out more: Care Information Scotland's financial assessment
If someone has a health need then the NHS will still be responsible for meeting that need – free of charge. However, people in care homes will be asked to contribute (subject to their financial circumstances) towards their social care and accommodation costs.
Only those who need to be in hospital will be exempt from charges relating to their accommodation. Everyone else, whatever their age or disability should contribute to the funding of accommodation costs, following a financial assessment.
Leaving hospital/discharge planning
For most people, discharge from hospital will be quick and straightforward. However for some older people, and those with long-term or complex conditions, advance planning may be required to make sure the right support is available, in the right place, at the right time.
Discharge planning is a process that helps identify the services and support a person may need when leaving hospital. Planning will start as soon as possible after admission. The planning process will make sure that the right care is available in the community in time for the person's discharge.
The Discharge Flowchart helps highlight the process involved in hospital discharge planning,
The Road to Discharge is an infographic showing the discharge from hospital process.
We have developed two leaflets which provide information for patients, family and carers:
We have also produced guidance for local authorities and NHS boards on hospital based complex clinical care.