Choosing a care home on discharge from hospital: guidance

Purpose and context

1. This document provides updated guidance for local authorities and NHS Boards and their Integration Authorities on the Social Work (Scotland) Act 1968 (Choice of Accommodation) Directions 1993. It provides detailed advice on managing choice of care home for people assessed as requiring on-going long term care, following a hospital stay. This guidance does not apply to short breaks, respite or periods of Intermediate Care provided in a care home setting. You can find out more about Intermediate Care on the Scottish Government’s website

2. Separate guidance is available for individuals who are delayed in hospital and require an interim move to a care home to wait for a package of care to return to their own home.

3. It is aimed at staff involved in the discharge of patients who are clinically fit for discharge, and, after all other options have been explored, are assessed as requiring long-term care in a care home. It will also be of interest to patients themselves, their family, carers and advocates. Example public information leaflets and letter templates are also available for use locally.

4. The aim of this guidance is to achieve a clear, consistent approach for staff, patients and their families to arrange timely discharge to a care home. This will in turn improve the patient journey by reducing unnecessary, prolonged and potentially damaging hospital stays as well as freeing up beds for other patients.

5. Section One of this guidance provides guidance on, and interpretation of the Directions on Choice. Section Two of this guidance provides a more detailed practitioner’s guide for use by health and social care staff involved in discharge planning and care home allocations.

6. Under the Carers (Scotland) Act 2016, unpaid carers have the right to be involved in the hospital discharge process of the person they are or are going to be caring for. They also have the right to have their views taken into account in assessing the needs of the person being cared for. A Good Practice Guide to Involving Carers in Discharge Planning provides more advice.

7. Where a patient lacks capacity to consent staff should make enquiries to ascertain whether a Welfare Attorney or Welfare Guardian with appropriate powers has been appointed, as per the Adults with Incapacity (Scotland) Act 2000 (see page 7 for further details).

8. It is universally recognised that once a patient has been deemed clinically fit for discharge from an acute episode, prolonged hospitalisation is rarely the best option. Similarly, once any hospital based rehabilitation has been completed, the patient should move from hospital as soon as possible into a more homely community setting, preferably in their own home; or into sheltered accommodation, a care home or other community setting.

Who will this guidance affect?

9. This policy will apply to:

• Patients who have been assessed as requiring long-term care in a care home after all opportunities for rehabilitation or reablement, through the use of Intermediate Care, have been fully investigated and discussed with the patient, family or proxy.
• Patient, family or proxy who have identified a home of choice with no current vacancy.
• Patient, family or proxy who are repeatedly uncooperative or unwilling to engage with the discharge planning process, by refusing to make suitable care home choices.
• Patient, family or proxy who are unwilling to move from hospital until a vacancy becomes available at their preferred home of choice.
• Patient, family or proxy who are unwilling to move to another care home temporarily (an interim move), when their preferred home of choice is currently unavailable.
• Patients who are not eligible for Hospital Based Complex Clinical Care and do not accept alternative arrangements.The guidance on Hospital Based Complex Clinical Care provides more information.

10. This guidance applies equally to all patients, regardless of who is ultimately funding their care (i.e. self-funders, or wholly or partly funded by the local authority).

11. However, this guidance does not apply to individuals waiting for a package of social care to return to their own home and require an interim move to a care home.