Choosing a care home on discharge from hospital: guidance

Directions on Choice

12. The Social Work (Scotland) Act 1968 (Choice of Accommodation) Directions 1993 apply to local authorities that arrange care home accommodation to a person under the Social Work (Scotland) Act 1968 (the 1968 Act). The directions place a duty on local authorities in Scotland to arrange places for people in a care home of their choice, provided:

• The accommodation is suitable in relation to the individual’s assessed needs.
• To do so would not cost the authority more than it would usually expect to pay for accommodation for someone with the individual’s assessed needs.
• The accommodation will be available within a reasonable period
• The person in charge of the accommodation is willing to provide accommodation, subject to the authority’s usual terms and conditions for such accommodation.

See page 19 for further interpretation of the Directions on Choice, and Annex A for the original Directions.

13. There is clear evidence^{[1] [2]} that an unnecessary prolonged stay in hospital can be detrimental to a person’s physical and mental wellbeing and can result in:

The Effects of Bed Rest on Older People

Dizziness / Fainting

• Postural Hypotension (drop in blood pressure on standing) noted after as little as 20 hours bed rest

Reduced Muscle Strength

• A muscle at complete rest loses 5% muscle strength every day
• 3 weeks in bed reduces fitness equal to 30 years of aging
• On-going muscle weakness 3-5 years after discharge

Delirium

• Sensory deprivation (no glasses or hearing aid) can lead to confusion & delirium
• 70% of older patients can acquire pressure ulcers within 2 weeks of admission to hospital

Institutionalisation

• 5 times more likely to be admitted to a care home on discharge

14. Patient choice is one of the many factors affecting delays in discharge from hospital. There are a number of reasons why these types of delays occur:

• patient, family or proxy unwilling to start or engage with the choice process, e.g. not responding to telephone calls, correspondence.
• patient, family or proxy disputing the hospital discharge, insisting on patient staying in hospital.
• patient, family or proxy have made a choice of care homes, but have not identified one with a suitable vacancy or interim home.
• patient, family or proxy refusing to move to (or in the case of self-funders refusing to pay for) an interim care home.

15. This guidance provides advice on how to deal with these cases. However, clear local protocols, that are robustly and consistently implemented with the support of all staff including senior managers, clinicians, ward and social work staff are essential to improve discharge planning and improve outcomes for patients.