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Discharge to a nursing home

Related theory

Despite the ageing population and pressure on acute hospital beds, care home admission from hospital is a transition pathway that is poorly understood and little researched (Harrison et al. [16]). Discharging a patient to a care or nursing home requires careful thought as the decision to move into a care home is complex and often difficult and traumatic for individuals and their families (Lord et al. [24]). The impact on a patient and their family or carer may be significant, particularly where the person lives with a partner or family member and the move would be a loss for both of them. A thorough multidisciplinary assessment is essential, taking into account the individual needs of the patient and their family or carer and exploring all the options before deciding on a care or nursing home. Harrison et al. ([16]) suggest that it is important in aiding the process to ensure that significant discussions are documented, to include opportunistic conversations that nurses and others have with patients and their families. This ensures decisions and actions are recorded and it also facilitates better continuity of care.
In most cases, the family or carer will look for a care home placement. This can be quite a daunting process and it is worth providing a list of questions and things to look for when assessing a care or nursing home (Table 3.2). Additionally, the local clinical commissioning group will be able to provide the family with a list of registered nursing homes for them to view.
Table 3.2  Questions and things to look for when assessing a care or nursing home
 Questions
First impressions
  • Is the home easy for family and friends to visit, particularly those who have to rely on public transport?
  • Does the home have its own transport?
  • Is the main area accessible for people with disabilities, e.g. those with wheelchairs or who are poor sighted or hard of hearing?
  • Do the staff answer the door promptly?
  • Do the staff appear friendly and welcoming?
  • Do there appear to be several members of staff on duty?
  • Do the residents look well cared for and clean?
  • Is there an up‐to‐date registration certificate on display?
Note: it is usual to sign a visitors’ book on arrival.
The accommodation
  • Are the home and the rooms clean and fresh?
  • Are the rooms single or shared?
  • Do the rooms have ensuite facilities?
  • Can you bring your own furniture and personal belongings?
  • Where are the nearest toilets and are they accessible?
  • Is there a telephone in the room and/or mobile phone reception?
  • Is there a Wi‐Fi connection? And is there a fee for this?
  • Are there quiet areas to sit in?
  • What are the mealtimes?
  • Is there a choice of meals and diets?
  • Is there a laundry service on site?
Personal needs
  • How often do the hairdresser, dentist, chiropodist, religious support and GP visit?
  • Does a resident change GP if they move from the local area?
  • Where are medications stored?
  • Are there newspapers easily available?
  • What activities are available to facilitate continuation of hobbies?
  • Does the home arrange outings?
  • Are there quiet areas for family and friends to visit?
  • Can they stay for meals?
  • Is there an overnight room where they can stay?
Finances and contracts
  • What are the fees?
  • What services do the fees include, e.g. chiropody, hairdresser?
  • What are the terms and conditions?
  • Is there a reduction if the patient is admitted to hospital or goes on holiday?
  • What is the notice period or procedure for terminating a contract?
  • When is the room available from?
Nursing needs
  • How many qualified nursing staff are on duty day and night (in a nursing home)?
  • How often do qualified nursing staff review a resident (in a nursing home)?
  • How often does the community nursing team visit and review residents (in a care home)?
  • What is the daily care routine?
  • If the patient has very specific nursing needs, how will they be managed? Refer to the list given by the ward staff on the patient's specific healthcare needs.
  • How often does the community palliative care team visit?
  • How often is the GP or doctor in the home?
  • Although a difficult thing to consider, is the home able to support patients to remain in the home for end‐of‐life care?

Complications

Nursing and care home placements can be delayed while waiting for funding to be approved or waiting for a suitable bed to become available and it may therefore be necessary to consider an interim placement. It is important that the patient and their carers are aware that there may be time limits on the stay in hospital so they will be required to find a suitable placement within an agreed timescale. Many hospitals have a policy to support staff where patients and their carers are delaying the process of arranging a nursing home placement.
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