Hospital discharge explained

Staff may say medically fit, medically optimised, or that there is no criteria to reside. The last is the phrase written into the national guidance, and it is a double negative. The criteria to reside are a nationally defined set of clinical checks, set out in Annex D of the Department of Health and Social Care's hospital discharge and community support guidance, and a doctor works through them to decide whether your relative still needs care that can only be given in a hospital bed. When none apply, there is no criteria to reside.

NHS England describes the discharge ready date as the date a patient is first assessed as discharge ready during the final continuous period before discharge. That can be days before your relative comes home, because the bed, the visits or the equipment still have to be found. It is why a ward can tell you on Monday that your mother is fit to leave and she is still there on Thursday.

None of this means the hospital is wrong. The words describe the hospital's side of the question and not yours, so the conversation about what happens at home is a separate one worth having early. What to do when the person you care for is leaving hospital is the practical checklist for the ward, and the hospital discharge and post-operative care pillar covers the weeks either side.

Local names vary. One area's rapid response team is another's home first service, and reablement, intermediate care and discharge to assess all describe versions of the same short-term support. If a term comes up that you have not heard, ask what it means and who provides it, because the answer decides who you ring on a Saturday evening.

Pathway 0 and pathway 1 are meant to be the norm. The guidance is explicit that other than in exceptional circumstances, nobody should be discharged directly into a permanent care home placement for the first time without first being given the chance to recover in a temporary placement. Where a permanent home does turn out to be right later, your relative is entitled to a genuine choice of accommodation once their eligible needs have been decided, which the Care Act statutory guidance sets out. If a care home is on the table, is live-in care cheaper than a care home? sets the two costs side by side, because care at home round the clock is an alternative hospital teams do not always raise.

The advantage for families is that nobody is asked to decide permanently about their mother's home in a corridor on the fourth day of a bad week. The weak point is that the free period ends on a date whether or not the review has happened. Funding care after a hospital stay covers what comes after the six weeks, and hourly care after a hospital stay sets a short-term package next to reablement.

One thing that should not be done on the ward is the NHS Continuing Healthcare checklist. The public guidance says that in the vast majority of cases it should be completed when the person is in a community setting, and describes assessments in an acute hospital as rare. If your relative's needs are mainly health needs, NHS Continuing Healthcare explained sets out the test.

Free does not mean automatic. Intermediate care and reablement are not offered everywhere or in every situation, and a family who assumes support has been arranged can find out on the day that it has not. Ask what has been arranged and from when, in writing if you can. The six weeks is a maximum rather than an entitlement, because the support is reviewed as your relative improves and can end at three weeks.

If your relative's savings are below £23,250 when the free period ends, local authority funding for care at home explains how the means test works. If you will be doing a large share of the caring, you can ask the council for a carer's assessment of your own, which is free whatever your income.

A carer arranged privately fits around this rather than replacing it: reablement in the morning, a carer at teatime and overnight. Carers on PrimeCarers charge £18 to £25 an hour with our fee included, typically about £20, against £28 to £35 an hour for a similar visit through most agencies. Every carer on PrimeCarers has had an identity check, a right to work check and an enhanced DBS check on the Update Service, and has been interviewed online before their profile appears; their insurance covers them while they work, separately from those checks. References sit on a carer's profile, and skills and training are worth asking about when you speak to them.

PrimeCarers introduces carers and families to each other and does not provide or manage care, so the visits, the hours and the rate are agreed between you and the carer. Once a discharge date is being talked about and nothing has been arranged for the hours you are worried about, you can search for carers near the person's home and compare their rates, reviews and availability while your relative is still on the ward. Our pricing explains how the hourly rate and our fee work, what care costs where you live gives local figures, and what to arrange before discharge day covers the rest of the preparation. For the nights, short-term night care after a hospital discharge covers what sleeping and waking nights involve.

Discharge dates slip, sometimes by several days, so tell a carer you have booked as soon as a date moves. The contract between a client and a carer says a visit cancelled by the client is payable in full, with unplanned hospitalisation, illness, or another reason agreed with the carer as the exceptions, and a delay because your relative is still in hospital is the first of those. PrimeCarers charges nothing itself to cancel and does not set the terms between you and the carer.

Raise all of this with the ward first, and as early as you can, because a discharge that has not happened yet is easier to change than one to unpick afterwards. If that does not resolve it, every hospital has a free Patient Advice and Liaison Service, and what to do when the person you care for is leaving hospital sets out that route and the formal complaints process.

It is worth knowing the limit of what objecting achieves. The national guidance states that people do not have the legislative right to remain in a hospital bed once they no longer require care in that setting. Arguing for a better plan works. Refusing to take your relative home does not stop the discharge, and the energy is better spent on the support attached to it.