How Does Domiciliary Home Care Reduce Delayed Discharges?

One of the most critical determinant points for care outcomes is the very first moment when there is a transition from healthcare to social care services.

Before someone can be safely discharged from hospital, they will have an assessment to see if they have additional care needs and how these will be provided for.

It is important to ensure that these services are centred around the person, which is particularly important when it comes to home care services and the potential need for adaptations to avoid potential readmission as well as a delayed discharge.

What Is A Delayed Discharge?

Officially known as a Delayed Transfer of Care (DTOC), a delayed discharge is where a person currently in hospital is medically well enough to leave but the care package necessary to do so is not available.

Remaining in hospital more than is necessary is due to a wide and complex range of reasons, and defining when someone is “well enough to leave” can be more complex than it outwardly appears.

NHS England defines someone as being ready to be transferred into care when a multidisciplinary team agrees that they are ready, a clinical decision has been made to that effect and it is safe for them to transfer, whether this means to return home with appropriate care or into a residential setting.

This is to rule out situations where someone may be physically well enough to leave but for a range of other reasons cannot.

It often happens if there is a lack of intermediate care, delayed processes within the NHS, care services or both, although it can sometimes happen if adaptations are required to a home, or based on the choices of the person or their family if they are not ready to return.

Why Are Delayed Discharges Harmful?

The discourse surrounding DTOCs is unhelpfully focused on beds and not the people in them, which can obfuscate the harm that can be caused by a delayed discharge on overall recovery.

Staying in a hospital can sometimes lead to a difficult period of transition known as post-hospital syndrome which is in part caused by the stress of the recovery process but also due to the hospital environment.

People who spend time in hospital notice that their typical sleep patterns are disrupted, can sometimes feel discomfort or pain due to testing, may be required to be nil by mouth for a time, and any necessary procedures and can move with less certainty due to a period of inactivity.

All of these environmental aspects can lead to readmission and they are exacerbated if someone is not discharged from hospital at the right time. 

If a person is discharged too early it can lead to readmission, but the same is true if they are discharged too late.

How Can Home Care Help?

An effective, comprehensive treatment plan that includes not only long-term home care but also support during the vitally important intermediate period is essential for ensuring that people are confident enough to return home and avoid the risk of readmissions in the future through effective care planning.