In July 2015, Healthwatch published a report about a special inquiry that they have conducted to look at patients’ experiences of being discharged from hospital, both from accident and emergency departments and from hospital wards. Parts of this report deal specifically with the experiences of older people, many of whom are likely to have been living with some degree of frailty. Although the report does identify some areas of good practice, unfortunately it also highlights some wide-ranging problems experienced by older people in these situations. The main problems reported were:
- People experienced delays in their discharge due to lack of coordination between different parts of the health care system and often people’s condition, particularly their mobility, deteriorated whilst they were stuck in hospital waiting for these arrangements to be made.
- People felt that they were left without the services and support that they needed when they were discharged from hospital. This included emotional support as well as physical assistance and many people said they were given no information about where to go for help or how to find the support that they might need in the community.
- Some older people felt that they were stigmatised because of their age or condition and that they were not treated with dignity and respect.
- People did not feel that they were properly involved in decisions about their care or given the information that they needed to be involved in the planning of their ongoing care, treatment or follow-up. This lack of basic information and the inability to be involved in key decisions was a very strong theme in many cases.
- People did not feel that their full needs were considered. They felt that the organisations only dealt with the problem that had brought them in to hospital rather than considering their full range of needs and other things that might be important to them. This included other health needs as well as other important aspects of their lives, particularly the role of older people as carers themselves for spouses or other dependants.
This report therefore highlights an urgent need to treat older people in hospital, and approaching hospital discharge, with greater dignity and respect. Engaged and well-informed professionals need to provide this group of older people with much better information regarding their condition, and support them to make their own personal decisions regarding their future care and support. A holistic approach is needed which empowers individuals to set goals which reflect their full range of needs and to plan how to reach them. They must also be offered any help they might require to identify and access the support they need to reach their goals and to monitor their progress towards them.
In other words, applying the core principles of supported self-care to support older people across the transition from hospital back to the community would address many, if not all, of the problems identified in this report. Supported self-care therefore has the potential to considerably improve the experience of care across the transition from hospital back to the community for all older people, but particularly for older people living with frailty.
What can health and care professionals do to support this self-care?
- Apply the frailty fulcrum and take an holistic approach to understanding and assessing the needs of the individual in hospital and through the discharge and transition of care process;
- Keep older people moving as much as practically possible during their stay in hospital and involve families in encouraging this;
- Promote independence and basic self-care throughout the hospital phase of care, especially if delays occur;
- Improve the effectiveness of communications with individuals and their families;
- Explain to families the importance of minimising delays and encouraging independence even in the hospital setting.