Going to hospital

Going into hospital is a worrying time. If you are a carer you have the added worry of thinking about what will happen to the person you care for if you go into hospital.

If the person you care for goes into hospital you may intend to carry on providing some care whilst they are in hospital. Far from giving you a break from caring, there are often extra responsibilities you have to take on.

However, it is worth bearing in mind that hospital visiting can be tiring and it may be good to have  a break from visiting. Some carers use the hospital admission as  a break from caring so that they can recharge their batteries.

Whichever situation you are in, it’s not an easy time and you are likely to have important decisions to make.

NICE has produced national guidance about hospital admission and discharge requiring coordinated health and social care services. However you may find that your experience is differentIf you have any concerns about a hospital admission or discharge, speak to the Hospital Advice and Complaints Team at the relevant NHS Trust:

What will happen to the person I care for if I have to go into hospital?
The person I care for is in hospital. Should I tell the staff that I am a carer?
What support can I get as a carer?
Help with car parking costs
The person I care for has dementia and I am really worried about how being in hospital will affect them
A sudden hospital admission
What will happen after the person I care for is discharged
The person I care for is in hospital as a result of their mental health
What is discharge to assess?
Our Hospital Liaison Workers

What will happen to the person I care for if I have to go into hospital?

Admission to hospital will usually either be in a planned way or as an emergency. If you know you are going to be admitted and there is no-one else who can take over the care and support of the person you care for, contact your local council’s duty desk.  They will discuss options open to you and can set up alternative care arrangements.  If you are admitted as an emergency, tell someone in the hospital and they will contact the local council on your behalf. If you have a Carers Emergency card, this will inform ambulance or hospital staff that you are a carer. They can alert the 24 hour Emergency Call Centre.

The person I care for is in hospital. Should I tell the staff that I am a carer? 

It’s a good idea to tell staff that you are a carer and you could ask to fill in a ‘Carers Conversation’ form. This records the care you are able or not able to provide on the ward. As long as the person you care for consents you should be included in any meetings and planning about their care and discharge. If you have a Lasting Power of Attorney (Health and Welfare), you will need to make ward staff aware of this and they will need to see the original.

The Carers Charter covers all hospitals in Bristol and South Gloucestershire and was developed in consultation with carers. It sets out what you can expect from them as a carer.

What other support can I get as a carer?

Carers Support Centre has a team of Hospital Carer Liaison Workers who work at the Bristol Royal Infirmary (BRI), Southmead Hospital and South Bristol Community Hospital. They provide one-to-one support for carers whilst they, or the person they care for, are in hospital.

Help with car parking costs 

Southmead Hospital and the BRI both have schemes to help carers who are providing care to someone in hospital.

Southmead Hospital runs the Carers Support Scheme. If you spend more than 3 hours, several times a week, supporting a patient on the wards you may be entitled to free parking and access to the staff restaurant.

BRI runs the Carers Information Scheme. Carers providing support on the wards to patients can get discounted parking and a carers sticker to identify you. To find out more about these schemes ask on the ward or talk to a Carers Support Centre hospital liaison worker.

The person I care for has dementia and I am really worried about how being in hospital will affect them

Ask to complete an ‘All About me’ form which provides staff with information about the person you care for. It helps the ward to understand the person you care for. For example it could include information about what they like to be called and their normal routines.

If it would help you, ask if you can speak to a member of the Hospital Dementia Team. Both trusts have dementia teams. These are small teams with medical, nursing and training leads, which support patients with dementia and their families.

At the BRI and South Bristol Community Hospital (SBCH), contact Rachel Price, lead dementia practitioner, on 0117 34 21708 or email Dementia.Team@uhbristol.nhs.uk. At Southmead Hospital, please contact Dementiacare@nbt.nhs.uk or call 0117 414 9066.

If the person you care for is agitated, ask about a twiddle muff. These are knitted/ crocheted muffs and blankets, which provide a source of visual, tactile and sensory stimulation.

Both trusts fully support John’s Campaign. Carers of people with dementia have the choice to stay in hospital with the person they care for. If you would like to stay on the ward, please let the ward staff know and they should be happy to accommodate you.

A visual identification system the Forget-Me-Not is used in the hospital to make all staff aware that someone has a diagnosis of dementia, or has a current cognitive impairment. These will be displayed on the patient board, by the bedside and in patient notes.

There are memory cafes in each of the Bristol hospitals. These provide an opportunity for those with dementia, their family and/ or carers to socialise and speak with someone. Speak to ward staff or contact our Carers Liaison Service to find out more.

A sudden hospital admission

If someone has been perfectly well, and then suddenly admitted to hospital you are likely to be in shock and will probably be experiencing all kinds of emotions and feelings . You may be facing important decisions and may be considering taking on this caring role for the first time and don’t know what to expect. Try to remember that it is your choice whether or not to take on a caring role. It’s important to think about the amount of support you are able to provide and what help you might need.  It is important for you to consider how your caring role is likely to affect your life and wellbeing and the impact it will have on  your own life, work and relationships.

There may be lots of practical things to sort out, like money and work as well as dealing with the emotional side of things. It’s important to think about your own health and to get support for yourself. You may need to talk to your employer, get benefits advice, get some practical support and find someone you can talk to about your own feelings.

What will happen after the person I care for is discharged? 

Once the person you care for is considered fit to be discharged, it will either be decided that they need additional support or they are well enough to return home without any extra support. Carers should be included in this decision. You should not be expected to take on additional caring or become a carer for the first time. You will need to be clear and realistic about what you can and can’t do.

Discharge from hospital can happen in a number of ways and it varies based on the local authority and sometimes the ward.

The person I care for is in hospital as a result of their mental health

If the person you care for is a voluntary patient they are free to leave if they want to. However, if they are detained under the Mental Health Act there are special rules that apply to the discharge procedure. There should be a meeting to assess the support they are going to need in a community setting. They may be referred to the Community Mental Health Team (CMHT). If they are under 18 they may be referred to the Child and Adolescents Mental health service (CAMHS). If they are over 65 they may be referred to the older person Community Mental Health Team (CMHT).

If the person you care for has long-term complex needs they may come under something called the Care Programme Approach (CPA). As a carer you should be involved in this as long as the person that you care for consents. The CPA means that the person should have regular review of their care plan and the support of a Care Programme coordinator amongst other things. Find out more about the CPA on Minds website.

Discharge under the Mental Health Act can be complicated. If you feel you need extra support and information contact a specialist mental health charity like Mind or Rethink.

Find out more about discharge under the Mental Health Act on the Rethink website and on the Mind website.

What is discharge to assess?

Bristol and South Gloucestershire residents are being helped to return home sooner from hospital under a new initiative called ‘discharge to assess’. It works on the principle that once a patient is considered to be medically stable, it is important for them to leave hospital as soon as possible to avoid infection or further illness. Previously there may have been a period of delay whilst the patient is assessed on the ward to find out what ongoing support should be in place. This new process can be daunting for patients and their carers and it is imperative that they are informed and consulted throughout the process from admission to discharge. Now, the patient can be discharged to one of three settings where any necessary assessment will take place.

Broadly speaking it should work in the following ways, however, it will depend on the individual situation and where you live so you may find your experience is different. If you are concerned about the discharge and arrangements make this known to ward staff and try to contact a Carers Support Centre carer liaison worker for support.

  1. Home with support

The patient who has the essentials they need at home and is safe to be alone between visits is likely to be discharged home. If they are going to need some ongoing social care, home-based rehabilitation or medical treatment, this should be assessed and put in place. This could include a package of care at home and  home visits from physiotherapists and occupational therapists.

  1. Rehabilitation facility

A patient who require rehabilitation, re-ablement or recovery services will be discharged to a community bedded facility where they will receive more therapeutic care for up to 6 six weeks. Most patients are discharged home from here. If the person is discharged from the BRI they may be sent to South Bristol Community Hospital or another centre for rehabilitation. At Southmead hospital there is a specialist unit where the person may go for rehabilitation.

  1. Care home

A patient who is considered to require a more supportive environment will be discharged to a health funded bed in a care home. From there, health and social care professionals will assess to identify the most appropriate setting to meet their needs in the longer term.