Are older people being sent home from hospital too early?

When you or your loved one go to hospital, you expect to go in with a problem, ailment or condition and leave in a much better state.

This is the hope of every patient, regardless of their age. So why are older people being sent home early?

Many families who readmit elderly loved ones claim that the hospital sent them home too early just a few days earlier.  

It’s been suggested that hospital staff are put under pressure to free up beds for other patients.

One qualitative study looked to analyse the interactions concerning hospital discharge of frail and elderly patients – particularly from the perspective of patients and the medical staff.

A nurse in one ward said, “There is a very high inflow of patients all the time – so you have to discharge patients to make beds available. As soon as you feel care can be given out of hospital, you must facilitate it.”

It’s often elderly patients who suffer the most as many of them need more time to recover than younger people, and are being discharged earlier than necessary.

Many older people get admitted to hospital with complicated health issues, often with a combination of a number of conditions as well as dementia.

But determining the best time for discharge is a difficult task – both for the patient and the health care team

There are many people that take part in the decision to send someone home – usually led by a doctor, and supported by social workers, nurses, nurses’ aides and other health professionals.

It’s also important to note that while most discharged patients are on the road to recovery, they aren’t always fully healed when a decision is made to release them.

One of the challenges is that many elderly patients did not participate in the medical decision-making regarding their discharge from hospital.

Many of them said that they needed to – and wanted to – stay longer in hospital than they were allowed to.

One patient explained, “I think it’s totally wrong to send me home. I’ve been here for two days and now I’m going home again. But I’m not better than I was when I came here.”

Generally, most communications regarding discharge are between the doctor and the nurse, after which the patient was simply informed about the decision.

The staff was highly focused on patients getting rapidly discharged, which made it difficult to fulfil the complex needs of these patients.

However, sometimes a patient needs to be readmitted to the hospital, and it’s simply no one’s fault.

The study concluded that elderly patients require hospital care from time-to-time, and that these patients have been increasing in number.

So for that, it is important that hospital care is adapted so that elderly patients are provided with good and dignified care.

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  1. I think the pressure is on for Nursing Staff to free up beds. The demand is higher than the bed availability also older people being admitted have more complex needs requiring more time. We need to change what we are doing, adapt what we have previously done. One concern I hear raised all the time is an older person is admitted to hospital, the full assessment and plan of action/treatment is delayed. This person might be lying there for 2 days before they actually feel they are being completely assessed. Now this may not be the case, but it appears to be to the person and their partner/spouse/carer. The communication is not flowing and all the planning in the world needs to include both parties from the start. The health team will gain more information and save more time by talking directly to the person/s. An action plan needs to swing into place immediately. The longer an older person lays there, the more chance of deterioration occurring . Also be mindful of the carer, family member coming in to support that person or waiting on news. An example is an older friend of mine was told the rehabilitation team were coming in the following morning, so please be here at 730am. She arrived to sit with her husband (diabetic/dementia) from 730am that morning till 530pm that night. No one appeared. She enquired to staff and asked to speak to the Unit Manager. The Unit Manager was not available, later discovering she was interviewing for staff vacancies. My friends husband was becoming more agitated as he had to remain in bed until assessed by the physiotherapy and rehabilitation team. My friend was also very concerned and distressed to the point I arrived to visit and take her for a cup of tea. In the staff cafeteria she broke down and was beside herself with concerns for the management of her husbands care (feeling no one was listening to her), physical/mental exhaustion and no idea what was going on. I spotted a Social Worker I knew out of the corner of my eye and grabbed the poor man finishing his lunch break ! This is just one experience. What got me was my friends experience rekindled my own 7 yrs ago. I was the one sitting here in tears 7 yrs ago with no idea of what was happening with my own Mother. There is a lot of great work being done to improve the care of older people in Hospital . I have been involved with the Victorian Care of Older People Clinical Network as a Consumer Representative. Last year I had the opportunity of presenting at their annual forum at Alfred Health in Melbourne – “Innovations into preventing Harm of Older People in Hospital”. I have also been involved with “Best Care of Older People in Hospital ”

    . https://www2.health.vic.gov.au/hospitals-and-health-services/patient-care/older-people/resources/implementation/case-study-consumer

    https://m.youtube.com/watch?v=8Q1rOoJSoaU

    Another concern is in the race to discharge an older person from Hospital are we ensuring they have the support and care at home ? Discharged on a Friday night, are the services in place as of then? Discharge back to a Residential Care Facility, what time of night, who is there on shift (qualifications to do observations and follow- up care if a person deteriorates and knowing what to look for )?

    I recall my father being discharged on a Friday night to be found 5 days later collapsed, hypothermic (cold house) and very unwell by a community worker.

    I also recall having the conversation or disagreement with the Discharge Planner when she could not see the problem with my father (having dementia) being discharged by Taxi into the care of his sister (also with dementia waiting on placement into care) . I was at work at the time and had been told my father would be discharged the following day, so had made plans accordingly. Then I received a phone call a day early at 10am to say come and pick up your fathe now !

    Now these are just a few of the experiences and in no way am I sharing these to knock or criticise anybody. I think it is through patient/carer experience that we can stop and take note and work together on how we can come up with some suggested positive solutions to improve on what is currently happening.

    I see our future as needing more community reliance to support and be the ears and eyes for older people.
    “We do it best when we all work together “.

  2. This has been a long standing issue. While working as an Assessor with the Aged Care Assessment Service, I was frequently called to provide an assessment for an inpatient. Often on arrival I would find the patient to still have an IV in situ, or be waiting to receive a blood transfusion that day, and therefore deemed “unstable”. The impetus is to free up hospital beds. Many of the ACAT’s are auspiced by one of the health networks, thus creating a conflict of interest. In saying that, dependent on the reason for requesting a hospital admission, it is expected (and often better for the resident) to be treated in their residential home. A decrease in the availability of GPs to make home visits compounds the whole issue.

  3. I agree with all of Maria’s comments as I have been through something similar…..Communication is appalling and no-one listens. No regard given to carer…patient sent from hospital when deemed able and sent to country town to await an assessment by social worker. Nothing in place to support patient’s need for stoma care and staff not trained to cope with this….just appalling….patient hardly able to walk as had been left in hospital for 6 weeks because not enough staff there to take time to get them up and going, this also in country situation..with too little staff to attend to getting patient up and moving…..9 weeks before patient was moved to rehab and start life again. Horrendous experience!

  4. My Mum was 94 admitted to hospital on 22/5/2021 with pneumonia.
    A few days later, she collapsed in hospital and they called us in. She was extremely ill, and she was on oxygen. but survive. The very next day a doctor called me to say they were sending her home the next day. I was shocked and said she nearly died yesterday. The doctor said oh no she’s fine, we’ve taken her off the oxygen, she’s sitting up chatting to people. I asked them to keep her over the weekend, but they refused. . To cut it short, They sent her home, it was clear she hadn’t recovered. Mum was extremely ill. She died on the toilet the next morning g n the early hours.

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