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Discharge and preventing readmission

We often visit people who live in care homes.Sometimes we are told that it may have been possible for the person to remain in their own home if more help and support had been available to them.We were keen to hear from people what services made it more likely that someone would be able to return to their own home.  We were told about various things that are often helpful.

We heard in one area that staff felt that older people were disadvantaged compared to younger adults because there is no intensive home treatment team available for older people.Some areas also told us that there was a maximum amount of home care support that someone would receive before the local authority would consider the care package too expensive.

In another area we heard that the local authority social work department will provide home helps or carers up to four times a day but no more than that limit.

However, we did hear from some staff that even when a full care package is in place it cannot provide the level of support to counteract the social isolation and loneliness which precipitates many admissions.We heard from people that befrienders, as well as formal carers, were very important particularly for people with dementia, we heard that some day centre support for people, particularly lunch groups and drop in centres are closing and that this limits social support for people.

Night-time was described as a particularly difficult time for people to get the help that they need.Often someone may just need reassurance or checking but at night-time this can be difficult to arrange.Staff described difficulties if someone suffers from "night-time wandering".

We heard from staff in different areas that the traditional style day hospital had previously been viewed as a valuable resource for people and helped to maintain people in their own homes for as long as possible though many of these had closed or were facing closure.

The benefits of new technology have been well promoted recently and staff are now more likely to give consideration to the use of technology in enabling someone to return home. In one area we heard about a delay in getting some telecare aids such as active mats, buzzers and SMART technology

Some of our visitors were surprised that nursing staff in many of the wards we visited had themselves not visited the care homes that people often move on to.Some staff did though have regular contact and where this was happening we were told that care home placements were usually successful and met the needs of the individual.

Throughout the country we heard about a lack of specialist care home provision, usually for people with dementia who have associated challenging behaviours.We were told that often people would move on to NHS continuing care facilities when this would not have been necessary it there had been specialist local care home provision.