OPINION: Live-in care must become the default discharge strategy amid coronavirus outbreak

Peter Seldon H&S BW

By Peter Seldon, CEO of Consultus Care

As the NHS gears up for the burden likely to be placed on already stretched resources by coronavirus, attention is turning once again to the excessive number of elderly patients in hospitals. Not only are they blocking much needed beds, but they are also the primary at risk group. So how can they be protected from exposure to the virus?

The truth is that many of these elderly individuals should not be in hospitals. They could and should be at home – with the right care, they would be happier and healthier. Instead they are either moved to a step down ward or discharged to residential care, leading to poor outcomes and a high risk of rapid readmission. Elderly individuals should not be subject to this revolving door of hospital admissions – it is a model that is both financially and morally flawed.

A tailored live-in care package enables elderly patients to be discharged sooner to their own homes, where they can recover in familiar surroundings and are far less likely to be readmitted. With coronavirus prompting long overdue reconsideration of elderly care, Peter Seldon, CEO Consultus Care, asks “isn’t it time for live-in care to be the default NHS discharge strategy?”

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Long Overdue Action

This current healthcare emergency may be accelerating decision making, but NHS policy makers have known for years that bed blocking by elderly patients in general hospital wards is compromising the NHS. In addition to costing the NHS £640,000 every day, leaving patients in hospital long term reduces their wellbeing, often leading to complications and decline.

It is well known that if elderly people in hospital are able to return to their own homes, their wellbeing is dramatically improved. The live-in care model is well established. With a professional, qualified carer living in a their home 24/7, people can return to familiar surroundings with all the benefits of dedicated, one-to-one care. In addition to home-cooked food, an elderly person can receive visits from friends and relatives at any time of day. They can also be reunited with much-loved pets, which are also proven to improve wellbeing.

Plus, of course, trained carers will spot any potential health issues, such as urinary tract infections, and enable the early interventions that are key to reducing the risk of emergency hospital admission. By sending patients home to a live-in carer, NHS Trusts can not only ensure bed places are released for urgent cases, but with these elderly individuals far less likely to require readmission, there is an ongoing improvement in bed availability.

Flawed Discharge Model

No one is underestimating the huge challenge faced by highly pressurised NHS Discharge Teams. Discharge too early, and an elderly patient could be readmitted – with the NHS Trust incurring a penalty if that occurs within 30 days under the non-payment for performance (NP4P) policy.

Fail to discharge, and the bed blocking crisis escalates. The default position for most NHS Trusts is to discharge an elderly patient to a residential or nursing home, or to simply move them to a step-down ward within the hospital. Arrangements with low-cost residential care homes may appear to be a solution to bed blocking, but far too often elderly patients are released too soon, to under-funded care homes unsuitable for their recovery. The result can be further decline and a rapid readmission to the hospital.

Having undertaken due diligence on a handful of low cost residential care providers, the discharge pathway appears clear. But it isn’t working. It is creating an additional and unnecessary financial burden for the NHS, resulting in a miserable and unacceptable experience for any elderly individuals.

Happy at Home

The best place for the elderly is at home. The outcomes are better and the costs are lower. And with live-in care at home, people are happier. According to research from the Live-in Care Hub, a third of those in residential care and over half (53.3%) in nursing homes never leave their home. This compares to just one in seven (14%) of those using live-in care.

The figures are even more stark when considering the day-to-day activities that people enjoy: 97% of those with live-in care do at least some of the things they value and enjoy, despite many being sick, frail and close to the end of their life. In contrast, one in eight (11%) people living in nursing homes say they don’t do anything they value or enjoy with their time. In addition to being happier, those living in their own homes are safer and less likely to experience the ‘older age’ incidents that are an inevitable part of ageing.

So how can hard-pressed NHS Discharge Teams confidently discharge an elderly individual back to their own home? While there may be a perception that there is simply not enough time to undertake the required due diligence for each individual, regulated live-in care providers will work with patients while they are still in hospital to undertake a rigorous care needs assessment. Comprehensive discharge support includes liaising with health care professionals and meeting the patient and family in hospital. It includes undertaking a risk assessment at an elderly person’s home and then producing a tailored health care plan. With live-in care providers requiring an estimated advance notice for managed live-in care service of no more than three to five working days and no more than 48 hours for live-in nursing, the entire discharge process can be rapidly escalated.

Call for Urgent Action

There are now 12 million people aged 65 or over in the UK – the primary at risk group for coronavirus. Of course, many of the elderly individuals in hospital still require treatment and continuous nursing care, but according to NHS England, there were 149,100 delayed transfers of care in December 2019, which is equivalent to 4,777 hospital beds being used by people who are medically fit to be released.

As the national health crisis escalates, NHS thinking regarding elderly patient discharge has to change fast. This no longer just a case of bed blocking and unnecessary cost; it is about inadequate discharge processes potentially putting lives at risk. Elderly individuals will be safer at home – and the onus is on the NHS to make that happen sooner rather than later.

Tags : Consultus Carecoronavirus
Sarah Clarke

The author Sarah Clarke


  1. I could not agree more Peter. Live-in care is a brilliant option and provides safe one to one care to people at home, likely to a much higher standard than they can receive in a hospital or in residential care.

    NHS really needs to look at the overall picture and work with providers to explore the options for improved outcomes for patients.

    Trudi Scrivener, Ashridge Home Care

  2. I’m a RGN and a RMN with experience in live in nursing. I’m looking to join an agency as a live in nurse.

    1. Dear Debbie

      Would you be kind enough to contact our Head Office 01732 770403 to discuss further.

  3. I have worked for ConsultUs as a live in Carer and am now a registered RMN – I completely agree that live-in care is a gold standard outcome and should be considered for a safe default discharge.

    My experience as a live-in Carer shows me that live-in care is only available to those with funds in hand who can afford to pay for the care they receive from live-in Carer and necessary charges payable to the agency supplying the live-in Carer.

    My experience as an RMN shows me that many folk who could and should be discharged home, often are not, (resulting in bed-blocking issues), due to the fact they cannot afford a privately available discharge card support package. Resources from free services through NHS to support them at home for a safe discharge are currently very limited and rapidly becoming more so. Reliance on family carers is telling on the carers themselves financially, emotionally and mentally and my in my experience does not always lead to a happy outcome.

    It is challenging meeting safe discharge for patients and we endeavour to work with options available at the time to give, where necessary, a bespoke care support package to achieve safe discharge home, or as may be required, to supported accommodation.

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