The rapid discharge of patients from hospital to care homes during the height of the COVID-19 crisis, without taking into account the needs of the whole care system, has had tragic consequences, ADASS has said.
In its Coronavirus Survey, ADASS found that a significant proportion of people leaving hospital last month did not receive an assessment of their needs as part of ‘discharge to access’.
Only 65% of directors of adult social services reported that every individual in their local authority area is receiving an assessment of their needs, while just 11% of directors believe that every patient was discharged to the right place for them to best meet their needs.
ADASS warned that if there is a shortfall in assessment and reablement and people are discharged to care homes rapidly, this then limits choice and reduces the ability to help people home.
Equally, people may be in homes they wouldn’t have chosen or might have chosen to go home, it said.
ADASS president James Bullion said: “A focus on rapid discharge when there were shortages of PPE, questions about testing and the ability to isolate people in social care meant that some people ended up in the wrong
place to meet their needs and with insufficient community support or reablement to help them get home. We must change our approach.
“We have to think of hospitals, community health services, social care, family carers, housing and communities as one wide set of supports that help us to live the lives we want to lead as well as keep us alive.”
ADASS explained that an absence of testing for people leaving hospital during the period of rapid discharge could have accelerated the spread of coronavirus in care settings.
Over half (54%) of directors either disagreed or strongly disagreed that people were tested on discharge from hospital during the period of rapid discharge.
Around a quarter (23%) thought that more than half of care home COVID-19 infections were attributable to rapid hospital discharge.
Meanwhile, 27% of respondents reported that people were discharged to providers that didn’t have sufficient PPE and 24% to settings where they could not isolate safely.
“Given what we know about the spread of COVID-19 in care home settings in particular, it is obviously greatly concerning that untested individuals were potentially discharged to settings that had insufficient PPE and also to where suspected COVID-19 positive individual could not isolate safely,” said ADASS.
Bullion said the government must now ensure that social care is “never again” left exposed to a pandemic.
“This starts by protecting those of us with care and support needs from the current and subsequent waves of COVID-19 and extends to ensuring social care is at the centre of all future emergency planning and preparation.
“Whilst the wider population may be moving out of the coronavirus peak, COVID-19 will be with older and disabled people for a very long time. Easing the lockdown is about more than opening doors it is about unlocking people’s lives – restoring care and support, assessing needs, preparing for the inevitable surge in demand for care and enabling us all to live our lives again.
“Learning the lessons from the COVID-19 pandemic, the Government must seize the opportunity to reform and reset social care as part of the wider post COVID-19 recovery.”
Home care and live-in care providers have previously warned that 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.
Not only is this a commercial issue for domiciliary care providers, but it potentially undermines the choice and independence of those being discharged from hospital.
When contacted by HCI, a spokesperson for the Local Government Association said councils follow a “Home First policy” i.e. people should be able to return home if at all possible.
“The NHS guidance for discharge from hospital also specifies this, however there may of course be some variation in how some acute Trusts follow this guidance,” the spokesperson said.
HCI has yet to receive a comment from NHS England and NHS Providers on the matter.