Supporting older people through a hospital stay

The Social Care Institute for Excellence’s weekly analysis of research findings behind specific social work practices

A stay in hospital can cause older people a great deal of anxiety. They may have worries about being away from home, particularly if it means leaving someone who depends on them. They may be concerned about how they will cope in the hospital environment.

If they are facing a major operation or have a worrying medical condition their anxiety levels will be especially high. Although some older people will have plenty of support from friends, family and carers, others will not have anyone close to them to rely on and will need support from professional agencies.

If an older person has a planned admission, there are some practical things they can do in advance to prepare for their stay and they may need support to do this. If they have caring responsibilities, for example, they will need help to find someone to take over their responsibilities while they are in hospital. They will also need to find someone to take care of any pets.

If their home is going to be empty they will want to be sure that it will be safe and secure while they are away and that, if their stay is likely to be lengthy, all utility and other bills are paid.

If a hospital stay is unplanned and an older person is admitted in an emergency, following a fall for example, they will need urgent support to put these measures in place. Hospital staff should be able to help initiate this process.

An older person who has never stayed in a hospital or has not stayed in one for some years may not know what to expect. They may be concerned that they will lack privacy and comfort, especially if they are on a mixed ward and surrounded by people of different ages.

If English is not their first language they may fear that they will not be able to communicate with medical staff. Even where language is not a problem, it can be difficult to communicate after some types of medication or if the person is recovering from an operation or feeling very unwell.

Everyone is entitled to be treated with dignity by hospital staff and if an older person feels that they are not being treated with dignity they need to know where they can go for help. The Patient Advice and Liaison Service (PALS) offers a free and confidential hospital-based service where patients can express any concerns they may have about their treatment and also ask for advice and information.

Discharge from hospital can cause further anxiety to older people. They may feel nervous about leaving the safety, security and company that they have become accustomed to on the ward. They may wonder how they will cope when they return home, especially if they are going to have to adapt to reduced mobility and new equipment and adaptations to the home. If they are not fully recovered and will need further care at home they may worry about putting a strain on family and friends.

Alternatively they may have to go into residential care, either on a temporary basis, or, if they are not going to be able to manage on their own in the long term, on a permanent basis. They will need reassurance during the assessment process that they will have the services and support that they need to recover fully at home or to make the transition to residential care.

Recovery may take some months, even for those who can expect to regain a reasonable level of health. An older person may need some encouragement to regain confidence and to gradually return to the life they were leading before going into hospital.

It is difficult to know in advance exactly how much support an individual may need on returning home after hospital, so it is quite possible that their needs may have to be re-assessed at some point after their return. Ongoing support from professionals which ensures that the needs of the person are fully met will ensure that an older person enjoys the best possible outcome after their stay in hospital.

Practitioners’ messages

● The anxiety that most older people feel about a stay in hospital can be reduced by planning in advance to ensure that their home will be safe in their absence, that anyone who depends on them will receive good care and that they have no other worries relating to their time away from home. With emergency admissions it is not possible to plan ahead so agencies should put the support in place as soon as possible.

● Older people should expect their cultural needs to be met during their stay in hospital. This may mean that they need support to ensure that they have an interpreter if necessary, that they have access to a representative of their faith, that any dietary requirements are satisfied and that hospital staff respect cultural needs.

● Older people are entitled to dignity in care. If they are not receiving the best standards of treatment, they need to know how to make their feelings known and understood.

● Leaving hospital can cause further anxiety. Older people need to feel fully involved in the assessment process and to be reassured that they will have the services and support they need when they return home.

● Some older people find it very difficult to readjust to life after hospital and need further support, possibly from a GP or social worker.

Further information

● Helping you through a hospital stay

● Dignity in Care

● Age Concern 

● Help the Aged

Author CORNES Michelle, et al

Title Delayed discharge from hospital: supporting older people to exercise choice

Reference Working with Older People, 12(1), March 2008, pp.16-20

Abstract The government’s reimbursement policy introduced fines for local authorities if a patient could not be discharged from hospital because they were waiting for an assessment or placement. One of the policy’s aims was to allow people to exercise” data P sites.< English three in collected on focuses article The bed. hospital a lying when exercised be can really choice whether investigate They choice. of exercising the by caused delays underpinning issues some explore to policy reimbursement study Health-funded Department findings draw authors care. term longer their regards as choice? genuine>

Author McLEOD Eileen, et al

Title For the sake of their health: older service users’ requirements for social care to facilitate access to social networks following hospital discharge

Reference British Journal of Social Work, 38(1), January 2008, pp.73-90

Abstract Facilitating older service users’ access to social networks following hospital discharge is recognised in social care analysis and policy as critically important. This is because of the associated benefits for restoring physical health and psychological well-being. However, it tends to be a neglected dimension of current social care/intermediate care. This paper draws on a qualitative study of voluntary sector hospital aftercare social rehabilitation projects in five UK localities, which focused on addressing this issue. By examining older service users’ feedback and experiences, the study confirms the health benefits of social care facilitating access to social networks at this crucial juncture. By providing sensitive interpersonal interaction, advocacy and educational assistance, social care workers supported older service users’ re-engagement in a variety of networks. These included friendship, recreational and family groups, healthcare treatment programmes and locally based contacts and organisations. As a result, material, interpersonal and healthcare resources were accessed, which contributed to restoring and sustaining physical health and psychological well-being. The process of such social care also emerged as critical. This included ensuring that objectives reflected service users’ priorities integrating low-level home care offering befriending and challenging the pre-set time frame of intermediate care.

Author HEALTHCARE COMMISSION

Title Caring for dignity: a national report on dignity in care for older people while in hospital

Publisher London: Healthcare Commission, 2007, 64p

Abstract In this national report on dignity in care, the independent watchdog warns NHS trusts of further checks, including unannounced visits, where there are clusters of evidence suggesting a problem at a hospital or on a ward. The commission says that overall it was encouraged by signs that the trusts were generally getting the right systems in place. But there was work to do to offer dignity in care to all of the people all of the time and evidence showed this was not always the case. The national report draws on assessments at 23 NHS hospitals, commission surveys of 80,000 NHS inpatients and nearly 130,000 NHS staff, the commission’s analysis of 10,000 complaints and National Patient Safety Agency information on safety incidents. The report also highlights eight other trusts identified as providing dignity in care.