Discharge to access supporting people back to independence

Discharge to assess (D2A) is the national hospital discharge policy that requires people to be discharged from hospital within 24 hours of a decision that they have been made medically better following a crisis.
Assessment of ongoing care needs is carried out in home environments not in a hospital bed. This process forms part of the Embrace programme’s aim to help reduce the time people spend in acute hospitals and ensure people are supported to live independently wherever possible.

Sam Buckingham, senior occupational therapist at Royal Cornwall Hospitals NHS Trust explains how assessing a person in their home environment, helps health and care services build a better picture about their care needs, following a stay in hospital.

Richard* had been admitted to hospital several times due to a long term heart condition, he lacked confidence to look after himself after his most recent hospital admission and was convinced he needed a long term care plan when he returned home. Having seen Richard in his home environment, Sam saw his potential for independence.

Sam worked with the short term enablement and planning service (STEPs) to increase Richard’s awareness of his actual rather than perceived care needs, encouraging him to wash, dress and prepare meals without assistance. Slowly they were able to build on Richard’s activity tolerance and motivation by going for a walk outside. This in turn helped with his anxiety over his heart condition and low mood.

Richard was able to express that he felt lonely and isolated, so Sam organised the befriending service at Volunteer Cornwall to take him on accompanied walks, to build his confidence. She also provided equipment to make day to day tasks easier for him.

Sam said: “Once Richard was discharged and I assessed him at home, I was able to see his potential. He didn’t believe in his capabilities to look after himself and I have worked with STEPs to help him feel more reassured about living independently. He wanted to have a long term care plan, but with some support and adjustments in his day to day life, I have been able to help Richard through his anxieties about his heart condition and living alone.”

Sam added “I feel that the discharge to assess approach fits really well with people like Richard, with therapy assessments taking place outside of a hospital setting. If you see a person in their home environment you can look at the whole picture and understand what they may struggle with. As we have seen with Richard, mental health and well-being plays as much part as physical health in the path to recovery and reablement.”

*name has been changed to protect privacy.

Added on 11/02/2021, in News - Embrace Care