Introduction

Hospital discharge is a common experience for many individuals in the course of their lifetime. The circumstances can vary widely: from the child with complex disabilities returning to the family home to the older person of 90 years old returning home after a fall; from the individual with mental health problems discharged after a lengthy hospital stay to the individual with acquired brain injury following a road traffic accident adjusting to a new way of living. Despite its everyday occurrence, the challenges that arise around the transition from hospital to community are some of the most intransigent in health and social welfare. This chapter will seek to explore why this is the case and to map out what can be done to improve the transition back to the community for the range of individuals caught up in this experience.

Exploring the evidence base

An early study conducted by Neill and Williams (1992) detailed a common picture that has not yet been displaced. The focus was on the discharge of older people (aged 75 plus) to home care in four local authorities and included interviews with older people and carers and with home carers at two and 12 weeks post discharge. Most of the hospital admissions had been unplanned and the majority of the older people lived alone or with another older person. One in five received few visitors while in hospital and half the individuals did not have relatives to assist with the return home. The result, as illustrated by vignettes from the interviews, included individuals returning home to decaying food and unheated rooms. Delays in transport were common, with patients waiting from early morning until evening. Hospital car drivers did not usually see people indoors and some patients were left unable to negotiate steps to their front door.

Only for 8% of the individuals had the referral for home care been made prior to the day of discharge and for a further 18% on the day itself.