Information & advice

Being in hospital can be a difficult time both for you and those close to you. You may be admitted for planned treatment or unexpectedly‚ perhaps after a fall.

It can help you feel more confident if you know what to expect while in hospital and what support can be arranged when you are ready to be discharged.

Our information guide covers:

• understanding the steps that lead up to planned and emergency admissions to hospital‚
• the quality of care you should expect while in hospital
• what should happen when it is time for you to leave hospital

You can download our free information guide from the top right corner of this screen.

Index

• Arranging a hospital appointment
• Tests and treatment as a day patient
• Emergency admission to hospital
• Care in hospital
• Safe environment
• Food and nutrition
• Dignity and respect
• Consent and right to refuse treatment
• Travel to hospital
• Hospital discharge
• Who should arrange care services for you?
• Assessing your carer’s needs
• Intermediate care
• Drawing up a care plan
• Benefits while in hospital
• Deciding who should pay for your care
• Arranging help if you have fewer care needs
• Leaving hospital – practical points
• Reviewing your care plan
• Problems and complaints
• Useful organisations
• What should I do now?

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Arranging a hospital appointment

If you and your GP agree you should see a specialist‚ the new ‘Choose and Book’ scheme means you can choose where you go‚ either locally or at another location in England. Your GP should explain the choices available to you. You will then be given a unique reference number and password so you can book the appointment later by phone or online.

Asking these questions may help you make a decision:

• Do I know someone who has been treated there?
• How quickly can I be seen?
• How easy is it to get there by public transport or car?
• Would the location and visiting times be convenient for visitors?
• Is there adequate‚ affordable car parking?

By December 2008 you should wait no more than 18 weeks from the time your GP refers you to the start of your treatment.

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If your GP is considering a referral‚ ask about ‘Choose and Book’ and request a copy of Choosing your hospital‚ an NHS booklet designed to help you decide. It gives details of at least four local hospitals with information from their ‘annual health check’‚ such as waiting times and how patients rated each hospital. See ‘Choose and Book’ for more information.

At your out-patient appointment‚ ask the specialist how different treatments might affect you in the days and weeks afterwards. This will help you understand what to expect and plan for.

The following information guide may be useful:

• Your health services

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Tests and treatment as a day patient

Some tests and treatment are offered on a day patient basis‚ including scans‚ bladder‚ bowel or digestive system tests‚ and operations to remove cataracts. However‚ there may be things you must or must not do in the 24 hours before and afterwards. You may need someone with you‚ at least for the first night.

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Hospitals usually provide an information pack‚ so check this will arrive in plenty of time to make arrangements.

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Emergency admission to hospital

If you have a fall or suspected heart attack‚ you will be taken to a hospital A&E department. Once you have been assessed you may be:

• treated but not admitted if immediate support can be provided at home. You may then be offered intermediate care services
• moved to a Medical Admissions Unit (MAU) for your condition to be monitored or tests completed before treatment is decided
• admitted to a medical or surgical ward.

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If you live alone and will be in hospital for some time‚ ask someone to check your house is secure and the fridge clear.

If you‚ or a family member‚ have had several falls recently‚ ask A&E staff or your GP about intermediate care services.

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Care in hospital

Hospitals in England must meet standards covering not only the quality of medical care but also hospital food‚ the safety and cleanliness of hospital premises‚ and how well privacy and dignity are respected.

Government reports and patient surveys indicate that improvements could be made in the care of older people in hospital.

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To find out how well each hospital has met the standards‚ look at the ‘annual health check’ on the Healthcare Commission website or see ‘Choose and Book’.

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Safe environment

The possibility of contracting MRSA or clostridium difficile while in hospital is a particular concern for older people and their relatives. Hospitals are bound by the Government’s code of practice that lists 11 compulsory duties to prevent and manage these infections. Isolating patients who have an infection and encouraging staff and visitors to wash their hands thoroughly are important ways to stop infection spreading between patients.

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When you see alcohol gel bottles at the entrance to each ward or by patients’ beds‚ use them to wash your hands when you arrive and before you leave.

Look in the Choosing your hospital booklet if you want to find out whether your hospital is managing to reduce MRSA infection rates.

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Food and nutrition

Many older people may be malnourished when admitted to hospital. While there‚ they may have a poor appetite and not be well enough to eat their meals without support. This can significantly affect recovery and was highlighted in an Age Concern campaign called ‘Hungry to be Heard’.

It is important to let staff know if you:

• need help filling in the menu
• find menu choices unsuitable due to allergies‚ cultural or personal preferences
• have difficulty reaching your meal or drink
• find opening a yogurt carton or cutting your food difficult
• prefer smaller meals with between-meal snacks
• have difficulty chewing or swallowing.

As part of an admission assessment‚ you may be weighed on arrival and regularly afterwards. If there are concerns‚ a dietitian may visit you.

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Speak to a doctor or nurse in charge of the ward as soon as possible‚ if you have‚ or know a family member has‚ special dietary needs or preferences.

Also tell them if you have arthritis or visual problems that make it difficult to eat and drink. Read more about our ‘Hungry to be Heard’ campaign.

‘I can’t see very well and often wasn’t sure what I’d ordered to eat. Since I told them‚ someone helps me fill in the menu. The assistant who brings my meal makes sure I can reach it. If I ask her‚ she’ll tell me what I ordered and where different foods are on the plate.’

For more detailed information see our Factsheet:

• Staying healthy in later life

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Dignity and respect

Elimination of mixed-sex general wards has not been achieved by all hospitals and may not be possible in specialist units such as stroke units‚ intensive care or medical admissions units. However‚ if you are treated on a mixed ward‚ staff should strive to ensure your privacy and dignity.

Staff can show dignity and respect in many ways:

• asking you how you would like to be addressed and speaking in a courteous and friendly way
• finding out and ensuring all staff are aware and respond sensitively if you have hearing or visual difficulties or memory problems
• not treating you as ‘invisible’ when your bed is visited on a ward round
• ensuring medical matters are discussed with you out of earshot of other people
• responding promptly to requests for help to go to the toilet then responding promptly when you need help to return to bed
• ensuring curtains round the bed are secure when you are being examined or using a commode.

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If you have any worries about the way you or a relative are being treated‚ raise them with the nurse in charge of the ward. If you prefer you could talk to the hospital Patient Advice and Liaison Service (PALS).

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Consent and right to refuse treatment

You have the right to a clear explanation of any proposed treatment‚ including the risks and benefits‚ before you agree to it. If treatment involves an anaesthetic you will be asked to sign a consent form.

Even if others consider it unwise‚ you have the right to refuse treatment as long as you understand what that might mean.

If you lack the capacity to consent to proposed treatment because you are unconscious or have a brain disorder like dementia‚ a doctor must act in your best interests. It is not possible for a relative to give consent on your behalf.

If you lack the mental capacity to make a decision about serious medical treatment and have no family or friends to support you or represent your views‚ medical staff are required to appoint an Independent Mental Capacity Advocate (IMCA) to represent your interests.

You can‚ as a result of the Mental Capacity Act‚ make an ‘advance decision’ indicating your wishes about treatments should you lose mental capacity in the future.

You can set up a personal welfare Lasting Power of Attorney (LPA) to give someone authority to make health and welfare decisions on your behalf if you lose capacity in the future.

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Contact the Office of the Public Guardian for further information about arrangements you can make for decisions to be made on your behalf.

For more detailed information see our Information Sheet and/or Factsheet:

• Advance Decisions‚ Advance Statements and Living Wills
• Arranging for others to make decisions about your finances or welfare

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Travel to hospital

If your health condition or disability makes using public transport or getting in and out of a car difficult‚ you may be eligible for non-emergency NHS transport. There may also be a voluntary driver scheme that can help if you cannot use public transport.

If you receive the Pension Credit Guarantee Credit you can get help with reasonable travel costs‚ including parking. Ask for details before your appointment. Otherwise‚ you may be eligible for help towards travel costs through the NHS low-income scheme.

Some hospital car parks offer special rates for regular users. Some cancer charities can help if travel costs for frequent treatment cause financial difficulties.

If you are visiting a close relative or close friend you may get help from the Social Fund. There is no other Government scheme to help hospital visitors.

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Ask your GP practice about non-emergency NHS transport. Your local Age Concern may know if there is a voluntary driver scheme.

Contact the out-patient clinic if you receive Pension Credit Guarantee Credit and ask how to claim your travel costs. If you need to take a taxi‚ check this is acceptable with them beforehand.

Call the Help with Health Costs helpline and ask for an application form if you think the low-income scheme could help you.

Ask at the department you attend or contact the hospital Patient Advice and Liaison Service to find out about hospital parking concessions.

For more detailed information see our Information Sheet and/or Factsheet:

• Help with health costs
• The Social Fund and other sources of financial help

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Hospital discharge

All hospitals should be able to provide information on their discharge process. Most importantly‚ you should be told who is responsible. A hospital social worker and possibly a discharge coordination team are likely to be involved.

If you are having planned treatment‚ you may be invited for a pre-admission check. This provides an ideal opportunity to identify the support you are likely to need later. If you do not have such a check or you are admitted in an emergency‚ planning for your discharge should begin as soon as possible after admission.

Arrangements will vary depending on your needs and whether you can go home or need to consider alternative accommodation.

See section 'Arranging help if you have fewer care needs' if you are only likely to need help for a week or two‚ perhaps with shopping and light housework‚ and visits from a district nurse or your GP.

You are entitled to an assessment to decide what help you may need on leaving hospital‚ regardless of who will be paying for this help.

The key steps are:

• deciding if the NHS should remain responsible for your care
• assessing what help you might need when you leave
• assessing your carer’s needs (if you have one)
• deciding whether intermediate care would help
• drawing up a care plan
• deciding who will be paying for your care
• leaving hospital – practical points
• reviewing your care plan.

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Mrs Patterson‚ an active 83 year old‚ tripped and fell while out shopping…

‘When I fell an ambulance was called and I was taken to the A&E department at the local hospital. It turned out I’d broken my hip. They kept me in and I had a hip replacement operation. The operation went well and I was out of bed the next day and taking a few steps.

‘After a week‚ I moved to the community hospital for intermediate care. The occupational therapist wanted to see if I could move from walking with crutches to using a frame and then a stick‚ in three weeks. The care assistants took me home to see how I’d cope‚ particularly with the stairs as my flat’s on the first floor. I reached my targets and was ready to go home at the end of the three weeks.

‘I was so bewildered after my fall‚ I can’t believe I’ve come so far. I felt really low but the staff have given me so much confidence. They’ve given me a trolley on wheels so I can move things safely. I wouldn’t carry hot drinks myself otherwise and I’ve no one to carry things for me. I’ve got a commode in my bedroom for night time. I don’t want to stumble on my way to the bathroom.’

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Who should arrange care services for you?

If you have significant health needs‚ the process described in the National Framework for NHS continuing healthcare should be followed to decide if the NHS should remain responsible for your care. This should take place before you are discharged and ideally involve social services. The outcome of the decision should be recorded in your notes. If the NHS remains responsible‚ your Primary Care Trust must provide a care package it thinks appropriate‚ usually in either a care home or your own home.

If‚ based on your health needs‚ it is agreed that the National Framework process should not be followed‚ you should still have an assessment – regardless of your financial situation – to establish your ongoing need for support. This allows a care plan to be drawn up and confirmation of whether your social services department has a responsibility to arrange services for you. Staff should always listen to your views about your situation and the help you might need. If you are likely to need special equipment or adaptations to your home‚ an occupational therapist may want to visit.

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Make sure the person responsible for your discharge has considered whether the NHS should remain responsible for your care. They should be able to provide information about the National Framework process or contact the Age Concern Information Line.

For more detailed information see our Factsheet(s):

• Disability and ageing: your rights to social services
• Local authority assessment for community care services
• Disability equipment and how to get it

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Assessing your carer’s needs

Patients and carers may have different needs‚ so as well as contributing (with your permission) to your assessment‚ your carer can ask for a separate assessment. Hospital staff should not take any support from your carer for granted.

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Contact Carers UK for more information.

For more detailed information see our Information Sheet:

• Carer's Allowance (CA)

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Intermediate care

Intermediate care is a time-limited programme that may include health and social care support. It can last for up to six weeks and will have clear goals it is hoped you can achieve in an agreed time.

Intermediate care may be offered following a stay in hospital to help you to return home or to find out if you can manage at home. It can also be offered if providing prompt support could mean avoiding admission to hospital. You can receive intermediate care at home‚ in a day hospital‚ community hospital or care home.

Services provided are free in England but do not have to be provided for free in Wales.

Rehabilitation usually starts in hospital and also involves staff such as physiotherapists‚ occupational therapists or speech therapists. It can continue for weeks or even months after you leave.

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Speak to the person responsible for your discharge from A&E or in-patient care if you think you or a relative may benefit from this type of support.

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Drawing up a care plan

To decide what help you could receive‚ your needs are compared with your local authority’s eligibility criteria. A care plan is then proposed. If you prefer to return home‚ options that might allow you to do this should be considered before it is suggested you move to a care home. The options might be adapting your home‚ moving to a more manageable property‚ or moving to sheltered housing or extra care sheltered housing.

Your care plan may include one or more of the following services – known as community care services – from your local authority:

• help with personal care – getting up and dressed‚ bathing
• meals on wheels – either hot or frozen
• aids and adaptations to your home – to make basic tasks easier and safer
• community alarm – so you can call for help if you need it
• a place at a day centre – offering activities‚ a hot meal and chance to socialise
• a place in a care home.

If you are unable to arrange services yourself‚ social services should make arrangements for you. If you are going home‚ they can arrange services for you or offer ‘direct payments’ so you can arrange services yourself.

If you disagree with your proposed care plan‚ discuss your concerns with the person responsible for your discharge. If you remain unhappy‚ you can make a complaint.

If you cannot contribute to your assessment because of a stroke or dementia‚ your local authority and the NHS have to make an informed ‘best interests’ decision. Involving your carers as much as possible will help them discover what your wishes would be. If you do not have family who can represent your interests and a change of accommodation is proposed‚ an Independent Mental Capacity Advocate should be appointed to represent your interests.

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Contact your local authority social services for information about their services for older people.

Download further guides about Help with care in your own home or How to find a care home.

Contact the Elderly Accommodation Counsel for further information on housing options for older people.

For more detailed information see our Factsheet(s):

• Finding help at home
• Local authority assessment for community care services

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Benefits while in hospital

Your state pension does not change no matter how long you are in hospital but Attendance Allowance (AA) and Disability Living Allowance (DLA) are suspended after 28 days. Pension Credit‚ Housing Benefit and Council Tax Benefit can be affected if you lose AA or DLA. Carer’s Allowance can be affected if the person you care for goes into hospital or you go into hospital. You will need to let the office that pays your benefits know when you go into hospital and when you are discharged.

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Deciding who should pay for your care

Local authorities can charge for services they provide. There is one system for charging for care in your own home and a different system if you need care in a care home. You may be able to get financial assistance from the local authority depending on the savings and income that you have.

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Ask your local authority social services department for details of its charging policies.

For more detailed information see our Factsheet(s):

• Disability and ageing: your rights to social services
• Local authority assessment for community care services

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Arranging help if you have fewer care needs

You may only need help with domestic tasks for a few weeks while you recover‚ particularly if you live alone. The person responsible for your discharge should identify what you need and help you make arrangements.

Organisations such as Age Concern may offer ‘home from hospital’ support. Sometimes they have a representative who visits or is based in the hospital. Often they can help get your home ready for your return and help with non-medical tasks such as shopping and light housework. Domestic care agencies can also help with domestic tasks.

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Your local Age Concern should have details of ‘home from hospital’ support. Contact the Commission for Social Care Inspection (CSCI) for details of domestic care agencies.

For more detailed information see our Factsheet:

• Finding help at home

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Leaving hospital – practical points

If the hospital believes you are ready for discharge‚ it is entitled to discharge you. However‚ you should not be sent home until the agreed support is in place – services ready to start‚ adaptations made to your home and equipment delivered. Your carers should be given adequate notice of the date and time of your discharge.

The person responsible for your discharge should ensure:

• you have clothes to go home in and front-door keys
• you have enough money for your short-term needs
• there is someone collecting you‚ or a taxi or hospital transport booked
• if your medicines have been changed‚ you and/or your carer understand the changes and you have a supply of medicines to take home
• you and/or your carer have been shown how to use any new equipment or aids and can use them confidently
• if you need continence products‚ a supply has been arranged
• your GP has been informed of your discharge and any help you need from a district nurse has been arranged
• you know who to contact later about your care plan or services.

If you are moving to a care home‚ the home should have the date and time of your discharge and a copy of your care plan. If the care home of your choice does not have a vacancy‚ you may be asked to make a temporary move if this will not be too disruptive for you.

For more detailed information see our Factsheet:

• Hospital discharge arrangements

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Reviewing your care plan

If you go home and social services have arranged support for you‚ they must check it is adequate within 14 days of you arriving home. If you live alone‚ this should ideally be a few days after you go home. After this‚ your care plan should be reviewed after an agreed time or at least annually.

If at any time you find the services are not suitable or inadequate‚ you should contact social services and ask for a care review.

For more detailed information see our Factsheet:

• Hospital discharge arrangements

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Problems and complaints

If you have problems during your discharge‚ always raise them at the time. If this does not resolve them‚ you can make a formal complaint. The NHS and social services each have complaints procedures. There is also a procedure for dealing with complaints that involve both the NHS and social services.

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For details of the NHS complaints procedure contact the hospital Patient Advice and Liaison Service and for social service complaints procedure contact your local authority.

For more detailed information see our Factsheet(s):

• Hospital discharge arrangements
• NHS services

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Useful organisations

Age Concern

Find details of your nearest local Age Concern on our site‚ or call the Age Concern Information Line on (free call) 0800 00 99 66.

Age Concern Northern Ireland
Tel: 028 9024 5729 (national call rate)

Scottish Helpline for older people (Age Concern Scotland)
Tel: 0845 125 9732 (lo-call rate)

Age Concern Cymru
Tel: 029 2043 1555

Carers UK

General help and advice for all carers.
Tel: 0808 808 7777 (free call)

Choose and Book

NHS Choices launched in summer 2007‚ provides information and encourages you to comment on your treatment as an NHS patient. You can compare hospitals to help you choose which hospital you would like to go to and book an out-patient appointment online.

You can:

• find a GP or dentist
• find out more about illnesses and treatments
• find guides‚ tips and video clips on health and lifestyle choices.

The website Choose and Book may also be useful.


Commission for Social Care Inspection (CSCI)

Responsible for the registration and inspection of social care services in England. You can read online or request copies of their inspection reports on domestic care agencies and care homes.
Helpline: 0845 015 0120 (lo-call rate)

Care and Social Services Inspectorate for Wales

Has similar responsibilities to CSCI (see above) in Wales.
Tel: 01443 848450

Elderly Accommodation Counsel

Maintains a nationwide database of housing for older people and provides guidance to help enquirers choose suitable accommodation.
Advice line: 020 7820 1343

Healthcare Commission

Independent health ‘watchdog’ responsible for checking quality and awarding an ‘annual health check’ to NHS and independent healthcare organisations.
Helpline: 0845 601 3012 (lo-call rate)

Help with Health Costs helpline

Contact to request an application form (HC1) if you think you might be eligible for help with travel costs through the NHS low-income scheme. Information is available in different formats.
Helpline: 0845 850 11 66 (lo-call rate)

NHS Direct

Call or look on the website if you want information on a particular medical condition or contact details for support groups that can help. Also call if you want a list of local GPs or details of your local PALS.
Tel: 0845 4647 (lo-call rate)

Patient Advice and Liaison Service (PALS)

Provides information‚ advice and support to users of health services. In Wales‚ NHS Complaints Advocacy Services have this role. To find your nearest PALS contact NHS Direct:
Tel: 0845 4647 (lo-call rate)

Office of the Public Guardian

Provides information on the Mental Capacity Act 2005‚ including two Making decisions booklets – one for individuals and another for families and carers. You can download a copy from their website or copies are available from customer services while stocks last.
Tel: 0845 330 2900 (lo-call rate)

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What should I do now?

Find details of your nearest local Age Concern on our site‚ or call the Age Concern Information Line (free call) on 0800 00 99 66.

The following Age Concern information guides may also be useful:

• Help with care in your own home (ACIG01)
• How to find a care home (ACIG02)
• Putting your affairs in order (ACIG15)
• Your health services (ACIG04)

You can order free paper copies of all our information guides through our online Information Guide order form.

We also publish books covering many of the above issues. Browse our online bookshop.