Discharging vulnerable patients safely
Complaints about premature or uncoordinated discharges from hospital to home or other care settings have consistently been in the top three complaints to Patient Ombudsman since the office opened.
In 2021/22, 11% of complaints about hospitals were about discharges and care transitions.
In addition, 19% of the complaints about home and community care were about long-term care home placement, including placements planned in hospitals. Patients and caregivers frequently report concerns about poor communication, inconsistent information, pressure to rush important decisions and coercive messages.
For many years, hospitals have been experiencing capacity pressures and challenges with managing the discharge of patients who require ongoing care but no longer require acute hospital care.
Discharge planning for patients who require long-term care and cannot go home safely to wait for a bed can pose a particular challenge given the long waitlists for long-term care homes. It is widely accepted that acute care hospitals are not optimal settings for elderly patients waiting for long-term care. In addition to reducing acute care capacity, patients waiting for long-term care are at risk for hospital-acquired infections and hospitals are not equipped to meet the social, recreational and physical activity needs of frail seniors.
The COVID-19 pandemic has added to these challenges. Human resource shortages, outbreaks and higher demand have increased pressures on hospitals to discharge patients as quickly as possible. At the same time, the massive outbreaks and high rates of resident death in long-term care homes early in the pandemic have decreased confidence in the long-term care home system for many and have made families more cautious about their selection of homes.
The pandemic has also highlighted the important role families and friends play in supporting patients in hospitals and residents in long-term care. As highlighted in Patient Ombudsman’s special reports on COVID-19, restrictions on visitation and the resulting isolation and lack of stimulation have had an impact on the health and well-being of patients and residents. Family and friends of patients and residents have shared the trauma of not being present to support loved ones or lost opportunities to say goodbye before a loved one dies. The ability to visit is a key consideration in families’ selection of care settings, including long-term care homes.
To ensure safe, fair and successful discharges and care transitions for patients, Patient Ombudsman suggest the following considerations:
- Engage patients, substitute decision-makers and family members early and often in discharge planning discussions. Ensure they have the opportunity to express their views and preferences, and that their views and preferences are considered and documented.
- Provide clear and consistent information, including in writing, to help inform decisions and ensure the information provided is aligned with provincial legislation, regulation and policy.
- Give patients and substitute decision-makers a reasonable time frame to make decisions.
- Ensure processes are flexible and consider patients’ individual needs and circumstances, including their social, cultural, and religious needs and any needs for special accommodation, such as the need for interpreter services.
- Recognize the stress and life-changing nature of long-term care home placement decisions and ensure that patients and their families are treated with courtesy and respect.
- Ensure patients and substitute decision-makers know who to contact if they have questions or disagree with the proposed options or decisions.