Talking to someone recently discharged from hospital
Please be aware - this information is for healthcare professionals
You have a unique perspective when you are providing care in someone’s home. You are well-placed to understand their care needs, especially after a potentially critical turning point such as discharge from hospital or a hospice.
Asking the patient some questions about their circumstances may help you understand their needs so you can take active steps to accommodate them.
Use your expertise and judgment on what’s appropriate in order to develop a rapport with the patient. These points should be used as a guide, not a checklist.
1. Their hospital experience
It’s helpful to give the patient a chance to talk about their experience in hospital or the hospice, and any concerns or anxieties they have about coming home. It may also be helpful to find out the reasons for their hospital or hospice admission, so you can learn more about the person’s understanding of their condition.
2. Advance care plan
The patient may have left hospital with an advance care plan in place. This should include what someone wants from their care at the end of their life and what should happen if they become unable to make decisions. It can be written in a document that is sometimes called an advance statement or, in Scotland, an anticipatory care plan.
The patient’s wishes, what they feel able to do, and practical limitations need to be considered. It’s important to reassure the patient that plans can always be changed, and that this is OK.
3. Changes in abilities
If the admission has been a turning point, the person may be experiencing a decline in their condition, which may make everyday tasks more difficult. This may have a negative emotional impact on the patient. If you think they may benefit from further emotional or psychological support, contact the district nurse, specialist nurse or GP.
You may be the first person to notice that they need adaptations to their home or new equipment. In this case, you may need to contact the district nurse, specialist nurse or GP.
4. Symptom control
You should identify any pain or symptoms that now require different management or better control. Remember that the care you are providing should be person-centred. This means focusing on your patient’s needs as an individual and giving them the opportunity to make informed decisions about their care and treatment.
Some people may be anxious about their symptoms. So remember to listen without interruption, and respond in an honest and open fashion. Take time to understand their needs and work in a way that supports them.
5. Emergency contacts
There should be a plan in place to manage symptoms, such as pain, that require immediate attention, especially at night or weekends. This may help to avoid unnecessary trips to hospital, and minimise distress.
Everyone on the multidisciplinary care team, including your patient and any family or friends involved in their care, should know about this plan.
This plan should outline who to contact and how to reach them. If there is a paper care plan in the house, make sure that any contact numbers listed in it are current and up to date. It may help to add a brief outline of role responsibility alongside the numbers.
Most areas in the UK have access to a call system often referred to as a Lifeline. This is a button that can be pressed to summon help in an emergency. You may be able to assist with completing the paperwork to order one. Try to encourage the person to wear the button or carry it with them. Some people prefer to use a mobile phone to carry around – check that it is charged when you visit.
6. Support at home
Talking about this may help you understand who is part of the patient’s support network and may help you establish what informal care arrangements the person has in place. This can change over time.
Some people with a terminal illness may worry about becoming a burden on their loved ones, so this question also gives the patient a chance to express any concerns that they might have. You can reassure them that help is available, and offer to help them find out more.
7. Support for family and friends
Any carers or families should also be considered when providing person-centred, holistic care at the end of someone’s life. Talking about this may lead to constructive conversations with family or friends about their needs and preferences.
It’s really important that family and friends know that there is information available to support them. You can signpost them to our information about being there for someone with a terminal illness.
8. Night care
Getting a good night’s sleep can be a problem for someone with a terminal illness, and their carers. Marie Curie offers a free overnight nursing service in some areas. For more, see our information about referrals and availability.
9. Choosing where to be cared for
National Institute for Health and Care Excellence (NICE) guidelines state that everyone living with a terminal illness should have the opportunity to discuss and develop a personalised care plan for current and future support and treatment.
This plan should include information such as where they want to spend their last days and hours. Everyone in the multidisciplinary team has a role in helping a person with a terminal illness to explore their options.
Find out if the patient has an advance care plan. If not, talk to their GP or district nurse to see if they can help the patient create one.
You can also refer people to our information on choosing where to be cared for. These wishes may change over time, so it’s important to reassure the person that it’s OK if they change their mind later.
10. Allowing the patient to talk
Remember to take the time to understand the person’s needs, provide a listening ear and take active steps to understand and meet their care needs.
During your conversation, the person may raise several worries or concerns, so it might be a good idea to ask them what they would like you to address first. This will help you identify their priorities and what’s important to them at this time.
It’s not unusual for patients and their families to become upset or cry during these conversations. This is not a reason to stop, as they may be keen to sort out issues that are worrying them. In a situation like this, you could acknowledge their distress, and ask if they wish to stop the conversation or take a break. For example, ‘I can see this is upsetting for you, would you like to stop or take a break?’ This allows the patient to control the conversation and let you know what they would like the next steps to be.
It is important that you make the person aware that, although your conversation is confidential, you may need to share any concerns with other professionals if safeguarding is an apparent issue.
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