Lack of care homes blamed for delays in discharge of old people

BMJ 2003; 326 doi: (Published 15 February 2003) Cite this as: BMJ 2003;326:352
  1. Sally Hargreaves
  1. London

    An acute shortage of places in care homes means that the government is likely to miss its target of speeding up the discharge of elderly patients by 2004, the National Audit Office said this week.

    Four thousand elderly people each day remain in hospitals throughout England despite being declared fit to leave, at an estimated cost to the government of £1m ($1.6m; €1.5m) a day. Thirty four per cent of elderly people wait for more than a month to be discharged after being declared fit to leave.

    Previous studies have shown that long delays in hospital mean that elderly patients lose their independence, face considerable stress, and are more likely to acquire infections.

    The National Audit Office says that the single biggest reason for delays—and one that affects 26% of patients—is a lack of capacity in post-hospital care.

    Yet despite government commitment to reverse the current crisis, much more will need to be done. “The government needs to get the building blocks and strategies in place now if it is to deal effectively with the 23% increase in the number of over 65s in institutional care predicted between now and 2020,” said Jeremy Lonsdale, the audit office's director of welfare studies.

    “There is still ongoing closure of care homes, and to reverse this is clearly central to reducing discharge delays,” he added. “More money would obviously help, but the government also needs to work at bringing the independent sector on board to maintain capacity.”

    Although the audit office admitted that there had been real reductions in delays, it made practical recommendations on how further reductions could be achieved. Improvements would be seen if more trusts started planning discharge earlier, the report says.

    A major cause of delays remains the length of time to carry out needs assessments, because of the current shortage of skilled therapists, Mr Lonsdale added.

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