Hidden Costs of Hospital Discharge

Most people who leave hospital can return to where they normally live and will get better without needing new or additional support. About 15 in every 100 people who no longer need hospital treatment need other forms of new support, such as community rehabilitation services or care at home. The number is even higher for older people and those who were treated for more serious illnesses/injury (groups we will focus on for this research).

Before the Covid-19 pandemic, the British Red Cross explored people’s experience of returning home from hospital without social care support. They found that people can feel anxious and that both them and their family sometimes struggle to cope well. Since Covid-19, there have been greater pressures on public services.

Whilst family often support someone who has left hospital, no recent work has been done to understand family experiences, and how caring affects them emotionally, physically and financially. There is also little understanding of the impact on the older person themselves. Some costs to social care teams at the council may also be unplanned or unexpected at the point of discharge from hospital. Social care leaders report that people are leaving hospital with increasingly complex needs, and councils are struggling with the cost of supporting them.

We want to identify and estimate the “hidden costs” associated with hospital discharge, to older people themselves, family members and councils. We will also explore the circumstances in which hidden costs are high and/or potentially avoidable.

We will recruit 40 older people (and their family members) as they leave one of two hospitals in the West Midlands. We will select people who either:

• return to where they normally live (with or without additional formal support), or
• move into a community facility to receive short-term rehabilitation or assessment.

We will interview people twice (at four and 16 weeks after discharge) to understand their experiences and how the older person is being supported. We will audio record interviews and use this for our analysis. We will also speak to health and care professionals to build up a full picture of what is happening, and check council records to get details of social care use.

People with lived experience have informed our research questions and the planned methods. A co-researcher with lived experience will conduct some interviews and help interpret findings. Others with lived experience will join our Advisory Group to provide strategic input.

We will consult relevant stakeholders (including the public, and health and social care professionals) on how research findings should be shared (such as creating resources and giving presentations), to best influence and improve future practice.