Fears over HSE plans for speedy discharge of older patients from hospitals to nursing homes

A HSE memo proposes that older patients who are waiting in hospitals for a nursing home place will have to take the first option offered.

Hospital overcrowding would be better addressed by fixing systemic problems rather than focusing on moving older patients to unsuitable nursing homes, the Irish Association of Social Workers (IASW) has said.

The association’s concerns are part of wider fears around changes proposed for the speedier discharge of older patients from hospitals to nursing homes.

A memo issued to hospitals in recent days by HSE chief executive Bernard Gloster proposes that older patients who are waiting in hospitals for a nursing home place will have to take the first option offered, even if the home is in a location miles away from family and friends.

The IASW said it acknowledges the crisis in hospitals, particularly the delayed discharge challenge, whereby patients have finished their treatment but remain in hospitals waiting for a place.

“The problems are systemic and need a co-ordinated and comprehensive response,” said IASW chairman Vivian Geiran.

Not all patients are the same, it is not just a ‘numbers game’ or just about ‘getting bodies out’ of hospitals. 

"Everyone is different and the system must be person-centred.

“Also, there needs to be a wider focus than just on issues facing older people. Social workers have a critical role in all this.”

He said proper rehabilitation facilities and supported community services are vital.

He said that in the absence of such facilities and services, “patients can end up re-presenting to acute hospitals, worse off than they were originally”.

“Rushed discharges may also contribute to worsened safeguarding issues for some.”

RCSI Graduate School of Healthcare Management senior lecturer Éidín Ní Shé fears that the desire to address hospital overcrowding is overtaking other issues.

“The metric of the trolley is being triumphed over the will and preference of older people,” said Dr Ní Shé.

“That is what is happening in this, and it goes against all the evidence that is available on the importance of rehab.”

Irish Nurses and Midwives Organisation general secretary Phil Ní Sheaghdha said large numbers of hospital patients who are aged over 75 and awaiting rehabilitation are not suitable for nursing home care.

“A lot of our members who work in the community are very concerned,” Ms Ní Sheaghdha told RTÉ.

“The community teams are not robust enough, they don’t have enough staff to look at what they’re currently dealing with. They’re trying their best to keep people at home for as long as possible.”

What's your view on this issue?

You can tell us here

The HSE has defended the plans, saying if a transfer to a nursing home after hospital is needed, this should be done quickly.

“Unfortunately, the first choice of any patient moving to nursing home care may not always be available,” said a spokeswoman.

“However, remaining in an acute hospital after a decision to discharge is not appropriate for the patient involved. It also presents serious patient safety risks for patients who may be in an emergency department awaiting admission to an acute hospital.

“This approach represents clinical and operational best practice and all those working in our hospital system are aware of that.”

The Irish Association of Emergency Medicine has welcomed the HSE plans.