“Is it acceptable to discharge a frail elderly person without continuity of care, thereby passing the costs on to the family?”

“My father, who is 84 years old and no longer able to look after himself following a fractured femur, is to be discharged from hospital with just 48 hours’ notice because he has been declared ‘clinically stable’. We cannot look after him on our own at home, and the application for rehabilitation or admission to a care home is still bogged down in the local health authority’s bureaucracy. The doctors have ordered us to arrange for his care at our own expense in a private clinic or to take him back home, otherwise he will be forcibly discharged. Is it legitimate to discharge a frail elderly person without continuity of care and by passing the costs on to the family?”

When the doctors declare his father to be clinically stable, the acute phase of his hospitalisation comes to an end. The National Health Service’s role, however, continues. An 84-year-old man who is no longer able to look after himself following a femur fracture is entitled to care that continues outside the ward. The Essential Levels of Care (LEA), as defined by the Prime Ministerial Decree of 12 January 2017, provide for a ‘supported discharge’ in such cases: the hospital organises this with the Local Health Authority (ASL) before the patient leaves, without passing the responsibility on to the family.

In practice, the ward involves the hospital social worker and requests a multidimensional assessment from the Local Health Authority (ASL). This is carried out by a committee of doctors, nurses and social workers which, depending on the region, is known as the UVM, UVI or UVG. The committee assesses your father’s needs and draws up the Individual Care Plan (PAI), which specifies where his care should continue: at home with integrated home care (ADI), in a rehabilitation ward, in a community hospital or in an accredited residential care home (RSA). The reform of local care services (Ministerial Decree 77 of 2022) has entrusted this process to the Local Operations Centres (COT) of the Local Health Authorities (ASL). Ask the ward whether your father’s case file has reached the COT and what stage it is at.

It is important to be clear about the costs. Rehabilitation following hospitalisation and community hospital care are included in the Essential Levels of Care (LEA) and are covered by the National Health Service. In accredited care homes, the National Health Service pays the healthcare portion, whilst the social care portion is payable by the individual or the local authority, depending on income. A private clinic remains your choice: delays on the part of the Local Health Authority do not oblige you to pay for a place that is the responsibility of the public service.

As you have 48 hours, take immediate action in writing. Write to the head of the ward and the hospital’s medical management, either via certified email (PEC) or by delivering the letter in person with a receipt of registration. Explain that you cannot guarantee the care your father needs at home and that the ASL’s assessment has not yet been finalised. State that you object to his discharge without continuity of care. Request that he remain in hospital, or be transferred to a suitable public facility, until the care plan is ready. Send a copy of the letter to the ASL district responsible for the application. The letter alone will not prevent discharge, but it obliges the hospital and the ASL to reply to you and to set out their decisions in writing.