European Doctors: How do you deal with patients who need social care awaiting discharge from hospital?

3 comments

1. Not a doctor, _but_, in cases where continued hospitalisation isn’t necessary, it is arranged for the patients to have visits from municipal caregivers, _hjemmeplejen_(Literally: “The Home Carer,”) or to have visits from home-nurses, also arranged from _hjemmeplejen_. _Hjemmeplejen_ in Denmark is as much part of the first line of healthcare professionals and nurses, generally, but sadly, nurses and caregivers are among the lowest paid public employees, employees of any kind actually, in Denmark.

   If it is thought that a patient would need round-the-clock help, they may be offered to move into a care-home, either elder-care or social-care, which is staffed by professionals as well; nurses, pedagogues, caregivers, and so-on, and also run municipally.

   Hospitals are run regionally.

2. Not a doctor but from the experience of my grandparents I can tell that there is an extensive network of mobile services that come to people’s homes and support them. My grandma has a nurse who is coming twice a day to dress/undress and shower her, a different service delving a meal for lunch, medication is delivered, hairdresser comes to her home, a cleaning service once per week.

   Much of this is paid for my the social care insurance but patients still have to make some co-payments.

   Hospitals employ people who help patients arranging stuff for the time after their release but everything is VERY bureaucractic and the staff at the hospital only does the minimum. The families still have to care for many things. My mum invests a lot of time and almost every week there is something to rearrange. I cannot imagine how people without children manage to do this.

3. Great question! Doctor here. The kind of – let’s call it „after-care“ – you are talking about is actually super important and while sadly it sometimes slips under the table atleast in my experience we try organise the care after discharge out of the hospital as best as possible. Problem is that – atleast here in Germany – this means an insane amount of bureaucracy and sometimes this means that „as best as possible/feasible“ means you can only assist a patients family with getting these processes started. Where I work we are lucky enough that we have a department that is primarily tasked with trying to figure this stuff out which is lifting a huge load of work from doctors, patients and their families. Getting the correct forms and filling them out correctly if it is most likely your first and only time doing so must be a nightmare. Now I know most of the common forms now, but they can still be somewhat vague or confusing and one cross in the wrong box can derail any effort to get in-home care etc.

   Usually the key question is „who is paying for it“ or in other words is there an insurance or a recognised level of need with the social care system that allocates enough money to pay for the care. Otherwise the private costs can get really high really fast.

   Also I would like to point out that in general I view it to be extremely problematic that alot of this essentially „social care management“ gets dumped on us working in healthcare. There are far more sensible tasks nurses and doctors can do than filling out dozens of pages of mundane paperwork so that a patient gets their rehab. Ultimately the system is designed to make it hard for patients to access the care they need outside of the hospital.