There are so many points within this thread to consider...
Ultimately the Government aim for a Home first approach.....in theory this is good to keep people safe and as independent at home as possible. But in practise it means we are discharging people sooner in their recovery with more extensive equipment needs and therefore increased package of care. Naturally takes longer to get a package of 2 carers to go in than 1 carer once a day.
Some people classed as self-funding don't want to pay towards or for their carers, and can't be made to. Takes time to reach this point...then they go home and can't cope so get readmitted.
They have less time and facilities in hospital for rehabiltation so get referred to community rehab team on discharge. (Lots of therapists in hospitals are now focused on safe discharge planning rather than rehab). They don't have the staff either and for some services you will want a few weeks to get seen, due to the volume of referrals, and will have lost any rehab potential you may have had.
No- one can make anyone accept and undertake any services or rehab despite all ways of trying, some just refuse for varying reasons. Lonely, afraid, don't want to go home, poorly controlled pain etc etc. Unfortunately they will still then be discharged from therapy and ultimately the hospital if a safe way of doing so can be achieved.....and agreed to.
It is quite rightly in a way difficult to get into a care home- last resort almost. There are less and less assessment beds so people do get sent home against the advice of the hospital because it is the social worker and system that have the say so on funding. Some people aren't going to be safe at home even with maximum input, but have generally to be seen to have tried it. Sometimes in this case families do all they can to stop a discharge.
Sometimes families just don't want people home even when the patient wants to and is fully able to do so, and prevent discharge. Funny how so many doorkeys suddenly go missing at point of discharge!
Sometimes you need to push for therapy input on a ward if you think your relative needs it- often wards are not blanket referral so they only see who they are asked to.
Sometimes care on the ward isn't good enough. Talk to the nurse in charge and the PALS team if you need to.
Often the staff are understaffed completely and that is neither right nor fair. This is the reason why they are striking to highlight the safety issues....and yes higher pay will attract more staff across professions which will improve safety and care.
Social carers and care home staff are often treated like rubbish and asked to do so much in so little time, that it isn't possible. They leave, no-one else starts and we end up with lots of people stuck in a hospital bed for no other reason than lack of carers.
Ultimately leads to a queue in a &e ....people in corridors and as has been noted today, shortage of oxygen cylinders across the country as so many extra are needing to be used as patients nit near piped oxygen. Hospitals then hit crisis point....everyone pushed to get everyone out possible in any way.....and the saga continues as not enough rehab or carers. More falls etc and back the people come in classed as a failed discharge.
There has always been winter pressures, but nothing like this. Extra beds are put in, but where do the staff come to cover them, so staff get further stretched. Operations get cancelled then patient deteriorates and gets admitted and so it continues.