Home care

Hospital discharge when a parent cannot go back home: what next?

October 8, 20267 min read

A patient in a wheelchair in a hospital corridor

A hospital in Poland discharges a patient when hospital treatment ends, even if the person has not regained independence. The family then has five realistic routes: care at home supported by a nurse funded by the National Health Fund (NFZ) and a carer, a care and treatment facility (ZOL), a rehabilitation ward, a short stay in a private care home, or palliative care. Most of this can be arranged while still on the ward, so it is worth starting the conversation with the attending doctor a few days before discharge, not on the day.

In short

A hospital will not keep a patient who no longer needs hospital treatment, but it must tell the family the discharge date in advance and issue referrals, prescriptions and orders for supplies.
The referral to a care and treatment facility and to home nursing care is issued by a doctor while the patient is still in hospital. In both cases the criterion is 40 points or fewer on the Barthel scale.
A place straight away is most often offered by a private care home. The average price in Poland is PLN 5,665 a month.

When a hospital can discharge a patient

Under the Polish Act on Medical Activity, discharge takes place when the patient's condition no longer requires services in that hospital. This is a medical criterion, not a care one. An internal medicine or neurology ward is not a place to wait while care is being organised, even if the patient is bedridden and lives alone.

The hospital does have obligations, though. If the patient is unable to make conscious decisions, a close relative has to be notified in advance of the date and time of the planned discharge. On discharge the patient receives a discharge summary with recommendations, prescriptions, orders for medical supplies and the necessary referrals. Medical transport is available when the patient's condition rules out ordinary travel, and it is ordered by the doctor.

What to arrange while still on the ward

After discharge, each of these matters has to be handled from scratch through the local clinic, which usually means more days of delay. On the ward everything is at hand.

Talk to the attending doctor about the prognosis and ask for a Barthel scale assessment. The result determines what care your relative is entitled to.
Ask about the hospital social worker. If the hospital employs one, they will help you contact the social welfare centre and point out facilities nearby.
Ask for a referral to a care and treatment facility or to a rehabilitation ward, if the doctor sees grounds for it.
Ask for a referral to long-term home nursing care, if the patient is going home.
Collect the orders for medical supplies: incontinence pads, a pressure-relieving mattress, a wheelchair or a walker.
Ask a nurse to show you the basics: repositioning, feeding, bed hygiene and giving medicines.

Five routes after discharge

Going home with help

A person who scores between 0 and 40 points on the Barthel scale is entitled to free long-term home nursing care. A nurse comes at least four times a week, carries out procedures and teaches the family how to provide care. She does not replace a carer, though, because a visit usually lasts several dozen minutes.

Day-to-day help can be provided by the municipality in the form of care services. The application is submitted at the social welfare centre, and the fee depends on income. A third option is a private carer, paid for entirely by the family. Before the patient comes back, it is also worth preparing the flat, especially the bed, the bathroom and the way to the toilet, which we cover in the article how to prepare a flat for a senior.

A care and treatment facility

A ZOL is for people who no longer need a hospital but do need round-the-clock nursing care. Treatment is funded by the NFZ, and the patient pays for board and lodging no more than 70 per cent of their income. The problem is time, because the wait for a place is often weeks or months. We describe the whole procedure in how to get a referral to a ZOL.

Inpatient rehabilitation

After a stroke, a fracture or orthopaedic surgery, a patient can go straight from hospital to a rehabilitation ward. The doctor decides, and the referral has to be obtained before discharge. It is a solution for a few weeks that gives the family time to prepare further care.

A short stay in a private care home

A private care home admits on the basis of a contract, without a referral or an official decision, often within a few days. Many families treat it as a bridge: their relative has care and rehabilitation in place while the family calmly waits for a ZOL place, finishes renovating the bathroom or looks for a carer. According to the Planeta Seniora report, the average price of a stay is PLN 5,665 a month, and half of all facilities fall between PLN 5,000 and 6,300. If the discharge date is already known, describe the situation in our form and we will send you suggestions of facilities in your area.

Palliative care

With an advanced, incurable illness, the doctor can refer the patient to a home or inpatient hospice. A home hospice means regular visits from a doctor and a nurse and free loan of equipment, and the care is funded by the NFZ.

Does the family have to take the patient home

This question comes up very often and the answer has two parts. Nobody can force an adult child to care for a parent personally in their own flat. At the same time, the hospital does not have to wait indefinitely. The Act provides that if nobody collects a person unable to live independently by the set date, the hospital notifies the municipality and arranges transport at its expense, and the municipality can claim the cost back from the people who owe maintenance. From the date set by the hospital's director, the patient or those same people can be charged the cost of the further stay.

That is why avoiding contact with the hospital is the worst strategy. If you are unable to provide care, tell the doctor and the social worker so directly and ask for help in finding a place. At the same time, report the case to the social welfare centre, which can grant care services or start the procedure for a referral to a social welfare home. You can prepare a finished letter in our free DPS referral application generator.

How to choose in practice

Start with two questions: how many hours a day your relative needs help, and whether that need will shrink or grow. If the doctor expects improvement within a few weeks, rehabilitation or a short stay is usually enough. If care is to be permanent and round the clock, compare long-term solutions straight away, which we cover in care at home or a care home.

Frequently asked questions

Can a hospital discharge a bedridden person who has no care?

Yes, if their condition does not require further hospital treatment. The hospital should, however, tell the family the date in advance, issue referrals and orders and, if necessary, order medical transport.

Who issues the referral to a ZOL after a hospital stay?

The attending doctor on the ward or the primary care doctor. A nursing interview and a medical certificate with the Barthel scale assessment are attached to the referral.

How long does it take to find a care home place after hospital?

In a private care home usually from one to a few days, because a contract and medical records are enough. The wait for a place in a ZOL or a social welfare home is typically weeks or months.

Does the NFZ provide care at home after discharge?

Yes, to a limited extent. With a score of 0-40 points on the Barthel scale, the patient is entitled to long-term home nursing care, meaning visits from a nurse at least four times a week. It is not round-the-clock care.