Patients may live or be discharged to a wide variety of social care settings and understanding these is important for any foundation doctor. This can help conversations with patients and their families and also give you an idea around any services the patient may already have in place on admission.

If you're looking to understand the multidisciplinary team members roles including reviewing funding and eligibility. have a read of our article on Discharge Planning

Independent Living/ Sheltered Housing
These are often flat or bungalows designed for older people to live independently whilst giving them an added layer of safety. Individuals have a tenancy on their own private flat and are responsible for all their living costs. They differ slightly from a private house as they often have a call system to summon emergency help if they needed but staff do not provide direct, on-site support. A member of staff may check in daily with a phone call or through an intercom system. Some schemes have day rooms with social activities for residents, although these are resident-led. There is often a minimum age and application process for these.

Supported Living
Supported living/ assisted living is the next step in from independent living. These schemes again consist of independent flats where individuals are responsible for their own tenancy and living costs, but there is support available. A team of support staff assist residents and the level of support can vary. Usually, help is provided with domestic tasks such as shopping and laundry, whilst some schemes include communal meals. All flats are self-contained with social areas and organised events for residents to socialise when wanted. There is usually a member of staff on-site 24hrs a day with an emergency call bell provided in each flat. These services aren’t regulated by the Care Quality Commission.

There may also be the provision for providing personal care, which may be delivered via an in house or external service. Often there is a maximum limit provided by in house carers (generally 21 hours per week) which external agencies can then extend. Any personal care provided is regulated by the Care Quality Commission.

Patients may use the terms Supported Living/Assisted Living/ Independent Living/ Sheltered Housing interchangeably therefore it is important to clarify exactly what is provided for them, as this may affect discharge planning.

Care Home
Patients often use this term and as professionals, it can be difficult to establish exactly what they mean.

This umbrella term includes many different forms of care but the main distinction to make is that of Residential home versus a Nursing home. Care homes can be run by private companies, charities or sometimes by councils.

Practical Tip: Patients admitted from Care Homes will often have a MAR (medication administration record) chart used by staff. Asking for a copy of this can assist you in establishing recent compliance with medication and also in checking you haven’t missed anything on your initial clerking! Care home staff can also give you a good idea of what the person is normally like and provide a good collateral history.

Residential Home
These schemes provide individuals with their own room in a live-in, home-style accommodation with staff on hand 24/7 to provide support. Some have carers in house and others require patients to have their own external care agency to assist with personal care such a washing, dressing, toileting and medication. They also provide a variety of social activities, with many employing a dedicated activities manager to oversee these. Residential homes are often tailored towards certain individuals needs, for example, specialising in mental illness or elderly care.

Nursing Home
Nursing homes are very similar to residential homes with the added provision of having a qualified nurse on-site at all times. This allows residents to benefit from someone to oversee and monitor care plan, provide and administer treatment such as injections. This also allows for the care of patients with more complex needs. Like residential homes, nursing homes often provide a wide range of social activities and are also often targeted towards specific audiences such as neurological disorders or learning disabilities.

Dual-Registered Homes
These are care homes that provide both residential and nursing care. These are often larger homes with multiple floors that split residents. For example, the ground floor may be for residential care whilst the first floor is for nursing care. The benefit of these homes for individuals is that there is an opportunity for the same home to continue their care should their care needs change. This means less stress for the individual and makes things easier for the family. To move to increased care they still need all the same assessments and paperwork.

Family Home/Own Home with Care Package
Patients may be discharged to their own homes or a family home with a package of care. This package could be for a short length of time or for the foreseeable future. This is covered more in the article on Discharge Planning.

Community Hospital
Patients may also have the option of going to a community hospital for rehab or further treatment. Community hospitals can provide basic nursing care but most do not have doctors on-site and therefore patients need to be transferred back should any emergencies occur.

Funding
Care costs money, whether this is through a package of care, independent living or a care home.

NHS Continuation Health Care Funding:
If the patient qualifies for NHS continuation healthcare funding, all their healthcare needs can be paid for in full by the NHS – it is NOT means-tested. There are however strict criteria to meet for this to apply which are explained more fully in our article on Discharge Planning. It is aimed at patients who need the care to address significant physical or mental health issues.

Personal Health Budgets:
This can be used to give the individual more choice in providers, however, this cannot be used to pay for a care home. It usually cannot be used to top up to pay for more expensive care. 

Means-Tested:
If patients are not eligible for NHS continuing healthcare, social workers should direct them to their local authority, who will, in turn, assess them and may grant them a means-tested care budget.

Private Funding:
There is the option of funding care costs privately. This can be very expensive however some patients may choose this option to have the care they desire.

References:
Written by Dr L Pennock (FY1)
Reviewed by Dr Corrinne Quah (Consultant Geriatrician)