HOSPITAL STAFF

A hospital occupational therapist talking to a patient in a wheelchair

Discharge

In the first scene, you will again meet Amelia, Jeff's disability support worker, and Jenny, a nurse, followed by a discharge planning meeting involving Jeff, Lynne, his sister, Amelia and Lorraine, a social worker.

In this scene are Cassandra, Frank, her father, Johnno, her disability support worker, and Lorraine, the social worker. They are joined by Anita, from the NDIS, and Eddy, an NDIS support coordinator.

Applying the Framework

Diagram showing the four framework processes, with the Knowing segment highlighted.

Knowing that

People with intellectual disabilities have the right to make decisions and exercise choice and control over their daily lives.
No one has the right to make decisions on behalf of a person with intellectual disability unless a guardian has been appointed, which will be for specific decisions.
It is appropriate to consider the supports a person needs to make a decision, rather than whether or not they have the capacity to make a decision.
At discharge, it may not be possible for family or disability support staff to meet the person's needs in the short and/or long term.
Disability accommodation, such as a group home, is staffed by disability support workers, who do not have medical or health training.
People who have NDIS funding can have it reviewed if there has been a change in their support needs.

Informing

tell the patient and others the specific decision that needs to be made
ensure all options are canvassed
ask the patient about their will and preferences
ask informal support people, such as family and disability support workers, about the type and amount of support they can provide
find out what organisations, such as supported accommodation providers and NDIS representatives, can do and possible constraints
tell the patient and those supporting them what the hospital can provide up to and post-discharge

Diagram showing the four framework processes, with the Collaborating segment highlighted.

Collaborating is when you

correct misunderstandings
reconsider options in the face of new information
ensure everyone involved in discharge planning contributes to the discussion
follow formal processes that may be required

Supporting

The patient with intellectual disability will be supported in the decision making when you and others involved in decisions

listen and act upon their preferences and concerns
postpone decisions until all options have been explored
engage advocates if it looks like the patient's preferences are being overridden
ensure the decision reflects the person’s will and preferences and minimises any risks

Summary

Quality hospital care requires that discharge planning involves the patient with disability, family and/ or disability support workers and their managers, and others who can provide information, and support the patient. Good discharge planning also relies on a hospital staff member, such as a social worker or discharge nurse, to coordinate the process and ensure the human rights of people with intellectual disabilities to make decisions and exercise choice and control.

You can find further information in Resources about support for decision making, the NDIS and hospitals, and advocacy for people with intellectual disabilities.

Activities

These are provided to support your learning, individually or in a group. You can write responses in the workbook sections available for download.

In your workbook, write your responses to the following:

Describe Lorraine's role in planning discharge for both Jeff and Cassandra.
Describe Jeff's preferences and wishes.
Explain if and how Lorraine, Lynne and Amelia demonstrated respect for Jeff's preferences.
Describe Cassandra's preferences and will and how she expressed them.
Explain why a final decision was postponed for Cassandra.
Identify any other options that might have been canvassed for Cassandra that would ensure her rehabilitation continued in an environment that met her preferences.

In groups of 4-5 participants, prepare for a role-play of a discharge meeting for a woman, Hanna, aged 52 years, who communicates with speech, but is often very shy in a group, especially if there are people she doesn't know. She has spent 5 days in hospital recovering from a fractured right arm (she is right handed). Before being in hospital, she had lived in a group home with 2 other women. Her house supervisor has indicated that at this time, she can't return to this home, at least not until she regains full function of her arm and hand. The meeting has been called by someone in the hospital to decide if Hanna can be discharged and to where. To prepare for the role play:

Identify who should attend the meeting.
List the information that would be needed by each person at the meeting.
Identify who would provide this information.
Explain how support would be provided to Hanna to ensure her preference and will is expressed and considered in the decision.
Following your role-play, each participant describes the application of each of Knowing, Informing, Collaborating and Supporting to the scenario. This step can also be completed by having one member of the group act as an observer, who then describes how each element of the framework was applied.

FINAL THOUGHTS >