Scenarios

Example 1 - Mrs S

Mrs S has diabetes, mild heart failure and a history of falls, the most recent of which has resulted in a hospital admission, with a fractured pubic ramus which is being treated conservatively with painkillers and full mobilisation. She also has vascular dementia with fairly stable mood but very variable levels of lucidity. This results in her forgetting she has mobility problems so she frequently forgets to use her walking frame and is therefore at high risk of falling. She suffers from constipation which is managed with laxatives; she eats a normal diet and drinks well. She has iron deficiency anaemia and occasionally needs iron infusions as a hospital outpatient.

During her recent hospital admission, Mrs S developed acute confusion and the doctors were not certain whether this was due to an infection or ‘acute delirium’ from the hospital environment. They commenced her on a course of antibiotics following confirmation she has a urine infection. She is losing motor and cognitive functions quickly in hospital and is already having difficulty feeding herself. 

Mrs S lives alone with 4 daily social care visits to help with washing, toileting and eating. She occasionally has night-sits if she is unwell. Her family are determined to take her home, believing that her confusion will settle once she is back in her familiar surroundings. They are happy to pay for extra care until it becomes clear how well she is regaining her independence.

Outcome of '5Q Care Test'

The 5Q Care Test determined that Mrs S's care could be fully met by social services as she did not need nursing. Although she is frail and currently has quite a high level of dependency, the discharge team agreed with the family that her best chance of an optimal recovery would be achieved by returning home with an increased package of social care plus supervision by the GP.

Example 2 - Mr P

 Mr P was deemed medically fit for discharge following an acute chest infection resulting in sepsis. Prior to admission Mr P was living in a residential home as he has a diagnosis of dementia and could no longer live independently. The home is willing to take him back and has kept his room. During Mr P’s stay in hospital his health deteriorated and he is now nursed in bed. He communicates very little now and is unable to express his needs.

Mr P has poor symptom control and requires nurses to titrate his medications to ensure his pain and other symptoms such as nausea are controlled. Nurses on the ward monitor and manage his symptoms regularly throughout the day and night as his symptoms can change rapidly. He is still ‘spiking’ a fever once or twice a day. Mr P's condition is at high risk of further health deterioration such as infection, malnutrition/ dehydration and pressure ulcers developing due to his immobility.

Mr P is compliant with all care interventions and does not display any significant behavioural issues however; in time of increased pain he becomes distressed and requires a lot of reassurance from a member of staff.

Outcome of '5Q Care Test'

The 5Q Care Test determined that although much of Mr P's care could be provided by carers, he required 24 supervision by a registered nurse due to his rapidly changing symptoms which required clinical judgement and responsive actions to avoid him suffering considerable distress. He was therefore discharged to a nursing home bed in the community, funded by the NHS for 28 days during which time he would be assessed for Continuing Health Care eligibility.