Care In Hospital

Disabled people suffer much the same illnesses and injuries as the population as a whole. Do not assume that contact with the HPSS is as a result of their disability. Disabled people are just as likely to attend hospital for reasons unconnected with their disability.

Good practice in the organisation of arrangements for hospital appointments, and in particular for admission and discharge, should be followed for all patients.

Communication and co-ordination are critical to effective admission and discharge arrangements and particularly for disabled people with special needs.

In emergency situations, it is important to make rapid assessment of a person's needs and to respond accordingly. People with mental health problems are likely to find the pressures of an Accident and Emergency Department particularly distressing, and it is important to be alert to their possible needs, whilst maintaining confidentiality about their illness. Check for any cards that people may carry relating to mental health advocacy or crisis care, just as you would be alert to SOS indicators for diabetes or epilepsy.

Pre-arranged admissions provide a greater opportunity to ensure that pre-admission procedures identify the particular needs or requirements that a patient is likely to have during their stay in hospital (for example, in respect of communication, medication or mobility). The referring GP should discuss with them their needs and highlight them for the hospital. Patient administration systems should then identify disabled patients so that staff are aware of their needs.

Some patients may bring their own “admission form” with them. For example, the Multiple Sclerosis Society produces an A5 leaflet for people with MS to complete prior to a hospital admission. This includes personal information about their condition. This recognises that the symptoms and effects of MS can vary widely between individuals and is intended to provide hospital staff with an idea of how much assistance the person is likely to require during their time in hospital.

In making arrangements for appointments, or for admission, care should be taken to ensure that communication and information is in the most appropriate medium for the needs of a particular patient. This should include attention to the needs of different ethnic minorities, who may otherwise face additional difficulties. For example, how are the communication needs of a deaf and non-English speaking person addressed?

Admission and the hospital stay

The admission of any patient should follow a standard procedure, and include the completion of an admission form, with a record of any needs of which a person wishes the hospital to be aware.

Many disabled people who are able to live independently at home find they cannot do so in hospital, because facilities are not suitable or accessible. A period as an in-patient can be disabling and could create dependency and loss of confidence. It is particularly important that disabled people are enabled to continue to do things for themselves that they would normally do. For this to be the case:

Some disabled people may find it difficult to cope with being in a public ward, and some separate rooms should be available if preferred. However, these facilities should not be used simply for the convenience of staff or other patients, buts should reflect the genuine wishes or needs of the disabled patient. Anyone in a separate ward should not be left to become isolated, or made to feel they are a nuisance if they use the nurse call buzzer.
Personal aids and equipment (such as spectacles, hearing aids, walking sticks, etc) should be kept in a visible place that is easily accessible to the disabled person, and not tidied away in a drawer or locker without the disabled person's knowledge or agreement.
Disabled patients may wish to bring items of specialist equipment into hospital with them, particularly if they are uncertain that equipment that they are used to using will be available in hospital. Discuss their requirements in advance, and make the necessary arrangements for equipment to be supplied in hospital or for disabled patients to bring their own with them.
Disabled people often need to keep their own routines. For people with physical disabilities, this is likely to include pressure care, bowel and bladder routines, pillow layouts, etc.
Arrangements should be made for carers or advocates to be present when wanted by a disabled person
Bathrooms and toilets must be accessible for disabled people, whether this is for wheelchair users and people with physical disabilities, or for people with limited vision or impaired hearing, etc.
Disabled people must have the same rights to privacy and confidentiality as any other patient.
There needs to be sufficient space for wheelchairs to be used, and chairs and beds need to be of suitable height and design to allow people to transfer from a wheelchair.
Fixed and/or individual portable mini loops should be in place to allow hearing aid users access to the same TV and video facilities as other patients. For people who are deaf or hard of hearing, Teletext subtitles are necessary.
Portable textphones (e.g. Minicoms) should be available in exactly the same way that a telephone trolley is available on the ward. It may not be necessary to have a minicom located on every ward, but one should be available (it might, for example, be shared between two or three wards as needed).

In addition:

A deaf person may need a sign language interpreter or lip-speaker, and it is the Trust's responsibility to arrange this. Reliance on relatives for important consultations, such as the first visit to a consultant, information about diagnosis and treatment, or discharge plans, should be agreed in advance with the patient. Arrangements should be in place for an appropriately qualified sign language interpreter to be available. Inform the deaf person in advance who will interpret for them, and find out if they have a preference for a British Sign Language or Irish Sign Language, male or female interpreter (this can be particularly important in relation to matters of a personal nature)
Sign language interpreters are usually booked for a two hour period. If there are delays in appointments and clinics are running late, this can lead to an interpreter having to leave for their next booking, leaving the deaf person without an interpreter. If there is a deaf person with an interpreter on the appointments list, check how long the interpreter can stay, and if appointments are running late be prepared to move the deaf person up the list to ensure they have use of the interpreter. The Royal National Institute For Deaf People can give details advice on making bookings.

You will need to explain the layout and arrangements of a ward to a blind or partially sighted person:

Let them know who their neighbours are, and show them the way to the day room and other facilities.
Find out if they need further help in orientating themselves, and ensure that all staff on the ward are aware of their needs, such as explaining what and where things are on their meal tray.
A sign at the end of a person's bed may be appropriate to alert staff to the patient's sight loss. They should agree to the wording.

Staff need to know what to expect when a patient is admitted. A blind person would not normally expect their guide dog to stay with them in hospital, for example, but they would expect the dog to be with them if they were attending as an out-patient. Staff should be aware that the dog may need to be taken outside to relieve itself and that it may need a bowl of water, although it should not be fed. Detailed advice on helping visually impaired people in hospital is available from the Royal National Institute of the Blind.

People with learning disabilities may need particular support in hospital, either from their carer, an advocate or from hospital staff. Hospitals can be alarming places, and it helps to explain what is happening in plain language that is easily understood, and friendly.

People with learning disabilities (or indeed any other disability) must not be segregated against their wishes from other patients. Any discriminatory behaviour on the part of other patients should be discouraged by staff.

Extra time may be needed to allow for adequate explanation of any treatment and to provide reassurance to a patient with learning disabilities. It is preferable for patients to be cared for by the same staff whom they come to know and trust, rather than to be confronted with a series of strangers.

Boredom can be a particular problem for people with learning disabilities who have nothing to do and may not be able to read or entertain themselves in the same way as other patients. They may need more individual interaction, and there may be ways of using their own wider social networks to help with this. It can also be useful to ask them, and their carers if appropriate, for advice or any belongings from home that they might want to bring with them.

People with a learning disability may be accompanied by a family member or carer and hospital staff should not assume that it is possible for them to remain with the person for the duration of the time in hospital.

Discharge from hospital

As with hospital admission, discharge arrangements should follow a standard procedure. However, such procedures may be more complex in the case of a disabled patient, and it is all the more important that arrangements, and responsibilities for carrying out such arrangements, are clear. When a patient has continuing needs for health and/or social care, these will need to be addressed though careful multi-disciplinary assessment and care planning, which will involve different personnel in different circumstances. There are several key stages that need to be addressed, but the following are of particular importance:

Have any necessary aids or adaptations been supplied and fitted, and have the patient and their carer (where relevant) been trained to use them correctly?
Have steps been taken to activate or re-activate any services such as home care, or meals on wheels, and has confirmation been received that these will commence on the required date?
If the patient lives alone, have arrangements been made to make their home ready for their return?
Have take-home medicines and any dressings been given to the patient? Have they been given clear instructions on their use in the most appropriate format?
Has the patient been given information about any follow-up appointments, and is this in a form that is best suited to their needs, and that they can understand?
Has appropriate transport been organised for the patient where necessary, possibly including someone to accompany the patient home and to ensure they are properly settled before leaving them?
Has the patient's GP been notified of their discharge from hospital, and of any changes to medication?
Has the patient been given a named contact person and telephone number in the event of any difficulties or concerns following their discharge?

A person who has only recently acquired a disability will have different needs from someone who has been disabled for sometime, or who has had a life-long disability. All newly disabled people should be given appropriate information about their disability and about possible relevant organisations and support groups, as well as information about entitlement to any benefits, and how to obtain support and equipment.

(Source: “Less Disabling” Equality for Disabled People in the HPSS Access to Services. A Good Practice Guide (Patient Administration in Hospital)

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