There will be times when, for whatever reason an adult, or their representative, decides that they need to leave the service and therefore will no longer be in of receipt of care and support services. This maybe due to them being admitted to longer term care or moving out of the local area, for example.
Where the service has any concerns that the decision has been made by family or friends for example, and is not in the adult’s best interests they should contact the safeguarding adults team (see Taking Initial Action where there are Safeguarding Concerns).
Arrangements should be made to ensure that information is shared with relevant personnel, to ensure that the adult continues to receive care and support services which are not interrupted by the change in circumstances.
Where there is no new service in place by the time the adult wishes to terminate their contract with the service, all relevant information should be shared with their GP and any other key workers who provide a service to the adult.
2. Planned Transfers and Discharges
The reason for the adult’s departure should be documented in their case records. Details should include:
- reasons for transfer / discharge;
- proposed date for transfer / discharge;
- address and contact details of where the adult is moving to or of new service;
- the views and wishes of the adult concerned and their family / representative;
- summary of the adult’s care and support needs and the goals and outcomes they wish to achieve;
- what information has been shared with which agencies / professionals.
This should also include any meetings, including multi-agency meetings which discuss transfer or discharge from the service.
The information should include up to date assessments and care and support plans completed by the service, and any other assessments as appropriate, including deprivation of liberty, mental capacity, speech and language therapy (SALT) and risk assessments. See also Deprivation of Liberty Safeguards, Mental Capacity and Positive Risk Taking and Risk Assessments.
Where the adult is moving out of the local area and a psychiatrist is involved in their care, they should be informed of the move as they will retain their responsibilities for a six month period and will need to forward reports to a new service.
The key worker should make an entry in the service system that the adult is no longer receiving a service. The key worker should also ensure that all relevant agencies and family are informed that the adult has left the serviec.
3. Hospital Admissions
Where an adult who is receiving a service requires admitting to hospital for treatment, please see Transfer between Supported Living or Care Home Settings and Inpatient Hospital Settings.
4. Discharge against Advice
4.1 Adults with capacity
If an adult insists on leaving the service and has no intention to receive care and support from another service, their right to do so must be respected. The key worker or service manager should advise them about any potential risks that this may result in, and encouraged them to remain in contact for a while longer to enable staff to plan their discharge in collaboration with all relevant personnel, including their family etc. If they still insist on leaving immediately, they should be asked to sign a form stating they are doing so against the advice of the service.
Unless the adult is subject to the Mental Health Act 1983 (for example guardianship or supervised discharge in accordance with a community treatment order with a condition of residence to the provider’s residential care unit), they cannot be prevented from leaving if they have mental capacity and insist upon doing so.
The manager should liaise with the GP and any other relevant staff to inform them of the situation.
4.2 Adults without capacity
If an adult who does not have mental capacity states they no longer wish to receive a service and no other service intervention has been planned, the service manager should be informed. They should take action in line with the Mental Capacity Act 2005, and key relevant personnel should be informed such as the GP, community nurses or social worker.
An application may need to be made in relation to depriving of them of their liberty to keep them safe (see Deprivation of Liberty Safeguards).
If the adult is placed under a DOLS urgent or standard authorisation, they can be prevented from leaving for seven days under an urgent authorisation (which can be extended for a further seven days) or up to 12 months under a standard authorisation.
In such circumstances, the adult has the right to appeal the authorisation under the Mental Capacity Act 2005 (non-means tested legal aid is available for a care home resident who appeals against their DOLS authorisation to the Court of Protection. Also that they should be provided with a relevant person’s representative if there are no suitable family members to assist with this appeal).