Early Supported Discharge for Care of the Older Person: A Proposal

Abstract Background People living with moderate to severe frailty should receive timely, holistic and personalised care and support in the community. However, there are a lack of services providing timely rehabilitation at home for older adults. This gap contributes to prolonged hospital stays, delayed discharges, adverse outcomes and increased costs. A recent cohort study showed Early Supported Discharge (ESD) can have significant effects on patient outcomes for older adults admitted to hospital. There is evidence it reduces hospital length of stay (LOS) and costs post stroke. The aim is to identify the feasibility and benefits of a care of the older person (COTOP) ESD service in our setting. Methods A joint prospective review was carried out by the Frailty Intervention Team (FIT) and COTOP occupational therapists over 2 months (September - October 2024) to identify patients suitable for COTOP ESD. Results 20 patients were identified as suitable for discharge with COTOP ESD. Average age was 84 with most living with moderate frailty (60% CFS 5-6). 60% presented post fall. All had ongoing physiotherapy and occupational therapy needs. 8 patients transferred to off-site rehabilitation (direct from Emergency Dept), totaling 211 rehab days (cost €91,966 over 2 months, €551,976 annually) 5 inpatients experienced discharge delays after being deemed medically fit, totaling 216 acute bed days (cost €273,888 over 2 months, €1,643,328 annually). The COTOP ESD would be staffed by a multi-disciplinary team including a senior physiotherapist, occupational therapist and medical social worker, nursing staff, part time geriatrician, rehab assistant and health care assistants. Estimated annual running costs of €761,045. Conclusion COTOP ESD addresses a clear need for frail older adults, providing timely, community-based rehabilitation while adopting an integrated care approach. It would reduce LOS, improve patient outcomes and generate substantial cost savings while supporting patient flow and admission avoidance. Following on from this, a pilot service would be beneficial.