'Not safe for discharge'? Words, values, and person-centred care.

Abstract

The phrase 'not safe for discharge home' is often heard in relation to an older person in hospital, commonly due to functional limitations or risk of falls. But it remains unclear how such a standard of safety should be set in this context, or who should set it. In addition, labelling someone 'unsafe' to return to their own home has significant practical and ethical implications. After briefly exploring these issues, this Commentary suggests that a holistic approach and shared decision-making is required in this setting. Instead of simply declaring someone safe or unsafe for discharge home, specific 'safety concerns' (or 'hazards') should be identified and addressed as able. Ongoing specific concerns can then be discussed in conjunction with a patient's values and perceived benefits of returning home, in comparison with potential pros and cons of other discharge options. Overall, this paper suggests that paying attention to our words and values can enhance discharge planning and person-centred care.