Patients are being discharged from hospital - in spite of their needs or wishes - so beds can be freed up, a new report has said.
Care after discharge varied widely
Too many elderly people are denied choice and placed into nursing homes to suit local services, the Commission for Social Care Inspection concluded.
In January, fines were introduced for councils who did not accommodate patients within two days.
The CSCI looked at people's experiences since the policy was introduced.
Staff and patients from seven council areas across England were surveyed.
Although some areas had excellent arrangements that offered people choice in future care, others placed too much focus on numbers and not enough on people, according to the CSCI.
There were wide variations in what happened to people when they left hospital between different parts of the country.
The number of people going directly into care homes varied from only one in 25 in some areas to more than one in three in others.
In some parts of the country, half of the people surveyed had to go back into hospital again within three months, while in other areas only one in 12 were readmitted within this time.
The CSCI found a number of cases where people were being pushed into long-term residential care when they could have been supported to live in their own homes.
In the poorest performing areas, people felt they did not have any meaningful choice about their future care.
But in the best areas, people got the choice of a full spectrum of care services - with good access to rehabilitation and intermediate care.
COUNCIL AREAS COVERED BY THE CSCI REPORT
Bournemouth Borough Council
Cornwall County Council
London Borough of Lambeth
London Borough of Waltham Forest
Luton Borough Council
South Tyneside Metropolitan Borough Council
City of Sunderland Council
These people said their interests were put before systems and processes.
Overall, the amount of extra time that people had to spend in hospital because their council had not arranged care almost halved between October 2003 and January 2004.
David Behan, chief inspector of CSCI, said: "The new reimbursement system has helped people to get out of hospital sooner and, in the best areas we looked at, people have a real choice of the support they need to live life to the fullest.
"Unfortunately, despite this, in some parts of the country there is far too much of a focus on process rather than people."
He said there was a danger of looking only at the short-term options for people, and not the longer-term outcomes for them.
"In too many places there is not enough emphasis on the experience of people going into long-term care.
"If health and social services are just concentrating on rushing people out of hospital there is a real danger that this will end up dictating what will happen for the rest of their lives," he said.
Age Concern said the report should be a wake-up call for local authorities and health authorities.
Jonathan Ellis from Help the Aged said there were clearly important lessons to be learned.
"The needs and wishes of older people must be remain central to the process of being discharged from hospital and the choices that are available to individual older people .
"Decisions must always be taken for the benefit of the patient, rather than the service," he said.
But Health Minister Stephen Ladyman said the report highlighted the positive effects of the reimbursement policy after only six months.
"Reimbursement has, as acknowledged, provided an injection of cash in local services which help people live independent lives at home after periods of hospitalisation and has increased investment in services that prevent hospital admissions.
"Our target is to eliminate delayed discharges. Older people delayed in hospital are not getting the care they need," he said.
Sandra Gidley MP, Liberal Democrat spokesperson for older people, said: "It is shocking that patients are being pushed around to suit the needs of targets and bureaucrats.
"The Government mantra of choice clearly does not apply to older people."