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Pause or discharge: how teams decide when life intervenes

The hardest call in a community caseload isn't a clinical one — it's what to do when a client goes quiet, a family hits a hard month, or progress stalls. Pause too long and the caseload looks fuller than it is. Discharge too eagerly and you lose continuity. Here's how teams we've talked to make the call.

Every itinerant practice we've spoken to has the same drawer of 'maybe' clients. Visits stopped a few weeks ago. The family went quiet, or a hospital admission interrupted the rhythm, or the school holidays swallowed a fortnight and never quite spat the pattern back out. The client is technically still on the caseload, but no-one's actually carrying them.

Why the 'maybe' drawer matters

Two reasons. First, it makes capacity look fake — your team's caseload count is inflated by people you're not actually working with, which makes it harder to know if you should hire, take new referrals, or rebalance. Second, it makes the eventual conversation harder: the longer a client sits in the drawer, the more awkward it is to either re-engage or close.

Pause is for time-bounded reasons

Use pause when you and the family both expect to come back, on a known timeline. A six-week hospital admission. School holidays for a paediatric client. A move that's resolved by month's end. The pause is a clinical hold, not a question mark — it has a planned re-entry point.

When pause is the right call, we recommend writing the expected return date in the client notes. It anchors the team and creates a natural prompt to reach out if the date passes without contact.

Discharge is for open-ended drift

  • If you've gone two missed sessions in a row without a clear re-entry plan, the case is probably drifting, not paused.
  • If the family has stopped responding to messages for more than a fortnight, the relationship has paused — your caseload shouldn't pretend otherwise.
  • If goals have plateaued and the next-step plan keeps deferring, that's a signal that discharge or transition is the right call.

Discharge isn't a closing of the door. The client record stays, the goals stay, the contact info stays. If the family comes back in three months, you re-admit and the history is right there. What changes is your visible caseload — it tells you the truth about who you're actually carrying.

The Monday review

Build a five-minute Monday-morning habit: open Pending and Paused, ask one question of each — is this still on a plan? Anything older than the planned return date with no contact moves to discharged. Anything pending without a date set gets one. After three or four Mondays of this, the drawer empties and the caseload starts telling the truth.

How Carelyt models this

Each client has a status — Active, Paused, Pending, Discharged. The caseload view defaults to Active so the daily question 'who do I need to think about today' isn't polluted by the maybe drawer. The other views (Paused, Pending, Discharged) are one click away when you do want to look. Status changes are reversible and don't lose history — re-admit a discharged client and everything you had on them comes back.

We deliberately don't auto-discharge dormant clients. The decision should sit with a clinician who knows the family. The platform makes the question visible; the human answers it.

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