A review by the Care Quality Commission (CQC) found one patient had been in hospital in Leeds for nine months despite being fit to leave.
Inspectors uncovered “multiple examples of people having poor experiences” in the city’s hospitals, with one in 10 older people spending at least four weeks on busy wards.
Services were “under pressure and far more people stayed in hospital than needed to”, they said.
“Hospital wards were full and the average length of stay was the highest in the country.”
The review ordered by health and social care secretary Matt Hancock is one of a series investigating how elderly people are dealt with by hospitals, community health services, GPs, care homes and homecare agencies in England.
Inspectors said good community support meant fewer elderly people attended A&E but once they did, they were more like to be admitted to hospital and it was more difficult for them to return home.
They said patients were moved multiple times and held on wards which were not designed to support them.
In checks carried out in October, a unit at St James’s Hospital designed to make quick decisions about patients was holding onto them for up to a week due to a shortage of beds on wards.
“This impacted upon people as the area was very crowded with little privacy and dignity,” said the report.
In interviews with staff, they said “we did not feel that there was a sense urgency about enabling people to return home”.
Discharges were hampered by a shortage of nursing home beds in the city, with one patient with complex needs “trapped” in hospital after being turned down by 14 care homes.
The team found evidence discharges could take place at inappropriate times. One patient said they had been discharged after midnight without relatives with them and had to book a taxi to get home.
Alison Holbourn, deputy chief inspector for primary medical services at the CQC, said: “We found that the pressure on the system was most apparent in the flow of patients in hospital, where the shortage of suitable nursing care home places meant that people were often waiting to be discharged – putting further pressure on beds.
“To move forward it will take all parts of the system including social care, GP surgeries and the voluntary sector to play their part in finding solutions and integrating care.”
The report found collaboration between frontline community staff was a “real strength” in the city and praised the support available for patients with dementia.
There was a good voluntary, community and social enterprise sector with opportunities for people to receive support, particularly those at risk of isolation and loneliness.
Hospital chief executive Julian Hartley said: “We know we need to improve our discharge processes for our patients.”
Work was underway to simplify discharges which would help “relieve pressure on our hospitals which are often incredibly busy”, he said.
Coun Rebecca Charlwood, chair of Leeds Health and Wellbeing Board, said the report praised approaches designed to help people stay at home.
But there was “clearly work to be done to improve services” and the report’s findings would be used to challenge health and care services to deliver improvements.
The report is the latest system review to be published in Yorkshire. A review a year ago was heavily critical of services in York. Another inspection in Sheffield also called for significant improvements to the coordination of care.