Alzheimer's Society

Hospital discharge is the term used when a person leaves hospital once they are sufficiently recovered. People with dementia usually need further long-term help after leaving hospital. Some people with dementia move into a care home. Others need support in their own home or in the home of a relative or friend. This factsheet explains the different options.

Leaving hospital

People should not be discharged from hospital unless they are medically fit and have been formally discharged by a named doctor. Every hospital has a hospital discharge policy. This is a public document that you can ask to see. It should include details of how the hospital will arrange the discharge.

The planned date and time of discharge should be discussed with the patient and their carer. The hospital must ensure that transport to the person's home or care home has been arranged. It should also take extra care when making plans to discharge someone on a Friday, or during a weekend, as it may be difficult to contact home care workers and GPs on these days. Hospital discharge policies should include details of what to do in such circumstances.

The hospital discharge process should include:

• an assessment of the person's needs, living environment and support network (see below)
• a written care plan that records these needs
• confirmation that any required services are in place in time for the discharge
• a system for monitoring and, if necessary, adjusting the care plan to meet any change in needs.

Assessment for hospital discharge

Before a person is discharged, their needs must be assessed so that any support or care services that they need can be arranged before the person leaves hospital. Any organisations that will be providing these services must be made aware of when the person is due to be discharged, and when they should be visited.

If the patient's needs have changed considerably since they were admitted to hospital, they may require a multidisciplinary assessment. The person with dementia, and any relative or friend, should be fully involved in this assessment. It might also involve the person's consultant, nursing and ward staff, physiotherapists, occupational therapists and social workers. If the patient's needs have not changed considerably, they may need a simpler assessment.

At the time of the assessment, the person with dementia, their carer and/or their relatives are entitled to written information that explains:

• the health authority's eligibility criteria for NHS continuing care
• the services that the primary care trust and the NHS trust will provide
• the services that the local authority will provide, including the likely cost of these and any welfare benefits that the person or their carer may be able to claim to help pay for them
• the complaints procedures of the NHS trust and local authority.

The single assessment process

The hospital discharge assessment should be carried out in line with the single assessment process. This is a government initiative that enables health and social care staff to work together, in order to provide better co-ordinated and more consistent services for older people. Members of the hospital multidisciplinary team will work together to consider people's health and social care needs, and they will share assessment information in order to avoid duplication and delays. This should make the hospital discharge assessment relatively straightforward for the person with dementia and their carer.

NHS continuing care

Some people with dementia are entitled to free NHS care known as 'NHS continuing care'. Part of the hospital discharge assessment will involve considering whether the person with dementia is eligible for this care. This care can be provided in a hospital, a care home or in the person's own home. Each health authority has its own eligibility criteria that determine who is entitled to this free care. In most cases, only people with high care needs, or people who need specialist treatment, will be eligible for care paid for entirely by the NHS. However, many people with dementia who are eligible to receive NHS continuing care are not in fact receiving it.

For more details, see the Alzheimer's Society booklet When does the NHS pay for care?

Intermediate care

The hospital discharge assessment might also consider whether the patient requires intermediate care. This refers to a range of support services designed to help people regain their independence so that they can go home without returning to hospital again unnecessarily. Intermediate care services can be provided in the person's home, in a care home or in a day hospital. Intermediate care generally lasts for a maximum of six weeks, although other rehabilitation services can be provided for a longer period. Intermediate care is provided free of charge.

Care provided by the local authority

Services might be provided to help the person return home, or it might be decided that the person needs to receive care provided in a care home. Services provided by the local authority are means tested and the person with dementia might have to contribute towards the cost. The person with dementia and/or their carer might be eligible for certain benefits to help pay for these services. The assessment should consider this.

Palliative care

The NHS is responsible for providing care for anyone in the final stages of a terminal illness (called 'palliative care') free of charge. Palliative care services are intended to keep people comfortable and ensure that they have the best quality of life possible. If someone does not have long to live, they should not have to leave hospital accommodation unless they wish to do so. The accommodation might be in a hospice rather than a hospital, or the person might choose palliative care in their own home.

Delayed discharge from hospital

The Community Care (Delayed Discharge) Act 2003 aims to ensure that people do not stay in hospital longer than necessary. When a person is becoming ready for hospital discharge, the health authority must inform the local authority if social care services are likely to be needed. The local authority must then assess the person's needs and arrange any necessary services within a certain amount of time. If it does not do so, it can be fined under this act.

Complaining about the hospital discharge procedure

If you, or someone you know, are not happy with any aspect of the NHS − including a hospital's discharge policy, take the following steps:

• Contact the hospital in the first instance to try to resolve the complaint. The hospital may offer to bring in a conciliation service, which can often help to resolve complaints more quickly and amicably.
• If the matter is still not resolved satisfactorily, ask for an independent review to take place.
• If the complaint is still not resolved, contact the health service commissioner.

Your local Alzheimer's Society branch will always be willing to talk to you and offer advice and information to support your needs.

For more information, Dementia Catalogue, our specialist dementia information resource, is available on the website at alzheimers.org.uk/dementiacatalogue

Factsheet 453

Last updated: June 2008
Last reviewed: June 2008

Reviewed by Polly Hauxwell, Head of Service Development, Alzheimer's Society