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, and some may 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 discharge process and looks at the different options following discharge from hospital.
While many of the points will be relevant to anyone in the UK, the legal details in this factsheet relate to England and Wales only. People in Northern Ireland should contact the Society's local office to request the Northern Ireland version of this factsheet (see 'Useful organisations' for contact details).
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 staff will arrange the discharge. It will help to start to think about what will happen after a hospital stay very early on.
Plans about the date and time of discharge should be discussed with the patient and their carer. Hospital staff must ensure that transport to the person's home or care home has been arranged. They 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 'Assessment for hospital discharge' 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
- an assessment to see if the person qualifies for NHS continuing health care (see 'NHS continuing care' below).
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 informed of the timing of the person's discharge and when they should be visited.
If the patient's needs have changed considerably since they were admitted to hospital, they may require a multi-disciplinary assessment by several health and social care professionals. This assessment might involve the person's hospital consultant, nursing and ward staff, physiotherapists, occupational therapists, social workers, psychiatrists and registered mental health nurses. The person with dementia, and any relative or friend, should also be fully involved in this assessment. The assessment can include the person going on a home visit to see how they will cope and what help they might need. 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
- any services that the primary care trust and other NHS trusts will provide
- the services that the local authority will provide or arrange, 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 to provide co-ordinated and consistent services. Members of the hospital multi-disciplinary team will work together to consider the person's health and social care needs and share assessment information in order to avoid duplication and delays. This should make the hospital discharge assessment more straightforward for the person with dementia and their carer.
Deciding where the person will live
Some people with dementia may not be able to make a decision (lack the capacity to decide) about the best place for them to live when they leave hospital. If this is the case, someone else will need to decide for them.
The decision could be made by different people in different circumstances - for example, a social worker with the help of carers and family; someone who has been given permission by the person to decide on their behalf about the treatment they want (through a health and welfare Lasting Power of Attorney); or a deputy appointed by a court. (For more see factsheet 472, Enduring Power of Attorney and Lasting Powers of Attorney.)
The decision could be for the person to get support at home or it could be that the help the person needs will be best given in supported housing or residential accommodation. This decision must be made in the person's best interests and if there is a disagreement the Court of Protection can be asked to decide.
For people who don't have capacity to decide for themselves, and who don't have a carer or relative or anyone else who can speak for them, an Independent Mental Capacity Advocate (IMCA) may be brought in to help make sure that they have had their interests and wishes taken into account. More information can be found in factsheet 460, Mental Capacity Act 2005.
In cases where there are concerns about whether the person with dementia is being inappropriately detained in hospital, the provisions of the Deprivation of Liberty Safeguards may apply. For information, see factsheet 483, Deprivation of Liberty Safeguards (DoLS).
Equipment and adaptations
Part of planning for someone to be discharged from hospital should include planning to provide any equipment and adaptations a person will need to help them live safely at home, for example, wheelchairs, hoists or grab rails.
Care homes providing nursing care (nursing care homes) will usually have equipment such as occasional use wheelchairs, shower seats, hoists and grab rails to help the residents and to help staff safely care for them. Other equipment should be provided to the person as if they were living at home.
For information about where to get advice on equipment, adaptations and the financial assistance available, see factsheet 429, Equipment and adaptations to help with disability.
The hospital discharge assessment might also take into account whether the patient will benefit from intermediate care. This term is used to refer to a range of support services and equipment designed to help people regain some or all of their independence so that they can go home and reduce the risk of an incident that causes a return to hospital. For example, intermediate care could include a stay in a residential rehabilitation unit to regain confidence or nursing and care services to support the person when they first go home after a hospital stay.
Intermediate care services can be provided in the person's home, a care home, or a day centre or day hospital. Some areas have specialist mental health intermediate care services. 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 including healthcare-delivered reablement services.
Care provided by the local authority (council)
Services might be provided to help the person return home, or it might be decided that the person needs to receive care in a care home. Services provided by the local authority can be 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 hospital discharge assessment should consider this.
Increasingly, people will be offered a direct payment if they are eligible for community care services. The payment must be used to buy the services that the person has been assessed as needing. The local authority has a duty to offer direct payments but the person can refuse them and request that social services arrange the services. More information can be found in factsheet 473, Direct payments.
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. Palliative care may be offered in a hospice rather than a hospital, or the person might wish to have palliative care in their own home.
NHS continuing care
Some people with dementia are entitled to free NHS care known as 'NHS continuing care'. The hospital discharge assessment will include consideration of eligibility for continuing care. This care can be provided in a hospital, a care home or in the person's own home. There are national criteria (rules) about 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, some people with dementia who are eligible to receive NHS continuing care are not receiving it and it is worth asking if you think you or the person you are supporting may be eligible.
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 hospital (sometimes referred to in the discharge process as 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 will have to pay a fine to the hospital (or relevant NHS body) under this act.
Complaining about the hospital discharge procedure
If you, or someone you know, are not happy with any aspect of the service received from 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 complaint is not resolved, contact the Parliamentary and Health Service Ombudsman.
Alzheimer's Society Northern Ireland
Last reviewed: December 2011
Next review due: December 2013
Reviewed by: Jill Manthorpe, Professor of Social Work, Director of the Social Care, Workforce Research Unit, King's College London and John Holmes, Senior Lecturer in Liaison Psychiatry of Old Age, University of Leeds
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