Leaving hospital after coronavirus

Coronavirus has changed the way a person with dementia will leave hospital. Read our advice so you know what to expect when they are discharged. 

Because of coronavirus, there is new NHS guidance (in England and Wales) on how and when a person leaves hospital (discharge), whether they have coronavirus or not. 

Caring for people with COVID-19 has led to extra demand for hospital beds, so patients are being discharged more quickly than usual. If you or the person you care for is in hospital, the staff should explain to you how this now happens. 

When can a person with dementia leave hospital?

The person should only leave hospital when a doctor decides that it is medically safe for them to do so. They may be discharged even if they have had coronavirus and still have some minor symptoms. A cough can last after the infection has gone, and changes to smell or taste can remain for several weeks.

A few people will get worse from coronavirus again even after they’ve left hospital. The hospital should advise you about this, and tell you who to contact if this happens. You can call NHS 111 or your GP if you’re not sure who to speak to. If someone becomes seriously unwell, call 999 immediately.

Testing for coronavirus

Discharge to a person’s own home

When someone is being discharged to their own home, the hospital will test them for coronavirus before they leave. This is a swab test (where samples are collected from the mouth, throat or nose using a stick similar to a cotton bud) to show whether someone has the infection or not. It can take up to 48 hours (two days) to get the results of the test. If the person has coronavirus they will need to stay at home (self-isolate) for 14 days from when they received their first positive test result. 

Discharge to a care home

Everyone being discharged from hospital to a care home will also be tested for coronavirus. Patients who receive a negative test result will need to isolate in their room at the care home for 14 days.

The NHS in England introduced a ‘designated settings’ scheme in winter 2020/21. This means that anyone being discharged from hospital to a care home who has a positive coronavirus test is discharged to designated premises to complete the recommended 14-day isolation period. Some of these 14 days might be completed in hospital.

A designated setting might be a different care home or an NHS premises. It will be inspected by the Care Quality Commission (CQC) to meet strict infection prevention control standards.

In some cases a person may be able to return to their original care home if the premises is a designated setting. If not, the person will be placed temporarily in a designated setting and will then return to their original care home after the 14-day isolation period.

Meeting the person’s needs

A person with dementia may have complex care needs. These might have changed during their stay in hospital, because they were unwell. Previously, patients were assessed before they left hospital, so that any changes to their support or care could be put in place. Because people are being discharged more quickly during the pandemic, this is no longer possible.

The person should be assigned a case manager to manage their discharge and follow-up care, unless hospital staff believe they are able to return home without support. Case managers should work with ward staff to ensure individuals and their families are fully informed of the next steps, arrange transport and arrange ‘settle-in’ support. They will also liaise with other professionals, such as local ‘single point of access’ schemes, to arrange a timely assessment of the person’s longer term needs. 

It may be that the person’s level of care needs are too high for them to go home – even with extra support – and they can’t stay in hospital. In this case they may be discharged to a care home or a rehabilitation bed, often in a community hospital – see our advice on recovery and rehabilitation after coronavirus (COVID-19).

A lot of people are involved in helping a person to leave hospital and the assessment for their care. Although you should be given a leaflet giving the name of your main contact, it’s helpful to make a note of the names of anyone you speak to, in case you have questions or concerns. Where you can, ask that any decisions that are made are written down, so you have a record of these decisions. 

Paying for care after hospital discharge 

During the pandemic, any new or additional care the person needs after they leave hospital will be paid for by the NHS in England. This will continue until further assessments are completed to find out the person’s longer-term needs. This is true even if they have not had coronavirus and were in hospital for another reason. Care that was in place before hospital admission won’t be covered by these new funding arrangements. 

In England this funding will now be limited to a maximum of six weeks for people discharged from hospital from 1 September 2020 and will be less than six weeks if the assessments for future needs are carried out sooner. Time spent in a designated setting will count towards the six weeks. There is a similar funding arrangement in Wales.

If the person’s needs can be best met in a care home, they now won’t be able to stay in hospital until their first choice of care home becomes available. This may mean that they first move into a home that is not ideal in the long term. For example, it may be too far for family to visit or the cost of the home may be more than they or their local authority are willing to pay once the COVID-19 funding ends. 

It may be useful to explore what other homes can offer, so that you are prepared for the end of the pandemic (and when the COVID-19 funding ends). Our general advice on care homes may be useful, as may the National Care Forum COVID-19 checklist (PDF). Any move must be in the person’s best interests. This includes thinking about the impact the move itself may have on their health.

This government COVID-19 discharge funding will only temporarily pay someone’s care fees and only in situations where this is a new need. 

People discharged from hospital in England between 19 March and 31 August 2020 will receive the funding until they can have their care needs and finances assessed. How long this assessment will take will depend on how quickly their local authority and clinical commissioning group can work through their backlog, so it will vary from area to area.

Individuals discharged after 1 September 2020 should be assessed during the six weeks that the COVID-19 discharge funding is now limited to. If they aren’t assessed within the six weeks then usually the organisation that is causing the delay will be responsible for paying for the needs that the COVID-19 discharge funding was covering. Depending on their financial assessment, they may:

  • have to start paying their own care fees in full (often called ‘self funding’)
  • receive some funding from their local authority and contribute some themselves  
  • be eligible for another type of funding such as NHS continuing healthcare.

The person will not be charged for care they have already had as part of the temporary hospital discharge funding.

Last updated 5 February 2021

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