Things to consider after a person with dementia leaves hospital

Deciding where the person will live will depend on their situation. For example:

• If the person has set up a Lasting power of attorney (LPA) for health and welfare, their appointed attorney may be able to make the decision.
• If the Court of Protection has appointed a deputy for the person, the deputy may be able to decide. 
• If there is no deputy or attorney, the decision will be made by a health or social care professional, such as the hospital social worker. They may also ask colleagues for advice.

Whoever the decision-maker is, they must consider what is in the person’s best interests.

Can family and friends of the person with dementia be involved in deciding where they will live?

Family and carers should always be asked for their opinion when deciding where a person with dementia will live.

Some people may not have friends or family who can help represent them. If this is the case, an independent mental capacity advocate (IMCA) should be appointed to help ensure that the persons’ views and wishes are taken into account. A professional (usually a doctor or social worker) should organise this.

How are the best interests of the person with dementia protected in this decision?

There may be concerns that moving a person who lacks mental capacity to a care home or nursing home may limit their freedom. This is because they would be supervised and would not be free to leave. If someone’s freedom is limited, this is known as a ‘deprivation of liberty’.

If someone’s proposed care may result in them being deprived of their liberty, the care will need to be ‘authorised’. This means that an assessment will take place to ensure that the care is in the person’s best interests. The assessment will also make sure that there isn’t another workable option that would be less restrictive. 

If a person cannot decide where to live following discharge from hospital, this decision will be made by professionals as part of the discharge process.

The decision will usually be made by the social worker. They must consider the person’s needs and wishes, as well as any advice from the doctor or consultant. Carers and relatives should also be involved in these discussions.

Some care services are provided by the local authority (or local council) in England and Wales, or the local trust in Northern Ireland.

Local authorities have a duty to assess the care needs of a person with dementia. This is part of the assessment arranged following hospital discharge. Any person has a right to this part of the assessment, even if they then end up paying for their own care.

The person’s carer can also have their needs assessed by the local authority’s social services department. 

These assessments will be different for people living in England, Wales and Northern Ireland. 

If the care assessment shows that the person has care needs, the local authority will then look at how this care will be paid for. To do this, they will complete a financial assessment, also known as a ‘means test’. This will decide whether the person can fund their care themselves or whether the local authority will contribute to some or all of the cost.

The rules around paying for care will be different for people living in England, Wales and Northern Ireland.

Some people with dementia qualify for free NHS care once they have left hospital. This is known as ‘NHS continuing healthcare’.

This is available to people who need healthcare, which is care that involves medical support. It is not available to people who only need social care, which is care that involves help with daily living, like washing or dressing.

The hospital discharge process should consider whether the person may qualify for continuing healthcare. This process starts with a short checklist. If this checklist shows that the person may qualify for continuing healthcare, the person will then go through a more detailed assessment.

This assessment should usually be completed after someone has been discharged from hospital because this can give a better idea as to how well the person can manage in the community.

It is always worth asking for an assessment if you feel the person with dementia may qualify for continuing healthcare. In most cases, only people with the highest levels of complex, intense or unpredictable healthcare needs will qualify for it. 

Some people with dementia will be assessed as needing to enter a nursing home, rather than a residential care home.

If they don’t qualify for NHS continuing healthcare but do need a nursing home, they should receive NHS-funded nursing care. This is a set amount of money paid directly to the nursing home to help cover some of the nursing home fees.

The rest of the fees will be covered by the person themselves or by the local authority. This will depend on the results of the financial assessment carried out by the local authority (see ‘Care provided by the local authority or trust’ above). The amount of money is different for people living in England, Wales and Northern Ireland.

If the person was treated in hospital under section 3 of the Mental Health Act 1983, the local authority and NHS are responsible for providing and funding any related care that is needed after discharge. This can include any care that the person needs in their own home or in a care home. 

The hospital discharge assessment might also consider whether the person with dementia would benefit from intermediate care. Intermediate care refers to a range of support services and equipment designed to help people regain independence after a stay in hospital. It is sometimes referred to as ‘step-down’ care.

This might involve the person staying in a residential rehabilitation unit to regain confidence, or it might mean that the person receives extra nursing and care services for a short period of time after discharge. 

Intermediate care generally lasts for a maximum of six weeks, though it can be extended, and is provided free of charge.