Dementia Support Line
What happens during and after a person with dementia is discharged from hospital?
How and when a person with dementia is discharged from hospital will depend on their circumstances. Some people will not be well enough to leave hospital and will need end of life care. Depending on their needs, there are different places a person with dementia may be discharged to after a stay in hospital.
- Preparing for a hospital stay when a person has dementia
- How to support a person with dementia during a hospital stay
- You are here: What happens during and after a person with dementia is discharged from hospital?
Hospital care
What is hospital discharge?
During a hospital stay, you will hear the word ‘discharge’. This is the term used for when a person is considered ready to leave the hospital by medical professionals. It involves putting a plan in place to ensure the person is supported and safe when they leave.
Hospital discharge should be discussed as soon as possible following admission. There is now a legal duty in England to involve carers in discharge planning where a patient is likely to need care following their stay.
Hospital staff may ask you if you are able to provide care for the person. It is important to consider this request very carefully.
Assessment for hospital discharge
A doctor at the hospital will decide if a person is able to be discharged. To prevent delays, some hospitals operate a ‘criteria-led’ or ‘nurse-led’ discharge process. This is where a doctor will identify the criteria (goals) that are tailored to a person’s circumstances. When these criteria are met, the person will be able to be discharged without having to wait for another review from a doctor.
A discharge should only happen once they assess that the person is ‘medically optimised’. This means that they no longer need the same level of medical attention that they have been receiving in hospital.
A case manager (sometimes known as a discharge coordinator) should be allocated to ensure a safe and timely discharge. They should liaise between any professionals that need to be involved both within and outside the hospital. This can include a social worker, a care home manager or home care provider.
Hospital discharge process according to care needs
Pathway 0 – for people who are well enough to return to their home setting with no extra support.
If the person previously had professional care in place which has lapsed, it may need to be restarted. In Pathway 0, discharge is usually managed by ward staff.
There may be a local voluntary organisation which offers a ‘Home from Hospital’ scheme. This can help with tasks such as shopping or cleaning. The person should be transferred to a discharge area as soon as possible and should be able to leave hospital the same day.
Pathway 1 – for people who need additional time-limited support.
This will usually involve recovery and relearning skills at home, or within the care home they lived in before admission.
This may be referred to as intermediate care or reablement. They will be allocated a case manager, and their discharge will be managed by the care transfer hub, rather than the ward staff.
Pathway 2 – for people who need a very high level of care.
If the person cannot stay in hospital, they may be discharged to a care home, community hospital or to a bed-based rehabilitation facility.
Pathway 3 – for more complex discharges including those with significant health and social care needs.
This is usually for people who cannot return to where they lived before and are likely to need a longer-term placement.
Other than in exceptional circumstances (for example if the person is not expected to recover or gain any independence again), no one should be discharged directly into a permanent care home placement. They should be given the opportunity to recover in a temporary placement before their long-term needs are assessed.
Following a stay in hospital
After leaving hospital, the person may need more support than they did before. If this is the case, where they move to may have to change.
Sometimes this will be temporary, such as being discharged to a smaller community hospital or care home until they fully recover. Sometimes, this change will need to be permanent to keep the person safe. It usually won’t be clear whether the arrangement will be short or long term until their needs are assessed following a period of recovery.
Discharge from hospital into care home
Depending on the person’s individual circumstances, all options for where they live should be considered and discussed with them. Options may include:
- Living in their own home (with some support from family or paid carers).
- Assisted living (living independently but with assistance available if needed).
- A residential care home or nursing home.
If a care home or nursing home is required, patients and their families should be given as much choice as possible. People with dementia should be supported to make fully informed decisions. If they lack mental capacity to decide, a best-interests decision will need to be made. This may be made by their attorney under an LPA for health and welfare (if they have one) or by family members alongside professionals such as medical staff or social workers.
However, as the immediate placement must be available quickly and is only required to meet the person’s short-term needs, the choice may be limited. This may mean they are initially discharged somewhere which isn’t ideal if more care is required in the long term.
If a person disagrees with the placement, they should clearly explain the reasons why. As the placement is not designed to meet long-term needs, it is important to focus on why the placement isn’t suitable in the short term. Moving more than once in a short period of time can make some people with dementia feel disorientated or unsettled. So this may be worth raising.
In some areas, funding is provided to all hospital patients who need additional care following discharge. This is usually for a set number of weeks, or until their long-term needs have been assessed. In England, this may be known as ‘Discharge to Assess funding’ or ‘Section 75 funding’. Availability varies by area, so you will need to ask if this is available at your hospital.
Intermediate care
The hospital discharge assessment might also consider if the person with dementia would benefit from ‘intermediate care’. This refers to a range of support which can help people regain independence after a stay in hospital.
Intermediate care is sometimes referred to as ‘step-down’ care. This might mean that the person receives extra nursing and care services for a short period of time after discharge. It could involve the person staying in a residential rehabilitation unit to regain confidence.
Intermediate care generally lasts for up to six weeks and is free of charge. Anyone discharged home under pathway 1 or to a care home under pathway 2 should ask if they will receive this funding.
Not everyone will be eligible for intermediate care. For example, if time limited support is unlikely to help them regain independence. Staff will require the person to be able to agree what their goals are, such as making a meal or mobilising.
Someone with dementia should not be excluded based solely on their diagnosis. It should depend on each person’s ability to follow the process. Sometimes people with dementia may not be eligible if staff don’t think they can understand or remember instructions.
Aside from short-term funding, there are different types of financial support available to help pay for care. The assessment for these other types of financial support now take place after the person has left hospital.
Care provided by the local authority or trust
Local authorities have a duty to assess what care a person with dementia needs. 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.
Read: Assessment for care and support
NHS continuing healthcare (CHC)
Some people who leave hospital qualify for free NHS care. This is known as NHS continuing healthcare (CHC) and is put in place if the person requires further help with health needs. It is not available to people who primarily require social care, which is help with daily living, like washing or dressing.
The hospital discharge process should consider whether the person may qualify for CHC. This process starts with a short checklist. If this checklist shows that the person may qualify for CHC, the person will then go through a more detailed assessment. This assessment is often completed after someone has been discharged from hospital as this gives a better idea as to how well the person can manage.
In most cases, people with dementia are not classed as having a ‘primary health need’. Therefore, they may need to rely on means-tested social care instead of CHC. It is always worth asking for an assessment if you feel the person with dementia may qualify for CHC though.
Read: When does the NHS pay for care?
Funded nursing Care (FNC)
Some people with dementia will need the support of trained nursing staff. They 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 (CHC) but do need a nursing home, they should receive NHS-funded nursing care. This is a set amount of money paid directly to the home to 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. The amount of money FNC pays is different for people living in England, Northern Ireland and Wales.
Care fees and the Mental Health Act 1983 (section 117 aftercare)
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 needed after discharge. This can include any care that the person needs in their own home or in a care home. For more information, see factsheet 459 The Mental Health Act 1983.
Discharge conversations with hospital staff can often cause a great deal of worry for carers, family and friends. This is because it can be hard to decide what is the best option. You may want to provide care for the person but feel unable to due to your own commitments or health. You may also have feelings of guilt over the person needing outside help or a care home. These thoughts and feelings are very common, and normal.
If you do wish to help, and feel able to, be very clear which tasks you can help with and for how long. If you are worried that you won’t be able to provide the care they need, you must say.
You cannot be made to provide care for the person, no matter what your relationship is. The decision is yours and how it affects your life and health.
If you decide you aren’t able to provide care for the person, the local authority may be under a duty to meet their needs. But if you agree to provide care on an ongoing basis, this means the local authority are no longer under a duty to meet that need. Talk this through with the person and anyone involved in their care.
If you agree to provide care after discharge, but later change your mind, you will need to contact the local authority directly and request an assessment. Ask how long assessments are taking locally as there may be some delay.