Chapter 11 - Discharge from Hospital

Summary

Discharge planning of older people with dementia to a domestic or care home setting can present difficult practical, legal and ethical dilemmas to the hospital clinician. There may be a different and challenging profile of risks whichever strategy is pursued, but undoubtedly the issue of where someone lives or the care they receive has profound personal importance. Decision-making around these issues exemplifies the tension between preserving autonomy and protection of the individual. A hospital admission can act as a watershed point whereby a view is taken that the person requires a different approach to their care. If the person comes from a domestic setting, this may lead to instigating or modifying an existing care package or moving to a care home. Furthermore, it is generally accepted that the services available in the community for this large and growing patient group are inadequate, the applicable legal framework itself is often complex and unwieldy and, inevitably, the planning process involves more than a single agency. We discuss the key legislation, guidance and processes relating to discharge of a person with dementia from both general and psychiatric hospital settings.