Clinicians are less likely to be familiar with the provisions of the Care Act compared with the MHA or MCA. While the Act is primarily the domain of social workers and local authorities, its effects are so widespread that a general overview of it is helpful in planning care and providing safeguards for people with dementia. The importance to clinicians arises because so much hinges on the assessment of the person’s needs and that the assessment is carried out in accordance with the Care Act. In a typical case in the Court of Protection, the key documents before the court will be determined by the Care Act assessment. These relate to what the person needs and whether they have the capacity to accept or decline the services required. We discuss the main provisions of the Care Act, which places a series of duties and responsibilities on local authorities concerning care and support for adults, as well as safeguarding in the Act. We then discuss the role of Continuing Healthcare, which is legally underpinned by the NHS Act 2006 and the Care Act, with the overlapping legal schemes essentially working in parallel.

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.