Hospital Discharge Planning for Patients with Dementia

A Smarter Approach to Hospital Discharge Planning for Patients with Dementia

By Greg Brown, Owner of Home Instead Reigate & Tandridge

At a recent neighbourhood well-being meeting, I was struck by a conversation with someone involved in financial assessments for hospital discharges. Despite advising families on care options, they had never heard of Home Instead. That alone highlights a systemic issue: a lack of awareness about the full range of care solutions available, especially those outside the standard contract framework.

The reality is this: the discharge process often favours speed and cost-efficiency over appropriateness of care. For individuals with dementia, that can lead to distressing and costly outcomes.

The Standard Model Isn’t Working for Everyone

The Local Authority default is short, task-based visits post-discharge. For many patients, especially those with dementia, this simply isn’t enough. A 15-minute visit may suffice to prompt medication or assist with dressing, but it doesn’t offer the continuity, reassurance, or relationship-building that someone with cognitive decline so desperately needs.

It’s no surprise, then, that these individuals often end up back in hospital, starting the cycle again, each bed day costing the NHS around £1,400 to £1,500. That’s not just inefficient; it’s inhumane.

The irony? We’ve got capacity. Private care providers like Home Instead are available and willing to support discharge plans, but we’re not on the radar of those coordinating care. Why? Because we’re not the cheapest. But here’s the question we should be asking: Are we the most cost-effective in the long run? Absolutely.

The Real Cost of “Cheap”

Those under NHS or local authority contracts are often selected based on price, not suitability. They offer short visits with minimal flexibility. In some cases, this works. But in others, especially with dementia, it sets people up to fail. And when contracted providers can’t meet demand or don’t have a suitably trained team available, beds remain blocked, even when families are willing to pay for private care.

Yes, Home Instead’s services cost more per hour, but they come with specialist dementia training, extended visit times, and a relationship-led approach that reduces the likelihood of readmission. We’re not suggesting we replace existing contracts, but rather that we supplement them when appropriate, offering families a real choice and easing pressure on hospital wards.

Bridging the Divide

There’s a fundamental disconnect between what private care providers offer and what commissioners perceive as viable. It’s not about replacing existing systems but adding flexibility and nuance to them.

Imagine a scenario where someone from a discharge team is empowered to assess the best-fit care, contracted or private, based on the individual, not just the cost code. That means access to a ‘brokering’ body with knowledge of all local providers, not just the ones under contract. It’s not about selling anything, it’s about matching needs to the most appropriate solution, even if it falls outside the existing framework.

Let’s also consider the Better Care Fund or similar initiatives. If some of that funding could be allocated to appropriate providers like Home Instead, it would not only ensure better care but also significantly reduce hospital readmissions. It’s a win-win, fiscally and ethically.

Time for Smarter Choices

We need to move away from rigid, price-driven thinking and towards person-centred commissioning. Because behind every blocked bed or rushed discharge is a person who deserves better.

If we want to build a truly integrated health and social care system, we must make space at the table for all providers, including private ones who can offer tailored, compassionate and effective care.

Let’s start by asking: What does this person really need to recover well at home? The answer will not always be the standard cheaper contracted care providers.