Choose your situation
Hospitals are under significant pressure to discharge patients once they are medically stable. You do not have to accept an unsafe discharge — but you need to know your rights and use them quickly. Read this before any discharge planning meeting takes place.
Your relative is in hospital and discharge is being discussed
This is one of the most pressured situations families face. Staff need the bed and will move quickly once your relative is clinically stable. That does not remove your rights — it means you need to understand them and use them now. The NHS operates a Discharge to Assess model, meaning long-term care needs are assessed after discharge, not before. The key is knowing what must happen before your relative leaves, and what must happen in the weeks after.
Hospital discharge planning is supposed to begin on the day of admission. In practice, families often find out discharge is imminent with little notice. As soon as you know it is being discussed, ask to be included in the planning process. Under the Health and Care Act 2022, NHS trusts have a legal duty to involve family members and unpaid carers in discharge planning where appropriate.
Ask to speak to the discharge coordinator or social worker attached to the ward. They co-ordinate the process and should be your primary contact throughout.
- What is the proposed discharge date and what is the clinical basis for it?
- Has a CHC checklist screening been completed, or formally ruled out — and if so, on what grounds?
- What care needs has the team assessed my relative as having on discharge?
- Who will be responsible for arranging post-discharge care — the NHS, the council, or both?
- Is a Discharge to Assess placement being proposed, and if so, where?
NHS Continuing Healthcare (CHC) is funded entirely by the NHS for people whose primary need is a health need. It is not means-tested — savings and property are irrelevant to eligibility. If your relative qualifies, all care costs are covered. If not, they may still qualify for NHS-funded nursing care, which covers nursing costs at £254.06 per week for 2025/26.
CHC screening should happen before discharge planning concludes — certainly before any financial arrangements for self-funded care are agreed. It is frequently skipped or deferred. You have the right to ask for it explicitly, and to have any decision to rule it out confirmed in writing.
- Has a CHC checklist been completed for my relative — and if ruled out, on what grounds?
- If not eligible for CHC, have nursing care needs been assessed for NHS-funded nursing care?
- Who on this ward is responsible for CHC referrals?
The NHS Discharge to Assess model means your relative may be discharged to a short-term setting — their own home with a care package, or a step-down bed in a care home or community hospital — while the long-term assessment of their needs takes place. This is not the same as agreeing to a permanent placement. Do not sign anything that treats it as one.
Government guidance states that assessment of ongoing health and care needs, and a funding decision, should happen within four weeks of discharge. During that period, short-term care is funded through NHS and council arrangements. After four weeks, if the long-term funding route is not confirmed, responsibility shifts to existing local budgets.
- Is this a Discharge to Assess placement or a permanent placement? What is the difference in what I am being asked to agree to?
- What is the timeline for completing the needs and financial assessments?
- Who is my point of contact for the assessment process now that my relative has left hospital?
- If the assessment is not completed within four weeks, what happens and who pays?
If your relative will need ongoing care funded by the council, the council must carry out a formal needs assessment and financial assessment. The needs assessment determines what care is required. The financial assessment determines how much your relative contributes. For 2025/26: above £23,250 in savings and assets — full self-funder; below £14,250 — council funding applies (income contributions may still apply); between the two figures — a sliding-scale contribution.
Even if your relative is a self-funder, they are entitled to a needs assessment. This documents their care requirements and forms the legal basis for the care plan the home must follow.
- When will the needs assessment take place and can I attend?
- When will the financial assessment take place?
- Is the family home being included in the assessment, and on what legal basis?
- Is a Deferred Payment Agreement available if a care home placement becomes permanent?
Your parent is struggling at home and you're not sure what to do
This is the most common way families enter the care system — not through a dramatic crisis, but through a gradual deterioration. Falls, missed meals, confusion, declining personal hygiene, a carer running on empty. The right response is not to panic, and it is not to wait. It is to start the formal assessment process, which gives you access to support and creates an official record of needs that becomes important as things progress.
Under the Care Act 2014, every adult in England has the right to a needs assessment from the local council's adult social care department. This right exists regardless of how much money your parent has. The assessment looks at what help they need to achieve day-to-day outcomes — not whether the council will pay for it. The financial question comes later.
Request the assessment in writing, by email or letter, addressed to adult social care at the relevant local council. Keep a copy. If the council suggests a phone screen first, agree to it but confirm your written request for a full assessment remains in place.
- Your parent's name, address and date of birth
- A specific description of the difficulties you have observed — for example: fell twice in the past month, not eating regularly, no longer managing medication independently
- Your contact details and your relationship to them
- Whether your parent is aware of and consents to the referral (if they have capacity)
The assessment is usually carried out by a social worker or occupational therapist. It looks at how your parent's condition affects their ability to manage daily activities — washing, dressing, eating, moving safely, managing medication, maintaining relationships, and taking part in community life. It should be done with your parent present, and you can attend if they agree.
The assessment is not just about what they cannot do. It considers what they want to achieve and what outcomes matter to them. Wellbeing — not just risk management — is the central principle of the Care Act.
- Which specific daily activities meet the eligibility criteria for support?
- What support options are available locally — home care, day centres, equipment, adaptations?
- When will we receive the written outcome and the support plan?
- If my parent does not meet the eligibility threshold, what can still be arranged independently?
If the needs assessment finds eligible needs, the council carries out a financial assessment. Key thresholds for 2025/26: above £23,250 in savings and assets — full self-funder; below £14,250 — council funding applies (income contributions may still apply); between the two — a sliding-scale contribution.
The family home is not included in the financial assessment if your parent is receiving care at home rather than in a care home. It is also excluded from a residential care assessment if a spouse, civil partner, or dependent relative still lives there. If neither applies and care home placement becomes necessary, the home value is normally included — but a Deferred Payment Agreement can avoid any need for an immediate sale.
- Is the family home being included in this assessment, and what is the legal basis for that decision?
- What income is being counted and what is being disregarded?
- Is a Deferred Payment Agreement available if a care home placement becomes necessary?
- If my parent is a self-funder now but savings reduce over time, at what point would they become eligible for council contribution?
For many families, home care works well for a period and then becomes insufficient as needs increase. The point at which care home placement becomes necessary is not always obvious — and should not be driven by a crisis. Common indicators: care now requires overnight or round-the-clock supervision; falls that cannot be safely managed at home; complex medical needs requiring nursing input; the family carer can no longer safely continue; or a home environment that cannot be adapted.
If you believe home care is no longer sufficient, request a review of the needs assessment. Do not wait for a crisis — a planned transition is safer and less traumatic for your relative. The council has a duty to respond to requests for reassessment when circumstances have changed.
- Falls are happening more often, or a serious fall has occurred
- Your relative is not eating adequately, losing weight, or unable to manage medication
- Personal hygiene is declining significantly and they are resisting or unable to accept help
- You or another family carer are becoming physically or mentally exhausted
- Night-time supervision is now needed and cannot be arranged at home
Your relative has dementia and their needs are increasing
Dementia is a progressive condition. The care that was right six months ago may not be right now. For families, the challenge is knowing when the balance tips — when staying at home stops being the safest option, and when a specialist care placement would genuinely improve quality of life and safety. This guide explains how that decision is made, who makes it, and the legal framework behind it.
The care home decision for a person with dementia is rarely made by a single person at a single moment. Early in dementia, many people retain capacity to express preferences about future care — and those preferences carry significant legal weight even after capacity is lost. If your relative has not yet made their wishes known, encouraging them to do so while they still can is the most important single step you can take.
As dementia progresses, capacity to make specific decisions is assessed under the Mental Capacity Act 2005. Capacity is decision-specific — a person may retain capacity to choose what to eat but lack capacity to decide about a care home placement. Where capacity is absent, decisions are made in the person's best interests by whoever is legally authorised: an attorney under an LPA, a court-appointed deputy, or jointly between professionals and family.
- Has a formal capacity assessment been carried out for decisions about care and living arrangements?
- If my relative lacks capacity for this decision, what is the best interests process and who leads it?
- Is there a health and welfare LPA in place, and if not, does anyone hold that authority?
- Has my relative's GP been involved in the assessment of their care needs?
There is no universal threshold. The decision depends on individual needs, the home environment, available support, and the capacity of family carers to continue. But there are recognised indicators professionals and families use when assessing whether the balance has tipped.
These include: no longer being able to manage personal hygiene, eating, or medication without continuous support; wandering creating safety risks that cannot be managed at home; significant behaviour changes including aggression or distress occurring regularly; frequent falls or repeated medical crises; the family carer showing signs of breakdown; or night-time supervision now needed that cannot be provided at home.
- Is my relative safe at home overnight without supervision?
- Are they eating adequately and managing medication reliably?
- Is the current level of home care meeting their needs, or are there regular gaps?
- Am I, as a carer, able to sustain this without it affecting my own health?
- Has the GP or specialist assessed whether the dementia has progressed to a stage where residential care would be clinically appropriate?
Not all care homes are registered or equipped for dementia care. When assessing homes, look specifically at: whether the home has a dedicated dementia unit or specialist registration; staff training in dementia-specific care; the physical environment (secure outdoor space, low-stimulation areas, clear signage, familiar-style interiors); how the home manages behaviours such as wandering and agitation; and how the care plan is reviewed as the condition progresses.
The CQC inspection report for any home is free and publicly available. Read it in full — including the safety and caring domains — and check the date. A Good rating from three years ago may not reflect the home today.
- How many residents with dementia does the home care for, and what proportion of staff are trained in dementia care?
- What is the approach when a resident becomes distressed or agitated?
- How are care plans reviewed and updated as dementia progresses?
- Can my relative bring personal belongings and familiar items from home?
- What is the visiting policy?
People with dementia are not automatically entitled to NHS-funded care, but many have health needs significant enough to qualify for CHC or NHS-funded nursing care. CHC is frequently not assessed for dementia patients. If your relative is moving into a care home and CHC has not been discussed, ask for it explicitly before any care home contract is signed.
Average weekly care home costs in England as of 2025 are approximately £1,300 for residential dementia care and £1,500 for nursing dementia care, though costs vary significantly by region. For those above the £23,250 capital threshold, independent financial advice from a SOLLA-accredited adviser is strongly recommended to plan sustainably.
- Has CHC been formally assessed — not just informally ruled out — before we proceed?
- If not eligible for CHC, have nursing care needs been assessed for NHS-funded nursing care at £254.06 per week?
- What is the council's standard rate for dementia care in this area?
- If a top-up is required, what are the terms and what happens if circumstances change?
If you are the sole carer and cannot continue immediately — because of illness, injury, mental health crisis, or exhaustion — contact your local council's adult social care emergency duty team now. In a genuine crisis outside office hours, emergency short-term respite can be arranged. Do not leave your relative without care before making that contact.
You are a carer and you cannot continue as you have been
Unpaid carers in England provide an estimated £162 billion worth of care each year. The law recognises what this costs and gives carers specific rights. Too often those rights are never used because carers do not know they exist. If you are approaching a point where you cannot safely continue, the most important thing to know is this: you are legally entitled to support, and asking for it is not letting your relative down.
Under the Care Act 2014, every unpaid carer has the right to a carer's assessment from the local council, regardless of the financial situation of the person they care for. The assessment looks at your needs as a carer — your health, your wellbeing, your ability to work or maintain relationships, and whether the caring role is sustainable. If your needs meet the eligibility criteria, the council has a legal duty to meet them.
A carer's assessment is completely separate from the needs assessment of the person you care for. You are entitled to it in your own right, even if the person you care for refuses their own assessment.
- What respite care options are available to give me regular breaks?
- Is emergency respite available if I become suddenly unable to continue?
- What support is available for my own physical and mental health?
- Am I receiving all the benefits I am entitled to, including Carer's Allowance?
- What happens to the person I care for if I become unwell without warning?
Respite covers a wide range of arrangements — from a few hours of cover at home by a paid carer so you can rest, to a short-term stay in a care home for the person you look after. Day centres, sitting services, and short residential stays are all forms of respite. The right type depends on the person's needs and your own situation.
Local councils will fund respite that has been assessed as needed. Both you and the person you care for will normally need an assessment. Some councils will arrange emergency respite of 48 to 72 hours in a genuine crisis without a prior assessment. The Alzheimer's Society and Carers Trust can help identify local grants and alternative funding sources for respite.
- What respite options are available locally through the council?
- Can respite be arranged as a Direct Payment so I choose my own provider?
- Is emergency short-term respite available if I become suddenly unwell?
- Is the family home included in the financial assessment for a short-term respite stay?
If you reach a point where you genuinely cannot continue — because of your own health, a family emergency, or the caring role having become unsustainable — this is a recognised trigger for council action. Carer breakdown is one of the grounds under which the council has a duty to step in. You do not need to justify yourself or wait until things collapse entirely.
Contact the council and state clearly that you are no longer able to provide care. The council cannot leave your relative without care. If an emergency placement is needed while a longer-term arrangement is found, the council has a duty to provide it. Giving even a few days' notice, if possible, gives the council time to arrange something appropriate.
- State clearly: "I am no longer able to provide care and require the council to arrange alternative provision immediately."
- Give a specific date if possible
- If it is an immediate crisis, say so explicitly — councils have emergency duty teams operating outside office hours
Your parent is refusing care and you don't know what you can do
This is one of the most painful situations families face. Your parent is clearly struggling, you believe they need help, but they will not accept it. What you can and cannot do depends almost entirely on one thing: whether your parent has the mental capacity to make that decision. Capacity changes everything about what the law allows.
Under the Mental Capacity Act 2005, every adult is presumed to have capacity unless it is established otherwise. Capacity is decision-specific — your parent may have capacity to refuse a care home placement but not to manage their finances, or vice versa. You cannot assume they lack capacity simply because you disagree with their decision, or because they have dementia or another condition.
If your parent has capacity to refuse care, they have the legal right to do so — even if that decision puts them at risk. You cannot override it. What you can do is ensure the risks are clearly understood by all parties, ensure professional support is formally on record, and ensure you have done everything possible to make alternatives available and acceptable.
If there is genuine doubt about capacity, ask the GP or social worker to arrange a formal capacity assessment. This is a specific assessment of their ability to make this particular decision — not a general mental health assessment.
- Has a formal capacity assessment been carried out for this specific decision?
- If my parent has capacity, what options exist to make care more acceptable to them?
- If my parent lacks capacity, what is the best interests process and who leads it?
- Is there a health and welfare LPA in place that covers this decision?
If your parent has capacity, they can refuse any care — including a care home placement — even if that refusal carries risks. This is not a failure of the system. It is the law protecting individual autonomy. However, having capacity does not leave you with no options.
Social services still have a duty to ensure your parent's needs are assessed and that support is available if they change their mind. If your parent is self-neglecting to a degree that creates serious risk, the council's safeguarding team can be involved — though they cannot force care on a person with capacity. If their condition is deteriorating in a way that suggests capacity may now be affected, ask for a further capacity assessment.
- Ask the GP to visit at home — a medical professional is often more readily accepted than family
- Suggest a trial period — a week of home care, or a short respite stay, rather than a permanent change
- Consider whether the specific type of care being offered is the problem — many people will accept help with meals but not personal care, for example
- Explore whether a familiar or trusted person — a community volunteer, regular visitor — could introduce the idea
If a formal capacity assessment finds that your parent lacks capacity to make this decision, it must be made in their best interests under the Mental Capacity Act. The assessment must consider: their past wishes and feelings, including any advance statement made while they had capacity; the views of family and carers; the options available; and the least restrictive course of action that meets their needs.
If there is a health and welfare LPA in place, the named attorney makes the decision. If there is no LPA, the decision is made jointly by health and social care professionals in consultation with family. Where there is unresolvable disagreement, the matter can be referred to the Court of Protection.
- How have my relative's previously expressed wishes been taken into account?
- What is the least restrictive option that would safely meet their needs?
- If a care home placement is proposed, has a DoLS application been considered?
- If the family disagrees with the decision, what is the process for challenging it?
There are situations where a parent with capacity refuses care, is at genuine risk, and there is nothing the family can legally do to override that decision. The law's position — that a person with capacity has the right to make decisions that carry risk — reflects a deliberate balance between protection and autonomy. It is not a reflection of indifference to your situation.
What you can do: ensure all professionals involved are aware of your concerns and that they are formally documented; ensure your parent's GP is closely involved and making regular contact; contact the council's safeguarding team if you believe your parent is at serious risk from self-neglect; and request a carer's assessment for yourself, which you are entitled to regardless of whether your parent accepts care.
- Age UK advice line: 0800 678 1602 — free, 8am to 7pm, 365 days a year
- Carers UK helpline: 0808 808 7777
- Alzheimer's Society support line: 0333 150 3456
- Dementia UK Admiral Nurses helpline: 0800 888 6678
Nobody will do the CHC assessment and you don't know how to force it
You believe the person you're caring for may qualify for NHS Continuing Healthcare (CHC) — fully funded care paid by the NHS. But every professional you speak to either says it isn't their job, claims CHC doesn't apply, or simply does nothing. This is one of the most commonly reported problems families face. Here is exactly what to do.
Eligibility is based on health needs alone — not savings or income. If a person is found eligible, the NHS meets the full cost of their care. Until eligibility is confirmed, care costs remain the responsibility of the individual or local authority as applicable.
NHS National Framework for Continuing Healthcare and NHS-funded Nursing Care — GOV.UK, last updated October 2022. Always verify directly before acting on it.
The CHC checklist is a standard NHS screening tool. It is the first step in deciding whether someone needs a full CHC assessment. It is not a final decision — it simply determines whether a full assessment should happen.
Under the NHS National Framework for Continuing Healthcare, any trained health or social care professional can complete the checklist. This includes:
- Hospital nurses and discharge coordinators
- District nurses
- Social workers
- GPs (though many are unfamiliar with the process)
- Care home nurses, if the person is already in a home
- Occupational therapists
The professional does not need to be a specialist. They need to have been trained in using the checklist tool. If someone tells you "that's not my job," that is incorrect under the national framework.
If no professional will complete the checklist, you can go directly to the NHS Integrated Care Board (ICB) and request one. You do not need a professional to refer you — you can contact the ICB yourself.
In Dorset, the ICB runs an All Age Continuing Care (AACC) team which handles CHC directly. If you are outside Dorset, contact your local NHS Integrated Care Board and ask for their Continuing Healthcare team — the process is the same across England.
NHS Dorset — All Age Continuing Care (CHC) Team
Phone: 0300 303 4410
Email: continuing.care@nhsdorset.nhs.uk
Write to: All Age Continuing Care Team, NHS Dorset, County Hall, Colliton Park, Dorchester, DT1 1XJ
Source: nhsdorset.nhs.uk — All Age Continuing Care team page, last updated November 2025. Verify current contact details before contacting.
When you contact them, say clearly that you are requesting a CHC checklist assessment and that no professional has been willing to complete one. Ask for a response in writing.
- "I am requesting that a CHC checklist assessment is completed for [name]. I have been unable to get this completed through [GP / hospital / social worker]. I would like the CHC duty team to arrange this directly."
- "Please confirm in writing that this request has been received and advise when the checklist will be completed."
- "I understand that under the NHS National Framework for Continuing Healthcare, the ICB has a responsibility to respond to this request in a timely manner."
If the person is currently in hospital, the CHC checklist should ideally be completed before discharge — but it does not have to be. Under the NHS Discharge to Assess model, a CHC assessment can continue after someone has moved to a care setting.
However, it is easier to push for the checklist while you still have leverage. Once someone is discharged and settled, the urgency reduces in the eyes of professionals even if the health need is unchanged.
- "Has a CHC checklist been completed or considered for this patient?"
- "If not, who is responsible for completing it and when will it happen?"
- "We do not consent to discharge until we understand whether CHC is being assessed."
- "Please put in writing that CHC has been considered and the reason it is not being screened."
If the person's condition is rapidly deteriorating and they may be approaching end of life, the standard checklist process can be bypassed entirely. This is called the Fast Track pathway.
Under Fast Track, an appropriate clinician — which can include a GP, hospital consultant, or specialist nurse — completes a Fast Track tool directly. This can result in NHS-funded care being arranged within 48 hours. There is no checklist, no wait for a multidisciplinary team.
- "Does this person's condition qualify for the CHC Fast Track pathway?"
- "Can you complete the Fast Track tool, or refer us to someone who can?"
- "If Fast Track does not apply, can you confirm that in writing and explain why?"
If you have requested a checklist and the ICB has not responded in a reasonable time, or if a professional is actively blocking the process, you have the right to escalate.
- Make a formal complaint to NHS Dorset in writing, referencing the date you made your request and the lack of response or action.
- Contact Dorset Advocacy, which provides a free CHC advocacy service for people in Dorset. They can support you through the process and help you challenge decisions.
- Contact Beacon CHC, a national free advisory service. They offer up to 90 minutes of free specialist advice on CHC and can tell you exactly where you stand.
Free CHC Support — Dorset area
Dorset Advocacy: Free CHC advocacy service for Dorset residents. Outside Dorset, contact your local Healthwatch or search for an NHS advocacy service in your area.
Beacon CHC: Free national specialist advice on CHC (up to 90 minutes)
0345 548 0300 | beaconchc.co.uk