Can a hospital put you in a nursing home in the UK?

Following changes to hospital discharge policy in England, the priority is to discharge medically optimised patients as soon as possible, with assessment for ongoing care taking place outside of the hospital environment. This brings to light the question: can a hospital put you in a nursing home in the UK without your consent?

Quick Summary

A hospital cannot legally force a mentally competent person into a nursing home in the UK, but they can discharge them into a temporary care setting under the 'Discharge to Assess' (D2A) model for a period of rehabilitation and assessment.

Key Points

• Consent is Key: A mentally competent person in the UK cannot be forced into a nursing home by a hospital, as their right to refuse care is protected by law.

• Discharge to Assess (D2A): The D2A model allows for discharge to a temporary care setting for assessment and rehabilitation, but this is not a permanent placement.

• Mental Capacity Matters: If a person lacks mental capacity, decisions are made in their 'best interests', involving family and advocates in the process.

• Assessment is Mandatory: Long-term care needs are assessed after discharge from the hospital, during the interim D2A period, to determine the most appropriate permanent setting.

• Funding Rules Apply: Funding for care changes after the initial D2A period, with decisions based on assessments for NHS Continuing Healthcare or local authority means-tested support.

• Family Involvement is Important: Families and carers have the right to be involved in the discharge planning process and challenge decisions they disagree with.

Patient Consent and The Legal Framework

In the UK, patient consent is a cornerstone of medical treatment and care planning. For a mentally competent adult, a hospital cannot legally force a move to a nursing home; they have the right to refuse care.

If a person lacks the mental capacity to make decisions, any decision on their behalf must be in their 'best interests' under the Mental Capacity Act 2005. The hospital and local authority will involve family and carers, and families can challenge the decision. The NHS must involve patients and families in discharge planning. If a person lacks capacity, an Independent Mental Capacity Advocate (IMCA) may be involved.

The 'Discharge to Assess' (D2A) Model

The NHS in England uses the 'Discharge to Assess' (D2A) model to discharge medically fit patients who still need care, allowing assessment and recovery to happen outside the hospital. Patients might go to a temporary setting, like a care home, for up to six weeks for rehabilitation and assessment of their long-term needs.

The D2A Pathways Explained

The D2A model includes different pathways based on a patient's needs. For a detailed breakdown of these pathways, including the level of support, location, assessment, funding, and duration for Pathways 0, 1, and 2, please refer to the {Link: GOV.UK website https://www.gov.uk/government/publications/hospital-discharge-and-community-support-guidance/hospital-discharge-and-community-support-guidance}.

Who Decides Your Long-Term Placement?

A multi-disciplinary team assesses long-term needs after the D2A period, involving the patient and their family or Lasting Power of Attorney holder. While choices exist for permanent care homes, they can be limited by budget if publicly funded. Self-funders have more choice.

Refusing a D2A Placement

A mentally competent person can refuse a D2A placement. The hospital must ensure a safe discharge, which may involve social services discussions about risks at home. In rare cases where a person lacks capacity and is deemed a danger, a deprivation of liberty authorisation might be sought.

Funding Your Long-Term Care

After D2A funding, a financial assessment determines who pays for long-term care:

• NHS Continuing Healthcare (CHC): Covers full costs for those with a 'primary health need', not means-tested.
• Local Authority Funding: May fund care for mainly social needs after a means-test. Individuals might contribute or self-fund if assets exceed the threshold.

For more detailed guidance on the hospital discharge process in the UK, it is advisable to consult the official government guidelines, such as those found on the official GOV.UK website.

Conclusion: Your Rights Are Protected

While a hospital can discharge a medically fit patient to a nursing home for a temporary 'Discharge to Assess' period, it cannot permanently place a mentally competent individual in a home against their will. The process is heavily regulated, with a strong emphasis on patient involvement and assessment to determine the most appropriate care setting for the long term. Understanding your rights, and the D2A pathways, is crucial for navigating this complex process effectively.

Frequently Asked Questions

Can a hospital legally put me in a nursing home if I don't want to go?

No, if you have the mental capacity to make your own decisions, a hospital cannot legally force you to move into a nursing home against your will. They must respect your right to refuse treatment or care.

What is the 'Discharge to Assess' model and how does it relate to nursing homes?

The Discharge to Assess (D2A) model is a UK policy allowing medically fit patients to be discharged to a temporary care setting, which might be a nursing home. During this time (up to 6 weeks), their long-term care needs are assessed while they recover, before a permanent care plan is made.

What happens if the patient lacks the mental capacity to decide?

If a patient lacks the mental capacity to make an informed decision, a multi-disciplinary team, including social services, will make a decision in their 'best interests' according to the Mental Capacity Act 2005. Family and advocates are involved in this process.

Can my family or I refuse the D2A placement recommended by the hospital?

A mentally competent patient can refuse the placement. If they do, the hospital and social services must work with them to ensure a safe discharge plan is in place. Refusal does not mean the hospital has to keep the patient indefinitely.

Who pays for the temporary stay in the nursing home under D2A?

The temporary stay in a nursing home or other bed-based setting under the D2A pathway is funded by the NHS for the initial period of assessment, which can be up to six weeks.

What happens after the D2A period ends?

After the assessment period, if it's determined that long-term care is needed, a further assessment will establish funding eligibility. This could be through NHS Continuing Healthcare (for complex health needs) or a local authority means-test (for social care needs).

Do I have a choice of which nursing home I go to?

You should have a choice of care homes, even if your care is publicly funded. The choices may be limited by budget, but you can pay a 'top-up' fee for a more expensive home if you or your family can afford it.