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The NHS and Community Care Act 1990. Impact on the discharge profile of patients with dementia

Community Mental Health Team, Oak Tree House, 14-18 Christchurch Road, Ringwood, Hampshire BH24 1DN

Simon D. Nicholson, Consultant in Old Age Psychiatry

Forston Clinic, Dorchester, Dorset

AIMS AND METHOD

The Community Care Act came into effect in April 1993. In order to see what impact this would have on the discharge profile of dementia in-patients, prospective studies of in-patient discharges from a dementia assessment ward before the Act, and five and 41 months after the Act were conducted.

RESULTS

The proportion of patients discharged to their own homes and to residential/nursing home care remained unaffected by the Act. Duration of hospital stay increased after the Act in 1993 and 1996 (P=0.02) largely due to delays in placement into care homes. Placement delay was increased both in 1993 and 1996, but by 1996 the difference was no longer statistically significant.

Duration of hospital stay was unaffected by the Act for those patients discharged to their own homes.

CLINICAL IMPLICATIONS

The new care management process by social services was found to be associated with delayed discharges for people with dementia requiring residential/nursing home placements, thus causing pressures on beds and higher in-patient costs.

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