This page is part of PrimeCarers' guide to dementia care. It covers what is different about a hospital stay when the person in the bed has dementia. Hospital discharge explained covers the process for anybody leaving hospital.
The short answer
- Sudden confusion is usually delirium, not the dementiaIt comes on over hours or days, comes and goes through the day, and is normally caused by something treatable such as an infection, pain, dehydration or constipation.
- Time in a bed takes strength away quicklyNHS England says muscle wasting starts within 24 to 48 hours of admission, and much of what looks like decline is lost strength rather than lost memory.
- What you bring in and what you tell the ward both countGlasses, hearing aids, a clock and a note of the routine give staff something to work with. NICE lists regular visits from family among the things that help prevent delirium.
- A permanent move should not be settled on a hospital wardThe government discharge guidance says nobody should go straight into a first permanent care home place other than in exceptional circumstances. Recovery first, then the decision.
Checked against NICE guideline CG103, NHS England, the NHS and the government's hospital discharge guidance for England, September 2026. Care figures are what carers on PrimeCarers charge, our fee included.
Sudden confusion
Delirium, and how it differs from the dementia getting worse
Delirium is a sudden change in somebody's thinking and alertness, brought on by a physical illness or something else the body is dealing with. NICE puts it at about 20 to 30 per cent of people on medical wards, and having dementia is one of four things hospitals are told to check for on admission. The difference matters, because delirium has a cause and the cause can usually be treated.
| Delirium | The dementia moving on | |
|---|---|---|
| How quickly it started | Hours or days. Families often say they were not like this last week. | Months or years, a slow slide rather than a step. |
| Attention | Hard to hold a conversation or follow an instruction, drifting away mid sentence. | Usually held, even when the memory is not. |
| Through the day | Comes and goes. Clearer in the morning, worse in the evening and at night. | Fairly steady day to day, though evenings can be harder. |
| What tends to cause it | Infection, pain, dehydration, constipation, a new medicine, an anaesthetic, broken sleep. | The illness itself, which does not arrive over a weekend. |
How quickly it started
- Delirium
- Hours or days. Families often say they were not like this last week.
- The dementia moving on
- Months or years, a slow slide rather than a step.
Attention
- Delirium
- Hard to hold a conversation or follow an instruction, drifting away mid sentence.
- The dementia moving on
- Usually held, even when the memory is not.
Through the day
- Delirium
- Comes and goes. Clearer in the morning, worse in the evening and at night.
- The dementia moving on
- Fairly steady day to day, though evenings can be harder.
What tends to cause it
- Delirium
- Infection, pain, dehydration, constipation, a new medicine, an anaesthetic, broken sleep.
- The dementia moving on
- The illness itself, which does not arrive over a weekend.
Prevalence and risk factors from NICE guideline CG103. The four checked on admission are being 65 or older, cognitive impairment or dementia, a current hip fracture, and a deteriorating illness.
Delirium is not always the loud, agitated kind. Somebody can be quiet, sleepy and withdrawn and still be delirious, and that version is easier to miss on a busy ward. If your relative has become unusually flat or hard to rouse, say so as readily as you would say they had become agitated.
The NHS advice on sudden confusion is to get medical help straight away. On a ward that means telling the nurse in charge what your relative was like before the admission and asking what is being done to find a cause. At home it means ringing the GP the same day. Signs that dementia is getting worse asks the same question outside hospital.
Why they lose ground
Why a hospital stay is harder on somebody with dementia
A ward is set up to treat the illness that brought your relative in. It is not set up to hold on to the routine, the orientation and the strength a person with dementia depends on, and those are what slip during a stay.
Days spent in a bed
Strength goes faster than you expect
An unfamiliar room, and no routine
The two things dementia leans on hardest
Nights that are never dark or quiet
Lights, noise and observations
Meals and drinks that get missed
Why food and drink get missed
None of this means hospital is the wrong place to be. It means the length of the stay matters, and that getting home as soon as treatment allows is worth something in itself.
What helps on the ward
What you can do while your relative is in hospital
Families often feel there is nothing useful to do between visits. There is, and most of it is about giving staff the information and the objects they need to look after somebody they have only just met.
Three things that make a ward stay easier
0 of 10 ticked
Take in on the first visit
On every visit
Ask the ward
If your relative becomes distressed during personal care on the ward, the approaches that work at home work there too, and they are worth passing on to the staff. Aggression and agitation in dementia sets out what tends to calm a situation, and what sundowning is explains why the hours before bed are hardest. Alzheimer's Society publish guidance for families whose relative with dementia is in hospital.
Getting them home
How the discharge is decided, and where you come into it
Hospitals in England work to a model called discharge to assess. The Health and Care Act 2022 removed the requirement to assess long-term care needs before somebody leaves hospital, so that assessment now happens once they are recovering, usually at home. It judges the person your relative is at home rather than at their worst, and it means a family can be handed a discharge date with very little warning.
Route 0
Home, with the help they had before
Your relative goes home to the arrangement that was already in place, with no new health or social care support added.
What it means
The ward has judged that nothing has changed. If the admission itself was the change, say so before discharge day rather than after it.
What to ask for
Ask for the discharge summary and the medication list in writing, and ask who to ring in the first 48 hours if things are not right.
Route 1
Home, with new or extra support
Your relative goes home and new support starts there: a short spell of NHS and council recovery support, care visits, equipment, or a mix of the three.
What it means
This is the route that keeps somebody in their own rooms while the help is built around them. Short-term recovery support is free while it lasts, and what happens afterwards is a separate decision.
What to ask for
Ask which team will see them at home, on what day, and how many visits. Ask for a care needs assessment, and an assessment for yourself as their carer.
Route 2
A short stay in a community bed
A bed in a community hospital or a care home for a few weeks of recovery, with the longer-term decision left until afterwards.
What it means
For a person with dementia, a second move to a second unfamiliar room can undo ground that was gained on the ward, so it is worth asking whether the same recovery could happen at home.
What to ask for
Ask what has to improve before they come home, who reviews it and how often, and what the plan is if it does not improve.
Route 3
Straight into a permanent care home place
A new permanent residential or nursing home place, arranged directly from the hospital bed. The government guidance says this should happen only in exceptional circumstances.
What it means
A permanent move settled while somebody is delirious, weak and at their worst is being settled on a bad picture of them. This is the route to question hardest.
What to ask for
Ask why one of the routes above will not do, and ask for the decision to be looked at again once your relative has recovered. If they cannot decide for themselves, ask who is making the best interests decision and how you are being involved in it.
The four routes are the discharge pathways set out in the government’s hospital discharge and community support guidance for England.
The route is not fixed, and a family asking questions changes it more often than you might think. If you are being pointed towards a community bed or a permanent care home place, ask what would have to be true for them to go home instead. What to arrange before discharge day is a practical list, and discharge is tomorrow and there is no care in place is for when the date is already set.
Ask for short-term recovery support by name. The NHS calls it intermediate care and reablement: a team from the NHS and adult social care who help somebody get back on their feet at home. It is free and usually runs for a maximum of 6 weeks. Reablement, the free six weeks covers it.
If you think the discharge is unsafe or too early, say so to the ward and the discharge team, and put it in writing. Every hospital has a Patient Advice and Liaison Service for patients, families and carers, and Age UK give advice on leaving hospital.
Care for the first weeks
What care at home costs for the first few weeks
The weeks straight after a hospital stay are usually the heaviest, and then the need settles. Somebody who needs two visits a day in week one may need one by week four, or none, once strength and confidence have come back. Starting with more and stepping down is easier than starting with too little.
| What it covers | A week on PrimeCarers | When it suits | |
|---|---|---|---|
| Two visits a day | Getting up, washed, dressed and fed in the morning, then settled again in the evening, by a carer who comes at the same times each day. | £252 to £350 | Someone steady on their feet and safe alone between visits, where the worry is washing, meals and medication. |
| Two visits a day and sleeping nights | The same two visits, and a carer sleeping in the house so somebody is there if your relative gets up in the night. | £1,162 to £1,365 | The weeks after a hospital stay when nights are unsettled and the family carer has stopped sleeping. |
| A live-in carer with dementia experience | One carer living in the house, there through the day and sleeping there at night, working to a routine you agree together. | £1,260 to £1,340 | Someone who cannot be left alone for long, or a house where the gaps between visits are where things go wrong. |
Two visits a day
- What it covers
- Getting up, washed, dressed and fed in the morning, then settled again in the evening, by a carer who comes at the same times each day.
- A week on PrimeCarers
- £252 to £350
- When it suits
- Someone steady on their feet and safe alone between visits, where the worry is washing, meals and medication.
Two visits a day and sleeping nights
- What it covers
- The same two visits, and a carer sleeping in the house so somebody is there if your relative gets up in the night.
- A week on PrimeCarers
- £1,162 to £1,365
- When it suits
- The weeks after a hospital stay when nights are unsettled and the family carer has stopped sleeping.
A live-in carer with dementia experience
- What it covers
- One carer living in the house, there through the day and sleeping there at night, working to a routine you agree together.
- A week on PrimeCarers
- £1,260 to £1,340
- When it suits
- Someone who cannot be left alone for long, or a house where the gaps between visits are where things go wrong.
Visits are priced at £18 to £25 an hour and sleeping nights at £130 to £145, which is what carers on PrimeCarers charge with our fee included. An agency charges £28 to £35 an hour for the same visit. Live-in figures are the dementia and complex care band.
Past about 35 hours of visits a week, a live-in carer costs about the same and covers the gaps between visits, which with dementia is where a fall or a confused night tends to happen. The cost of care for dementia sets out all three, short-term night care after hospital covers nights alone, and the care cost calculator puts your figures against a care home.
Money coming in is worth checking too. Attendance Allowance is not means-tested, but it stops once your relative has been in hospital for 28 days and starts again the day they leave, so tell the office that pays it both dates. Council funding follows a needs assessment and a means test, and in England savings above £23,250 mean your relative pays in full. Funding care after a hospital stay and Attendance Allowance cover both.
How to start
From the ward to a carer at home
Four steps. The first two are free, and both are worth starting while your relative is still on the ward.
- 1
Write down what they could do before, and what they can do now
This weekWashing, dressing, walking, stairs, the toilet, meals, tablets and nights. Two columns, before and now. This is what the discharge team needs, and it becomes the care plan a carer works from. - 2
Ask for a care needs assessment, and one for yourself as their carer
FreeAsk the ward to refer your relative to the hospital social work team, and ask for a carer's assessment for yourself. Neither depends on savings, and asking early keeps it from holding up the discharge. - 3
Look at carers near your relative's home
FreeEvery profile shows the carer's rate, availability, reviews and the dementia experience they list. Message two or three about the parts of the day you are most worried about. Every carer has interviewed online, and their identity, right to work and enhanced DBS on the Update Service are checked before they appear. They are insured while they work. - 4
Book the first fortnight, then step down
Discharge weekBook what you are sure of for the first two weeks, then review it with the carer once you can see how your relative is settling. Visits can go up or down whenever they need to.
If the bigger question underneath this is whether your relative can go on living at home at all, do not settle it in discharge week. At what point should someone with dementia go into care? goes through that decision properly.
Questions
Questions families ask about hospital stays and dementia
Usually for two reasons at once. The first is delirium, a sudden confusion brought on by an infection, pain, dehydration, constipation, a new medicine or an anaesthetic, which can take days or weeks to clear once the cause is treated. The second is lost strength: NHS England says muscle wasting starts within 24 to 48 hours of admission, so a fortnight in bed leaves somebody weaker. Both can improve. How to tell delirium from the dementia getting worse sets out the difference.
Speed and attention are the two things to look at. Delirium comes on over hours or days, makes it hard to hold a conversation, and comes and goes through the day, usually worse in the evening. Dementia moves over months and years and does not swing about like that. If the change happened over a weekend, treat it as delirium until somebody has looked for a cause.
There is no set answer, and it varies from person to person. It can lift within days once the cause is treated, and it can take weeks. What matters is that the cause is found and dealt with, that sleep, food and fluids are protected, and that your relative gets back into familiar surroundings as soon as treatment allows.
Ask the ward sister rather than the reception desk. Explain which times of day your relative finds hardest, particularly mealtimes and the evening, and ask what the ward can offer. It varies between hospitals, but NICE lists regular visits from family among the things that help prevent delirium, so it is reasonable to ask.
The government's hospital discharge guidance says that other than in exceptional circumstances nobody should be discharged directly into a first permanent care home place without a chance to recover somewhere temporary first. Where your relative can make the decision, it is theirs to make. Where they cannot, it has to be a best interests decision under the Mental Capacity Act 2005, and you should be involved in it. Ask for it to be looked at again once they have recovered.
Short-term recovery support, which the NHS calls intermediate care or reablement, is free and usually runs for a maximum of 6 weeks. After that, care at home is means-tested, and in England savings above £23,250 mean your relative pays in full. Funding care after a hospital stay covers the options, including NHS Continuing Healthcare, which is not means-tested.