Table 2.

Twelve statements which formed the basis for recommendations

	Short heading	Statement	Subcomponents
1	To work in partnership	At hospital discharge, the patient living with memory loss, carer and services work in partnership:	By balancing skills, personal knowledge and time By allowing for life adjustments to be made so that there is a smooth, safe, transition from hospital to home By putting the patient and carer at the forefront of their care
2	To tailor and regularly review the discharge and care plan	Patients with memory loss, carers and services can regularly review the discharge and care plan so that it:	Accurately reflects personal and fluctuating circumstances, including readmission to hospital Provides the best and most suitable care environment for the patient Provides on‐going emotional support and advice to the carer which addresses their concerns
3	To have a written and mutually agreed discharge plan	Patients living with memory loss and carers should:	Clearly be made aware of the choices available to them at hospital discharge and beyond Have an initial written plan, which includes both health and social care information Be part of the agreement
4	To have timely information on planning of services, for example electronically	Patients with memory loss and carers should have a smooth transition from hospital to home and from secondary to primary care, examples are:	By having up to date information websites Timely information is provided electronically which acknowledges and recommends the next agreed step in the care plan
5	To have a named co‐ordinator of services and support	At hospital admission, a named co‐ordinator should be allocated:	To guide and support the carer and patient with memory loss through the health and social care system Be available for feedback and further information
6	To be informed about the implications and costs of care at home, respite care and care homes	Patients with memory loss and carers should be able to easily access information:	About the implications and costs of supporting a person at home On how to plan uptake of respite care and care homes if required
7	To have specialized support and signposting now and in the future	Specialized support, advice and signposting for carers and people living with memory loss and just out of hospital should be easily available:	To explain what health issues they may expect immediately To help them adapt to a changing life style
8	For the carer to have information on health status on the patient, and information on the availability of support in the community	Carers need to be informed about:	The health status and needs of the patient living with memory loss on leaving hospital to return home The availability, and choice, of services and support in the community
9	To have appropriately trained care workers	Patients living with memory loss and their carers should be assured:	The care package organized by the hospital with care agencies offers appropriately trained staff who work with the carer to provide a safe, reliable and patient‐centred service
10	To have more flexible care packages	Care packages need more flexibility to allow for:	The patient's recovery, for example to stay in bed longer than normal or to be taken out Being able to cancel and reinstate visits without risking the whole package or part of it being cancelled
11	To have improved care worker time spent with patient	Care worker visits to people living with memory loss need to be:	At the time agreed Offer good quality care Offer stability Offer meaningful social interaction
12	To have improved direct communication between families and care agencies	Carers and patients living with memory loss need:	An improved, direct form of communication with the care agencies regarding the type and quality of work conducted by care workers To ensure that the care provided meets the patient's needs, in particular for those who are new to the care system.