Most people arranging home care for the first time are doing it in a hurry, because somebody is in a hospital bed and the ward wants it back. This is what happens, what you are entitled to, and the two mistakes families make under that pressure.
Discharge to assess
The NHS in England mostly works on a discharge to assess model. The long-term assessment does not happen on the ward. The person goes home, or to a short-term bed, with support in place, and gets assessed there once things have settled.
There is sense in it. Nobody looks like themselves after three weeks on a ward, and assessments done there tend to over-estimate what is needed permanently.
What it means for you is that the care arranged at discharge is temporary by design. Treat it as the start of the conversation.
The first few weeks are usually free
Short-term reablement or intermediate care after a hospital stay is NHS-funded and provided without a charge and without a means test. It is intended to get someone back on their feet rather than to support them indefinitely.
Ask two questions on the ward and write the answers down. How long is this funded for? And what is supposed to happen on the day it ends?
The second question is the one nobody asks, and the day it ends is when families discover they are now buying care.
Ask about continuing healthcare before you buy anything
NHS continuing healthcare is fully NHS-funded care for people whose needs are primarily health needs rather than social care needs. It is not means tested, and it covers care at home as well as in a home.
It is assessed with a checklist first, and the checklist should be done before discharge where it might apply. Ask for it by name. Plenty of people who would have passed the checklist never get one because nobody mentions it.
If the answer is no, ask for the decision and the reasoning in writing.
The two mistakes
Signing a long contract in week one. The hospital social worker or a discharge team may hand you a list. The first agency with capacity is not necessarily the right agency, and the hours someone needs in week one are rarely the hours they need in week six. Keep the notice period short.
Accepting the package instead of asking for the assessment. The interim care is not the care plan. If you do not push for the full needs assessment when the short-term support ends, you can end up funding privately something the council would have had a duty to arrange.
What to sort out before the person comes home
- Keys. How does the carer get in at 7am without waking the house? Most agencies use a key safe and will tell you where to put it.
- Equipment. A bed downstairs, a commode, a frame, grab rails. The hospital occupational therapist can usually order these, and after discharge it goes through the council instead and takes longer.
- Medication. Get the discharge list and check it against what is in the cupboard at home, because they often disagree.
- The first 48 hours. Somebody should be there or phoning. Most readmissions happen early.
You can say the discharge is unsafe
You cannot be forced to take someone home into a situation that will not work, and a hospital cannot discharge to a home with no care in place if care is what the assessment says is needed.
If you think a discharge is unsafe, say so to the ward manager, and ask for it in the notes. Then ask for the hospital’s PALS team. Saying it politely and in writing changes what happens next far more often than saying it loudly.
Buying care quickly without buying badly
Ring three agencies, not one. Ask each one when they could actually start, because capacity is the real constraint and it varies week to week.
Then ask the short version of the usual questions: how many different carers, what happens if one is off sick, what is the shortest visit, and what is the notice period.