Hospital discharge and home care: what to do in the first 72 hours

Most families encounter home care for the first time in a hospital corridor. A consultant says the word "discharge." A nurse mentions "social services." The discharge coordinator appears with forms. And you are suddenly expected to understand a system you have never had to think about before, on a tight timeline, while your parent is ill in a bed behind you. This guide is designed for that moment. Here is how NHS hospital discharge actually works, who is responsible for what, and what you need to do in the first 72 hours to give the return home its best chance of going well.

How hospital discharge actually works in England

The NHS model for most planned discharges is now what is called Discharge to Assess (D2A) — a deliberate shift away from doing everything in hospital before the person leaves. The logic is sound: a hospital ward is a poor environment for assessing someone's long-term care needs. People are often more confused, more physically deconditioned, and less themselves than they will be once they are home in familiar surroundings.

D2A means the hospital sends your parent home — usually to a temporary care arrangement, either reablement or short-term funded care — and the proper assessments for their ongoing needs happen over the days and weeks that follow. In theory, this avoids delays. In practice, the quality of what happens at the point of discharge varies enormously between trusts and between local authorities.

NHS England's Hospital Discharge Service guidance (2023) sets out what hospitals are required to do. The key principles are that discharge should be both safe and timely — and that "timely" should not come at the expense of "safe." These two words are the foundation of your rights as a family.

The people you will meet

The discharge coordinator is usually based on the ward or in the discharge planning team. They coordinate the logistics: equipment, services, transport, referrals. They are your main point of contact during the discharge process. Get their name and a direct contact number as soon as you know discharge is being planned.

The ward social worker or hospital social worker carries out initial social care assessments during the hospital stay. Not every ward has one readily available; some trusts rely on a shared team or external social services. If one has not appeared by day two, ask.

Occupational therapist (OT) assesses the person's functional ability — can they walk safely from bed to bathroom, manage steps to the front door, get in and out of a bath — and recommends equipment and adaptations to make going home safe. The OT assessment may happen at the bedside, or the OT may visit the home before discharge.

The NHS continuing healthcare (CHC) coordinator becomes relevant if your parent has complex health needs that might qualify for full NHS funding of their care. More on this below.

PALS — the Patient Advice and Liaison Service — is the person to contact if you have concerns about how discharge is being handled. Every NHS trust has one. They are not advocates exactly, but they can escalate concerns quickly.

Section 2 and Section 5 notices: what they mean

These sound more bureaucratic than they are. Both relate to provisions in the Care Act 2014 that create a legal mechanism for hospitals to trigger community services.

A Section 2 notice is served by the hospital on the relevant local authority (and NHS commissioners, if CHC may be relevant), notifying them that a patient is likely to need care services after discharge. This is the hospital saying: this person is coming home, and you need to start planning. Receiving a Section 2 notice starts the clock on the local authority's duty to assess and arrange.

A Section 5 notice is given at least 24 hours before the intended discharge date. It confirms the patient is clinically ready to leave and that services need to be in place by that date. If the local authority fails to have services ready by then, they may become liable for any costs caused by the resulting delay in the hospital.

Most families never see these notices directly — they are served on the relevant authorities, not on families. But knowing they exist is useful, because it means you can ask the discharge coordinator: "Have you served a Section 2 notice? When do you intend to serve the Section 5?" These questions signal that you understand the process, and they tend to accelerate action.

NHS Continuing Healthcare: the funding screen at discharge

For anyone with significant health needs, the hospital should — by law — carry out a CHC Checklist before discharge. This is the first stage of the NHS Continuing Healthcare assessment process.

CHC is full NHS funding for care outside of hospital, for people whose care needs arise primarily from a health condition rather than a social care need. It is not means-tested — income and savings are irrelevant. But it is needs-tested, and it applies to a relatively small proportion of people leaving hospital. The assessment looks at twelve care domains: behaviour, cognition, psychological and emotional needs, communication, mobility, nutrition, continence, skin and tissue viability, breathing, drug therapies, altered states of consciousness, and other significant care needs.

If the CHC Checklist suggests CHC may be appropriate, a full assessment using the Decision Support Tool follows. This is completed by a multidisciplinary team and a recommendation is made to the NHS commissioners. Families can request that a CHC Checklist is carried out — if the hospital has not offered one and your parent has complex medical needs, ask explicitly.

If CHC is not awarded, the person may still qualify for NHS-funded nursing care (FNC), which is a flat weekly contribution (currently around £235 per week) paid by the NHS on behalf of people in care homes who have nursing needs. FNC does not apply to home care.

What equipment the hospital can arrange

Do not assume you need to buy or hire anything before asking the hospital. The occupational therapy team can arrange a range of equipment through NHS community loans:

• Hospital-style adjustable beds (useful where someone cannot get in and out of a standard bed safely)
• Pressure-relief mattresses (essential for anyone at risk of pressure sores)
• Commodes, raised toilet seats, and toilet frames
• Bath boards, bath seats, grab rails
• Hoists and slings (for two-carer transfers)
• Wheelchair or mobility aids

Equipment is provided on loan, not as a purchase, and must be returned when no longer needed. Lead times vary — some items can be delivered on the day of discharge, others take longer. The OT should be able to tell you what is available and when.

Key safes are slightly different. A key safe is a small metal lockbox fixed beside the front door containing a spare key, accessed via a PIN code. Carers use it to enter the property without the person inside having to get to the door. Most home care agencies will expect one to be in place before visits begin. They are often arranged by the agency, by social services, or bought and fitted by the family — they typically cost £30–£60 and require a simple screw-fixing to the wall.

If your parent lives alone and you have a front door key, fitting a key safe before discharge is one of the most important practical steps you can take. A carer cannot visit if they cannot get in.

Making sure care is in place before the person comes home

NICE Guideline NG27 — which covers transitions between hospital and community settings — is clear that discharge planning should start early, involve the person and their family, and ensure services are confirmed before discharge occurs. In practice, this does not always happen. Here is what to do to avoid being caught short.

From day one of the admission, ask:

• Has a discharge planning process started?
• Who is the named discharge coordinator?
• Will the OT be assessing my parent before they go home?
• Is a social care assessment being carried out?

Before any discharge date is set:

• Ask the discharge coordinator to confirm, in writing, what care will be in place on the day your parent returns home. Not "being arranged" — confirmed.
• If reablement is being offered, find out who the provider is, what time the first visit will be, and what the cover is for evenings and weekends.
• If the hospital is referring to a home care agency directly, ask for the agency's name and get in touch with them yourself to confirm the start date and visit times.

If care has not been confirmed 24 hours before discharge: Call the discharge coordinator and ask to speak with the ward manager or the hospital's Director of Nursing if necessary. If you are concerned, contact PALS. A Healthwatch report on hospital discharge (2022) found that families regularly felt pressured into taking relatives home before adequate support was arranged — this is a known, documented problem.

The first 72 hours at home: common pitfalls

Even when care is arranged in principle, the first three days at home are where things go wrong. These are the most common problems and how to address them.

No key safe in place. If the carer arrives and cannot get in, the visit does not happen. Fit the key safe before discharge day, give the PIN to the agency, and confirm they have it.

Medication not transferred correctly. Hospitals should send the person home with a sufficient supply of all prescribed medications, and a discharge summary for the GP. In practice, gaps occur. Before leaving, ask nursing staff to confirm what medications are being sent home and check the bag. Contact the GP surgery the next morning to ensure they have the discharge summary and any repeat prescriptions needed.

No evening or weekend cover. Some reablement and care packages cover weekdays only, or reduce visits at weekends. Check this before discharge. If evening cover is needed and is not in place, this needs to be flagged.

Falls in the first 24 hours. Someone returning home after a hospital stay is at heightened fall risk — they are weak, the home environment may have changed, and their usual confidence in moving around has often been knocked. If the OT has not visited the home, do a quick walkthrough: clear obvious trip hazards (rugs, flexes, clutter on stairs), ensure there is a light reachable from the bed, and check that the person can get to the toilet safely overnight.

Confusion about who to call. Write down four numbers and leave them somewhere visible: the home care agency (including out-of-hours), the GP surgery, the district nurse team, and a family member who can respond quickly. The person coming home may be managing a new diagnosis, unfamiliar medications, and reduced independence all at once. Making it easy to ask for help matters.

The carer doesn't show. It happens. If a carer is absent with no notice, call the agency immediately — not hours later. Good agencies have a duty manager available for exactly this situation.

What the Care Act says about your rights

Under the Care Act 2014, everyone in England has the right to request a needs assessment from their local authority — and the local authority cannot refuse one. This right does not disappear because the hospital is keen to discharge someone quickly.

The Care Act also places a duty on local authorities to carry out a carers' assessment for anyone who provides substantial care for a family member. If you are about to become the primary carer for your parent — or already are — you are entitled to this assessment in your own right. It is worth requesting.

If the local authority is slow to carry out an assessment, or if the care package offered does not seem to meet the assessed needs, the Local Government and Social Care Ombudsman investigates complaints about council-arranged care. The Ombudsman has published guidance specifically on discharge from hospital; it is worth reading if you feel the system is not working as it should.

What to do if you feel pushed before you are ready

Being clear and firm — without confrontation — is usually the most effective approach. Ask:

1. "What makes this discharge clinically safe, specifically?" — ask for this in writing if you have concerns.
2. "Is a CHC Checklist being completed, and if not, why not?"
3. "What care services are confirmed to be in place on the day of discharge?"
4. "Can I speak with the ward consultant before a discharge date is set?"

If you are not satisfied with the answers, escalate through PALS. If the situation is urgent and you believe the person will come to harm if discharged without adequate support, say that clearly and use the word "unsafe." It has legal weight.

Discharge-to-home checklist

Print this and take it with you to the hospital.

Before discharge is confirmed:

• Named discharge coordinator identified — name and direct number recorded
• OT assessment completed (at bedside or home visit)
• CHC Checklist carried out (or confirmed not applicable with reason given)
• Needs assessment by social worker started or scheduled
• Equipment ordered and delivery date confirmed
• Key safe fitted at the property
• Care package confirmed — agency name, start date, first visit time
• Evening and weekend cover confirmed
• Reablement option explored if relevant

On discharge day:

• Discharge medications checked against prescription list
• Discharge summary provided (for GP)
• Transport arranged (ambulance, hospital transport, or family)
• GP notified or notification confirmed
• District nurse referral made if wound care / catheter / injections needed

First 72 hours at home:

• Key safe PIN given to all relevant carers and family
• Medication sorted and clearly labelled
• Emergency numbers list written and placed visibly
• Fall hazards in home addressed
• First carer visit attended and logged
• GP appointment booked for within one week
• Carers' assessment requested if family member is taking on a caring role

For help choosing a home care agency once discharge arrangements are confirmed, our article on questions to ask a home care agency has a full interview guide. And if you are unsure who will pay for ongoing care, the funding guide covers every route.