What to expect, what to watch for, and when to act

The first fortnight after a hospital discharge is the most important and most unpredictable period in a person's return home. It's when most problems emerge — and most crises that lead to re-admission happen. It's also, when it goes well, the period that establishes a pattern of safe, stable care that can continue for months or years.

If you've organised home care for a relative who has just been discharged, this guide explains what the first two weeks should look like, what signs suggest the care isn't working, and what to do if something needs to change.

Day one: what should happen

The day your relative arrives home is a logistics and welfare day. Whether you're present or the home care agency is managing the transition, several things should happen:

The carer's first visit If a formal care package has been arranged to start on the day of discharge, the first visit should ideally coincide with or closely follow your relative's arrival home. The carer should:

Introduce themselves and take time to make your relative comfortable
Walk through the care plan with the family or patient
Familiarise themselves with the home layout — bathroom, bedroom, kitchen, medication location
Check that any equipment (grab rails, hospital bed, commode) is in place and the patient knows how to use it
Confirm the visit schedule for the coming week

Medication check Hospitals often discharge patients with a new or changed medication regimen. The first day at home is the highest-risk time for medication errors. Check that all medications have been dispensed, the dosing instructions are clear, and the carer knows which medications they are or aren't authorised to administer.

GP notification The hospital should have sent a discharge summary to the GP. Confirm this has happened and that a follow-up appointment has been booked within five to seven days of discharge.

The first week: what to watch for

The first week is an adjustment for everyone — your relative, the carer, and your family. Some friction is normal. Certain signs are not.

Signs things are going well:

Your relative knows their carer's name and feels comfortable with them
Visits are arriving on time and lasting the scheduled duration
Digital visit records (if applicable) are being completed after each visit
Your relative's mood and energy are gradually improving rather than declining
Medication is being managed safely and consistently

Signs that warrant a conversation with the agency:

A different carer has arrived for multiple visits without explanation
Visits are consistently late or shorter than scheduled
Your relative reports feeling rushed during visits
The care plan doesn't reflect what was discussed — tasks are being missed
Your relative's condition has changed and the care plan hasn't been updated to reflect it

Signs that warrant escalation or medical attention:

Signs of infection, wound deterioration, or unexplained pain
Confusion or disorientation significantly worse than at discharge (can indicate UTI, medication side effects, or delirium)
A fall, even if apparently minor — all falls post-discharge should be reported to the GP
Signs of low mood, withdrawal, or refusal of care — particularly in people with dementia or cognitive impairment
Your relative says they don't feel safe

Trust your instincts. If something feels wrong in the first week, raise it with the care agency's supervisor immediately. Don't wait for the scheduled review.

The care plan review — usually at week two

Most providers conduct a formal care plan review at around the two-week mark. This should involve:

A conversation with your relative (and family members if appropriate) about how the care is going
A review of any changes to health or functional ability since discharge
Any adjustments to the schedule, tasks, or carer allocation
Documentation of the review and updated care plan

If the provider hasn't initiated this review by the end of week two, request it. The first fortnight almost always reveals things the initial care plan didn't account for — this is normal, and a good provider will use that information to refine the plan rather than treating the initial version as final.

How to make the adjustment easier for your relative

Accepting care at home can feel like a loss of independence, even when it's clearly necessary. Your relative may resist, feel embarrassed, or need time to trust the carer who's helping them with intimate tasks. Here are things that help:

Involve them in choices where possible. Even small choices — when the carer visits, what they have for lunch, the order they do things — preserve a sense of control. Good carers understand this instinctively.

Don't step back too quickly. In the first week, being present for at least some visits helps your relative feel safer and gives you a direct read on how the care is going. This isn't about supervising the carer — it's about reassurance.

Talk about the carer positively. If your relative is anxious about a stranger in their home, your attitude signals to them how safe the situation is. Familiarity builds quickly if the relationship starts positively.

Watch for loneliness, not just physical needs. The transition from a hospital ward — with its constant activity and human contact — to being home can trigger a significant dip in mood. If your relative is seeing a carer once a day for 30 minutes and no one else, that may not be enough human contact. Consider whether the care package should include companionship time.

When to seek a re-assessment

If your relative's needs are significantly different to what was anticipated at discharge, or the current care package isn't meeting them, you can request a formal re-assessment. For local authority-funded care, contact the assigned social worker or Adult Social Care team. For NHS CHC, contact the care coordinator or ICB.

You don't need to wait for a scheduled review. If the situation has changed, the right time to request a re-assessment is now.

If the care isn't working — changing providers

The first two weeks sometimes reveal that the chosen agency isn't the right fit. This is more common than agencies like to admit, and it's not a failure. Change provider if:

The care consistently fails to meet the plan
The relationship between carer and client has broken down and a new carer hasn't solved it
You lose confidence in the agency's management or communication
Your relative is distressed and the distress is related to the care, not the underlying condition

Check your contract's notice period before changing. In an emergency, contact your local authority or ICB (if NHS-funded) to request interim support while a new arrangement is made.

Care-AI-UK can help you find a new CQC-registered provider quickly, with verified ratings and availability information so you're not starting from scratch.

A note on the longer term

The first two weeks is the beginning, not the end. Good home care evolves alongside the person it supports. When the arrangement is working well, you should see:

Your relative's confidence and wellbeing stabilising and improving
A carer (or small team of consistent carers) who knows your relative well
A care plan that is regularly reviewed and updated
Clear communication between the agency, family, and GP
A sense that your relative is living at home — not just surviving there

That's what the right home care, found quickly and vetted carefully, makes possible.

Find a verified home care provider near you →

In this series:

Article 1: What happens to home care when someone is discharged from hospital?
Article 2: Who arranges home care after hospital discharge — NHS, council, or you?
Article 3: NHS Continuing Healthcare explained — how to apply and what you're entitled to
Article 4: Questions to ask a home care provider before you agree to anything

The First Two Weeks at Home After Hospital: What Good Care Actually Looks Like