The decision about a care home is almost always made in the one week nobody is fit to make it — and the questions arrive mixed together, so the ones that can be undone are decided alongside the ones that cannot.

What is on the table, and what each one costs to undo

Mark what has actually been raised, what brought this on, and how much time you are being given. The tool sorts the items by how hard each is to reverse, says which genuinely has to be decided inside your window, and separates the two lists. Nothing is saved and nothing leaves the page.

Why it arrives in a crisis, and what that does

• The trigger is almost never the decision. A fall, a chest infection, a night in a corridor, a carer with shingles — the event creates a gap of days or weeks, and a gap of weeks gets answered with a permanent arrangement because that is the arrangement somebody has a form for.
• The pressure is usually real and usually not about you. Hospital beds are genuinely needed, discharge teams are genuinely measured on delays, and none of that makes a decision better. It is possible to accept that the bed must be freed this week and still refuse to sign anything permanent this week — those are different sentences.
• Nobody in the room is at their best. The person is deconditioned and frightened, the family has not slept, and the professional has eleven other discharges. Decisions made in that state should be the ones that can be revisited.
• An interim placement is not a defeat, it is the correct move. A short-stay or intermediate-care bed while an assessment happens keeps every option open, and it is what the reversible column exists for.
• Watch for the two questions being merged. “Can they go home tomorrow?” and “can they ever live at home again?” are not the same question, and the first is often answered as though it settled the second. Ask which one is being asked.
• Recovery after a fall or an illness takes weeks, and it is often underestimated at the point of discharge. Somebody who cannot manage stairs on day four may manage them on day forty with rehabilitation, and a permanent decision taken on day four cannot know that.

The things that can be undone — do these now

• A respite or short-stay bed. Days to weeks, ends when you end it, and it converts an emergency into a scheduled decision. This is the single most useful thing available in the first week.
• A trial or interim placement, where that exists locally. It gives the person and the family real information — how they actually are in that building, with those staff — that no visit can provide.
• Intermediate care, reablement or rehabilitation at home, under whatever name it has locally. A few weeks of it changes what somebody can do often enough that it is worth asking for by name before any placement is agreed.
• Increasing the care package, or adding night cover for a fortnight. Expensive and temporary beats permanent and irreversible while the picture is still moving.
• Equipment, a key safe, a falls alarm, a stair rail, a commode. Cheap, fast, undone by removing them, and collectively they change what "unsafe at home" means. Ask for the occupational therapy assessment specifically.
• Asking for the assessment itself. Requesting an assessment commits you to nothing and starts a clock that is otherwise not running. So does asking for it in writing.

The things that cannot — and how they get presented as urgent

• Giving up a tenancy. For somebody in social or rent-controlled housing this is close to unrepeatable, and it is often raised in week one to stop rent accruing. Ask what the rent actually costs against what the tenancy is worth if the placement does not hold.
• Selling the home. Whatever the funding rules where you live, the sale itself is not urgent in the first weeks, and a house sold to fund a placement that ends after two months cannot be bought back. Ask specifically whether a deferred arrangement or a charge on the property exists locally.
• Moving out of area to a cheaper or available place. Distance is what determines whether anybody visits, and visiting is what determines how the placement goes. A bed forty minutes away that people reach is worth more than a better one nobody reaches.
• Signing a permanent contract with a long notice period or a large deposit. Read the notice period and the fee-increase clause before anything else in the document, and ask what happens if it does not work out in month two.
• Clearing and emptying the house. Once the furniture and the papers are gone, going home stops being a practical option regardless of anybody's intention. It is also the step families most regret rushing.
• Giving up your own job to provide care. This is the one that gets decided by nobody discussing it, and it is very hard to reverse at fifty-eight. Ask about carer's leave, reduced hours and a formal carer's assessment before resigning anything.

The assessment and the money, in general shape

The names, the thresholds and who pays differ in every country and often between regions. The shape does not, and knowing the shape is what lets you ask a useful question.

• There is normally an assessment of need, and it is separate from the question of who pays. Conflating them is how families conclude they cannot afford something they were never going to be charged the full price for.
• Ask for it in writing and ask for a copy of the outcome. The written record is what the next professional reads, and what an appeal is built from.
• There is usually a route for urgent cases and a route for planned ones, and the urgent route is often faster than the queue you were quoted. Ask which route you are on.
• Health-funded and social-care-funded are usually different pots with different rules, and which one applies can change the cost enormously. Ask explicitly which is being considered and why.
• The carer is normally entitled to an assessment of their own, in their own right, and it is one of the most under-claimed things in the whole subject.
• Get the numbers in writing before agreeing anything: the weekly fee, what it excludes, how often it rises, and what happens if funds run out. "Excludes" is where the surprises live — chiropody, hairdressing, incontinence supplies, escorts to appointments.

The visit, and what a visit cannot tell you

The other clock

• The carer's collapse is a real event with a real date, and pretending otherwise is not devotion. When the person providing care stops being able to, everything becomes an emergency at once, and emergencies produce irreversible decisions.
• Count the actual hours, out loud, once. Nights included. Most people carrying this have never added it up, and the number changes the conversation with everybody including themselves.
• Respite used routinely is what makes home sustainable, not what precedes giving up on it. Booked in advance, taken whether or not it feels needed, and not cancelled because the week improved.
• Two carers is a rota; one carer is a single point of failure. If the arrangement fails the moment you have flu, that is the thing to fix now, and it is fixable while nothing is wrong.
• Guilt is not evidence. The feeling that a placement is a betrayal is nearly universal and tells you nothing about whether this placement, now, is the right decision. What tells you is whether the person is safe and whether the arrangement can hold.
• Your own health, job and finances are part of the arithmetic, not a selfish intrusion into it. A carer who loses their income and their health has not produced a better outcome for anybody.

The person whose life it is

• Start from what they want, even when it cannot all be had. "I want to stay at home" and "I need help at night" are both true, and the useful question is which parts of home matter most — the house, the street, the routine, the cat, the independence — because some of those survive a move and some do not.
• A promise made years ago is not a plan. "I promised I would never put her in a home" is a real thing to have said and it is not a decision-making rule. What was promised was that she would be looked after.
• Being confused about some things is not being unable to decide anything. Capacity is decision-specific and can fluctuate; somebody may be unable to manage a bank account and perfectly able to say where they want to live. Ask for the decision to be explained again, at a better hour, before concluding they cannot make it.
• If they genuinely cannot decide, the standard is what they would have wanted, not what would reassure the family — and their earlier words, if anybody wrote them down, carry real weight.
• Legal authority for money and care is a separate subject with its own paperwork, best sorted before a crisis and still worth sorting during one. If nothing is in place, ask the social worker what happens in the meantime rather than assuming a spouse can act.
• Tell them what is happening, including the parts that are undecided. Being moved without explanation is its own harm, and people who are told what is provisional cope with it better than people who discover later that it was permanent.

What people believe, and what is so

The drill: 16 decisions

Sixteen ordinary afternoons — the discharge meeting on a Friday, the tenancy notice, the cheaper home an hour away, the contract with a four-week notice period. Most have an instinctive answer that feels decisive and closes a door that did not need closing. Pick your move; every answer explains why.

The card

Print it and take it to the discharge meeting. The top two lines are the whole of it.

🖨️ Print the card