If you have ever tried to get a straight answer about your parent’s medical care, you know how confusing the system is. One person tells you to ask the doctor. Another says to call the case manager. A nurse says to wait for the physical therapist. A facility says to contact the primary care office. Meanwhile, you are left wondering who is actually responsible for your parent’s care and who is simply part of the process.
Here is the truth. The healthcare system does not have a single person overseeing everything. It has many people with different responsibilities, and unless you understand those roles, you will constantly feel lost.
This guide explains exactly who is in charge, when responsibilities shift, and who you should contact at each stage of your parent’s journey.
Part One The Biggest Misunderstanding Families Have
Families assume the doctor is in charge of everything.
Doctors are central to care, but they are not the ones coordinating the full plan. They make medical decisions, but they do not arrange services, communicate with every provider, or manage transitions.
Care is divided across many roles. Once you understand who does what, the entire system becomes easier to navigate.
Part Two Who Is in Charge in the Hospital
Hospitals have a very structured system, but families rarely receive an explanation.
The primary hospital doctor
This doctor oversees medical decisions such as diagnoses, medication changes, and treatment plans.
They do not arrange post hospital care.
The bedside nurse
Nurses monitor vitals, give medications, and support daily needs.
They do not decide discharge plans.
The case manager
This is the person responsible for discharge planning.
Their job includes:
- Arranging rehab
- Coordinating home health
- Sending referral packets
- Communicating with insurance
- Making sure orders are complete
If you want to know what happens after your parent leaves the hospital, the case manager is your main point of contact.
The physical and occupational therapists
Therapists determine whether your parent can safely go home or needs rehab.
Their evaluations influence insurance decisions.
The social worker
Social workers help with:
- Family concerns
- Emotional support
- Long term planning
- Elder resource guidance
Understanding these roles shows you exactly who to talk to and who is responsible for what.
Part Three Who Is in Charge After Leaving the Hospital
Once your parent leaves the hospital, responsibility shifts.
The primary care doctor
This doctor becomes the main medical decision maker.
They are responsible for:
- Reviewing medications
- Ordering follow up tests
- Monitoring recovery
- Referring to specialists
- Signing home health orders
But they do not manage day to day safety or coordinate services.
Home health agency (if ordered)
Once home health begins, the nurse becomes the leader of the home recovery plan.
They handle:
- Wound care
- Medication teaching
- Safety assessments
- Therapy coordination
- Monitoring symptoms
However, home health does not handle long term planning or supervision.
You, the family caregiver
Families are in charge of:
- Day to day safety
- Monitoring changes
- Scheduling appointments
- Communicating between providers
- Ensuring medications are taken
- Making decisions about next steps
This is why caregiving often feels overwhelming. Much of the responsibility falls on family, not the healthcare system.
Part Four Who Is in Charge in Assisted Living or Memory Care
Families often assume assisted living manages everything.
They do not. Assisted living provides support but not full medical oversight.
The facility nurse
This nurse oversees:
- Minor illness monitoring
- Medication management
- Daily care plans
But they cannot manage complex medical issues.
The primary care doctor
Still oversees medical decisions even if your parent lives in a facility.
The facility administrator
Handles staffing, care levels, billing, and safety concerns.
You, again
Families remain the central decision makers.
You decide:
- When to call the doctor
- When to request more help
- When needs increase
- When to consider a higher level of care
Facilities support your parent, but they do not replace family involvement.
Part Five Who Is in Charge in a Skilled Nursing Facility or Rehab
This is the one setting where families expect strong coordination but still face confusion.
The attending physician
Oversees medical decisions inside the rehab facility.
The therapy team
Runs the rehabilitation plan and determines progress.
The social worker or discharge planner
Responsible for:
- Discharge plans
- Equipment orders
- Home health referrals
- Communication with family
Facility nursing staff
Handle daily care and safety inside the building.
Even in rehab, many pieces are divided, which is why families must stay involved.
Part Six Who You Should Call for Each Problem
This section gives you the clarity most families never receive.
Medication concerns
Call the primary care doctor or home health nurse.
Confusion, wandering, or behavioral changes
Call the primary care doctor.
If in a facility, also notify the nurse on duty.
Decline in mobility
Call home health if services are active.
Otherwise call primary care for therapy referrals.
Discharge problems
Call the case manager at the hospital or facility.
Paperwork or insurance questions
Call the case manager, social worker, or insurance member services.
Sudden medical symptoms
Call the primary care doctor.
If urgent, go to urgent care or the emergency department.
Concerns about facility care
Speak with the charge nurse or administrator.
Having a simple map of who manages what prevents weeks of confusion.
Part Seven The One Person Who Holds It All Together
The healthcare system is fragmented. No single professional oversees everything.
The person who holds the system together is you, the family caregiver.
You are the central point of communication.
You track symptoms, schedule appointments, manage medications, and make decisions.
This is why caregiving feels heavier than families expect.
You are not imagining the complexity. You are coordinating a system built from disconnected pieces.
You deserve support in this role.
When You Need Someone to Guide the Whole Picture
If you want help understanding decisions, coordinating care, or making sense of the system:
Book a 1 to 1 Concierge Nursing Session
You will get:
- A clear explanation of who is responsible for each part of your parent’s care
- Guidance on who to call for which problems
- Support during discharge or care transitions
- A personalized care plan
- Clarity during confusing moments
You should never have to guess who is in charge.
Screenshot This Quick List Who Is Responsible for What
- Hospital case manager handles discharge
- Hospital doctor handles medical care
- Therapists decide rehab needs
- Home health nurse oversees home recovery
- Primary care doctor manages long term medical needs
- Assisted living manages daily support but not medical decisions
- You coordinate everything and make final decisions
