OBJECTIVE: To explore the service and support needs of individuals with acquired brain injury (ABI) and their family caregivers during the transition phase from hospital to home. METHODS: The study utilised a qualitative research design. Participants included 20 individuals with ABI and 18 family caregivers recruited from a specialist inpatient brain injury rehabilitation unit. Data collection entailed in-depth semi-structured interviews, which were conducted at three time points: pre-discharge, and 1- and 3-months post-discharge. Thematic analysis of the interview transcripts involved open, axial and selective coding techniques. RESULTS: The following primary themes, each with associated secondary themes, emerged from the analysis: (1) balancing the service and support equation; (2) negotiating the rehabilitation maze; (3) working with or against 'the system'. The first theme describes the varying types and level of support received by participants during the transition phase, while the second theme highlights the difficulties participants experienced in negotiating the rehabilitation process between hospital and home. The final theme depicts the challenges experienced by participants in accessing and utilising service support. CONCLUSIONS: The findings suggest that the scope of existing service models need to be extended to bridge the existing gap between inpatient and community services, thereby easing the impact of transition.