Background and Purpose— Very limited longitudinal data are available that assess the health-related quality of life (HRQOL) of stroke survivors after discharge from inpatient rehabilitation. The purpose of this research was to assess changes in HRQOL during inpatient rehabilitation and again 6 months after discharge. Methods— This was a prospective study of all eligible patients admitted to an inpatient stroke rehabilitation hospital over a 3-year period. HRQOL was assessed by means of the Medical Outcomes Study 36-item Short Form (SF-36). Dependent t tests were used to compare the scores at admission and discharge and at discharge and 6 months. Changes in HRQOL were calculated for the period of admission to discharge and of discharge to the 6-month follow-up. Results— Complete data were available for 85 patients. During rehabilitation, there were improvements in all 8 domains of the SF-36, with 5 attaining statistical significance. After discharge, 3 domains continued to improve, with 1 attaining statistical significance. However, there were marked and statistically significant declines in the other 5 domains of the SF-36. Feedback was obtained from a subset of the patients as to the reasons for these declines. Conclusions— Substantial gains in HRQOL during inpatient stroke rehabilitation may be followed by equally substantial declines in the 6 months after discharge. There is a need for longitudinal research into the HRQOL of stroke survivors and their families, as well as a need to ensure that adequate community services and support are available.