Guidance · Hospital to home
A Hospital Discharge Checklist for Elderly Parents
Collect the paperwork and answers before you leave, get the house ready for the paths your parent will use, and put the first week on one calendar. Here’s each step, and where we can help.
Endurance Home Care, the Stamford, CT family agency founded by brothers Chris and Tom Weldon, helps families bring a parent home from the hospital, and this checklist covers what to collect before you leave, how to get the house ready and how to plan the first week.
Doesn’t the hospital give us a plan?
It does, and it’s worth reading closely. Medicare’s Hospital Readmissions Reduction Program encourages hospitals to engage patients and caregivers in discharge plans, so expect paperwork that covers the orders, the follow-up and the medicines. What it can’t cover is home: who’s there in the afternoons, whether the way to the bathroom is clear, and who drives to the first appointment. That’s what this list is for.
If your parent was in the hospital for heart failure, diabetes with complications, pneumonia, COPD or a urinary tract infection, ask the team which signs mean you should call them. Together those five conditions accounted for 18.7 percent of hospital readmissions in 2020, so the hospital will have advice ready.
Endurance Home Care was started by brothers Chris and Tom Weldon, with their close friend Andrew Schwartz, after caring for their own grandmother. This checklist is the one families hand back to us first. For the bigger picture, read our family guide to transitional care after a hospital stay.
What to ask for before you leave the hospital
Six things to have in hand before you go. Each one is easiest to get while you’re still on the ward and can ask the team in person.
- The written discharge orders, printed and in your hand before you leave.Get it in writing
- An up-to-date medication list with every medicine, dose and time on it, including any that were stopped.Ask for this
- Who the follow-up appointment is with, and the date written down.Ask for the date
- Which services were ordered, and which agency is providing each one.Ask who
- Any equipment that was ordered, and the day it will arrive at the house.Ask when
- One phone number to call with questions once you're home, including in the evening.Ask for this
The fourth item is the one families most often leave without. If the doctor ordered nursing or therapy at home, that’s Medicare home health: it has to be ordered by a health care provider and provided by a Medicare-certified home health agency, and it comes as visits on that agency’s schedule. Follow the discharge team’s instructions for medicines, wound dressings and therapy. Our caregivers help with the day around them: meals, getting washed and dressed, moving safely, reminders and company. Ask which services you’re going home with, and write the answer next to the phone number.
Read next: what the first 72 hours after discharge look like.
How to get the house ready
Walk through the house once along the paths your parent will use most, and fix what you find. Each item shows the kind of help that covers it.
- Clear the path from the bed to the bathroom, and the path from the chair to the kitchen.Homemaking
- Put lights on in the hallway and on the stairs for getting up in the night.Homemaking
- Move everyday things to waist height, so nothing used daily is on the floor or up high.Homemaking
- Stock food that's easy to eat without cooking, and empty the bins before the homecoming.Homemaking
- Medicines set out the way the pharmacist or discharge team showed you, and someone to give a reminder at the right times.Medication reminders
- Someone close by for the first nights, and a ride booked for the first appointment.Safety supervision
You don’t have to do all of this yourself. Our caregivers help with the house and meals, medication reminders, rides to appointments, keeping someone safe as they move around, company, and hands-on personal care such as help in the shower and getting dressed. We provide personal care in Connecticut and New Jersey. In New York we provide companion care, by the hour, overnight, live-in or around the clock.
Who covers what in the first week
The first week comes down to one question: who’s taking care of each thing? Put the columns side by side and the gaps are easy to see.
| What the week needs | What the discharge orders cover | What the family arranges |
|---|---|---|
| Nursing or therapy visits | Ordered by a doctor and provided by a Medicare-certified home health agency. | The hours between visits: meals, getting washed and dressed, and company. |
| The follow-up appointment | Named in the discharge orders. | A ride there and back, and someone to sit with your parent in the waiting room. Transportation. |
| Medicines on time | Listed on the discharge medication sheet. | A reminder at the right times. Medication reminders. |
| Meals and a working kitchen | Not part of the orders. | Groceries and meals from the first day home. Homemaking. |
| Not being alone at night | Not part of the orders. | Someone in the house at night, awake if your parent needs help through the night. Overnight care. |
| Whether the plan still fits a month later | Not part of the orders. | Coordination of medical care and a customized monthly assessment, both of which Endurance is built around, with a Care Manager who keeps you updated. |
Put everything on one family calendar. Give each appointment a driver and each medicine time a person. Then look at the empty spaces, which are usually afternoons and nights. Those are the hours we can help with, so the family isn’t trying to cover them around work. If nights are the worry, overnight care gives you an awake caregiver for the night hours.
Start the calendar before the discharge date if you can. Most of what fills it comes from a short conversation with the hospital team, so bring our list of what to ask the discharge planner before you leave.
When there are more empty spaces than your family can fill, we can help.
It starts with a visit at home from one of our registered nurses, with the discharge papers on the table. Together you write the care plan: which hours need help, what kind of help, and what the family wants to keep doing itself. A Care Coordinator arranges the schedule and chooses a caregiver for your parent, who is introduced before the first visit. A Care Manager keeps you updated, and care plans are reviewed monthly after that, because a first week doesn’t look like a fourth one.
In the first weeks, a caregiver usually helps with groceries and meals, getting washed and dressed, reminders at the right times, the drive to the follow-up and the wait through it, and company, at night too if that’s when you need someone. If your list has more empty spaces than your family can cover, that’s the ordinary reason people call. Read how our transitional care support at home works.
Questions families ask before a discharge
What should be on a hospital discharge checklist for an elderly parent?
Before you leave the hospital, get the written discharge orders, an up-to-date medication list, the follow-up appointments with a ride booked for each, a note of which services were ordered and who provides them, and one phone number for questions. At home, clear the paths your parent will use, light the hallways and stock easy meals. Then put the first week on one calendar so you can see which hours still need someone.
How do I make the house safe before my parent comes home?
Walk the paths your parent will use most: bed to bathroom, chair to kitchen. Clear cords and loose rugs, light the hallways, move everyday things to waist height and stock meals that are easy to make. Safety Supervision and Homemaking are two of Endurance's listed services, so our caregivers can help with the house and with moving around safely, and when our nurse visits to write the care plan, you can walk through the rooms together.
What appointments happen after hospital discharge?
Your discharge orders name them. They often include a follow-up with the hospital team or surgeon, a visit to the primary care doctor and any therapy. Put every date on one calendar with a ride attached to each. Endurance coordinates clients' medical care and provides transportation, which one family said takes a lot off their plate. Our caregivers can drive your parent to appointments, wait with them, and help the family keep track of the dates, so nobody is scrambling for a ride.
Tell us what the first week needs.
Share the discharge date if you have one, and the hours you’re worried about. We’ll talk through the help that would make the first weeks easier. The first conversation is free, and nothing starts until you say so.