Coming Home From the HospitalA Checklist for Families in Los Angeles

Discharge day moves fast. Someone hands you papers, a nurse explains new medicines, and then you are in the car with your parent, wondering what happens next.

This checklist slows it down. It covers what to ask before you leave the hospital, the first 48 hours at home, the first two weeks, and the signs that mean call the doctor or 911. It is written for adult children in Los Angeles, but it works anywhere.

Before discharge: five questions to ask

1. "Does the discharge plan include home health?" If your parent needs nursing or therapy at home, the hospital doctor can order it. If it is not in the plan, ask why.
2. "Can we choose the home health agency?" Yes. Under Medicare, the choice of agency is yours by law, and the hospital must honor it. You can name an agency, for example, "We would like Comfort Care Home Health Services." Medicare Advantage plans may limit the choice to their network, so ask the plan too.
3. "What is the complete medication list?" Ask for a printed list that shows new medicines, changed doses, and anything to stop. Compare it against the pill bottles at home.
4. "What equipment do we need, and who arranges it?" A walker, a shower chair, a hospital bed, or oxygen. Ask what is ordered, who delivers it, and when. Medical equipment is usually covered under Medicare Part B, with you paying 20% of the approved amount after the deductible.
5. "Who do we call with questions after we leave?" Write down the name and number. Ask when the follow-up doctor visit is and whether it is already scheduled.

Keep the discharge papers, the medication list, and the face-to-face visit note together in one folder. The home health agency will need them.

The first 48 hours at home

• Expect the first home health visit. Medicare rules for agencies say the first assessment visit happens within 48 hours of the referral or your return home, unless the doctor orders a different date. At Comfort Care, the first nurse visit usually happens within 24 hours after the doctor or hospital sends the order, and we call before we come.
• What the first visit covers. The nurse reviews every medicine, checks vital signs and any wounds, looks at how your parent moves around the home, and confirms eligibility. You get a written notice of rights and costs. Together, you start the plan of care.
• Set up the basics. A clear path from bed to bathroom, a night light, the phone within reach, and the new medicines sorted by day and time.
• Write down questions as they come up. Save them for the nurse or the doctor's office. No question is too small.

The first two weeks

• Know your coordinator. At Comfort Care, each family has one coordinator who knows their name and calls them back. Ask any agency who your point of contact is.
• Know who is coming and when. We call before every visit, so nobody sits waiting all day. If a different clinician has to come, we call first and say who.
• Learn the plan of care. Your nurse and your doctor set it with you and your parent. Ask what each visit is for, and what "better" should look like in two weeks.
• Fall-proof the obvious spots. Loose rugs, cords across walkways, a slippery tub, and stairs without a rail. The physical or occupational therapist will point out the rest.
• Keep the follow-up appointment. The follow-up visit with the doctor is part of staying out of the hospital. Ask the agency if transportation is a problem.
• Stay in the loop from far away. With your parent's okay, the agency can update you by phone even if you live across the country. Ask for it.

When to call the doctor, and when to call 911

Call 911 for chest pain, trouble breathing, sudden weakness or trouble speaking, a fall with a head injury, or heavy bleeding.

Call the doctor's office or your home health nurse for a fever, a wound that looks red or leaks, new confusion, dizziness, swelling in the legs, a reaction to a new medicine, or anything that worries you. Your care plan will list the specific warning signs for your parent's condition.

A note on paying for care

With Original Medicare, covered home health services cost $0 if your parent qualifies, according to medicare.gov. The agency must explain any costs in writing before care starts. Our guide on what Medicare covers has the details, and how to choose an agency lists the questions worth asking.