Hospital discharge checklist for an elderly parent

Picture the call. You're at work, or in the car, or finally asleep. A cheerful voice tells you your mother is doing well and can go home today. Could you be there by two?

It sounds like good news, and mostly it is. It's also the moment when things get missed, because everyone is in a hurry and you are the only person in the room who has never done this before.

So don't trust your memory. Take a list. This one will do.

First, find the one person who knows

Somebody on that ward is in charge of getting your parent out of the door. In American hospitals the job is often called discharge planner or case manager. In a UK hospital, ask the ward staff who is arranging the discharge. Get a name and a direct number and write both down. You will want them again, usually at about seven in the evening.

Six questions before anyone puts a coat on

1. Why were they admitted, and what is the diagnosis now? Ask for it in words you could repeat to your brother on the phone. If you can't repeat it, you haven't really been told yet.
2. Which medicines are new, changed or stopped? In writing. "The same as before, plus the water tablet" is not a medication list.
3. What warning signs should we watch for, and what do we do if we see them? Ask which ones mean "call the doctor" and which ones mean "call an ambulance". Those are two different lists.
4. Are there limits on eating, walking, bathing or driving? And until when.
5. Who do we call with questions once we're home? You want a number that somebody answers at night. Questions don't keep office hours.
6. Can they safely be alone? If the honest answer is no, who is there for the first few nights? This is the question people skip, because the answer is inconvenient.

Six things that should be sorted before you leave

1. Follow-up appointments are booked. You know with whom and when. "Someone will be in touch" is not an appointment.
2. Home health, therapy or rehab has been ordered, and you know who is going to contact you.
3. Equipment is ordered, delivered or in the car. Walker, shower chair, commode, hospital bed, whatever was recommended.
4. Prescriptions have gone to the pharmacy, so you can pick them up on the way home instead of finding out at nine at night.
5. A copy of the discharge papers is in your hand. Not in the post.
6. Your emergency information sheet is up to date with the new medication list. If you don't have one, it is a single page: name, date of birth, medicines and doses, conditions, allergies, doctors, and who to call.

If you think it's too soon

Say so before they leave the building. Afterwards it is much harder. If you only take one sentence from this page, take this one:

Say this

"I don't think it's safe for him to go home yet. Who can I talk to about that today?"

You are not being difficult. You are the person who will be there at 3 a.m., which makes your opinion relevant.

In the United States, with Medicare. Within two days of admission the hospital should give your parent a notice called "An Important Message from Medicare about Your Rights". It explains how to ask for a fast appeal if you think the discharge is too early. Under Original Medicare the request goes to an independent reviewer (the notice calls it a BFCC-QIO), and it has to be made no later than the day of the planned discharge. Ask in time and your parent can stay in hospital while the reviewer decides, without paying for the stay beyond the usual coinsurance or deductibles. Medicare Advantage plans have their own appeal with different rules, so call the plan.

In England. Speak first to the hospital staff who arranged the discharge. If that doesn't settle it, the hospital's Patient Advice and Liaison Service (PALS) can advise you.

Two more sentences you can borrow

• "Before we go, I need the medicine changes in writing. Could you print them for me?"
• "Nobody can be with her tonight. What are the options if she can't be on her own?"

Say it politely, then stop talking. The silence does a surprising amount of the work.

The first night home

• Put the discharge papers and the medication list where everyone in the house can find them. Take a photo of both.
• Write the after-hours number on the same page as the warning signs. You don't want to be hunting for it later.
• Pick the one person the hospital and the doctor should call, and tell the rest of the family who it is.
• Keep a pen next to the list. Questions will turn up all week, and you will have forgotten them by the follow-up appointment.

None of this makes you a nurse. It makes you the person with the list, and on discharge day that is the next best thing.

This guide is general information to help you organize a discharge conversation. It is not medical or legal advice, and it doesn't replace what your parent's own care team tells you.