Hospital Discharge to Assisted Living in California: Rights, Timeline and Paperwork

Yes, when the person's needs fit what this kind of home may provide. Assisted living communities and board and care homes are licensed in California as residential care facilities for the elderly (RCFEs). They provide care and supervision, meals and help with daily activities. They are not medical facilities.

That is the test the hospital team and the home will both apply. Someone who needs daily skilled nursing or therapy after the hospital stay is usually sent to a skilled nursing facility first, and may move to a care home later. Our guide on moving from skilled nursing to assisted living covers that second step.

Two decisions are being made in parallel. The hospital decides when your parent is medically ready to leave. The care home decides whether to accept. Neither can make the other's decision, and you are the link between them.

Health and Safety Code section 1262.5 sets out what a California hospital's discharge planning must include. It is worth knowing what you can ask for.

• Each hospital must have a written discharge planning policy and process.
• Arrangements for care after the hospital must be made before discharge for patients likely to suffer adverse health consequences without adequate planning.
• Each inpatient must be given the chance to name one family caregiver, and the hospital records the name in the chart.
• That caregiver must be notified of the discharge or a transfer to another facility as soon as possible, and in any event when the doctor issues the discharge order.
• The patient and caregiver must be told about care needs after discharge, including medications and how to take them, in a language they understand, with a chance to ask questions.
• A patient expected to need long-term care must be given contact information for at least one public or nonprofit agency that gives information or referrals on community long-term care options, such as the area agency on aging.

The same section says it does not require a hospital to adopt a policy that would delay a discharge or transfer. It also says that if the hospital cannot reach the named caregiver, the discharge is not held up. In practice this means the law gives you a seat at the table, not control of the date.

Medicare adds a separate protection. A hospital patient with Medicare should receive a notice called An Important Message from Medicare about Your Rights within 2 days of admission. If you believe the discharge is too soon, Medicare says your parent may ask for a fast appeal, following the directions on that notice, no later than the day of the scheduled discharge. An independent reviewer decides. Medicare Advantage plans follow different rules, so read the notice your parent was given. The page on hospital discharge placement explains the appeal in more detail.

This is information, not legal advice. If you do not think the plan will work, say so to the case manager and the doctor in plain words, and ask what the plan is for each need your parent has at home.

No one can honestly give you a number of days. This is the usual order, and the first three steps can all start the day you hear the word discharge.

1. 1

   Tell the discharge planner what you are considering

   Medicare's discharge checklist tells patients to ask where they will get care after discharge, what the options are, and to tell the staff what they prefer. Say that you are looking at a licensed care home and ask who your contact is.

2. 2

   Ask the hospital to complete the medical assessment

   A care home must have a medical assessment, made within the last year and signed by a licensed medical professional, before it accepts a resident. A hospital physician, physician assistant or nurse practitioner who has just examined your parent is well placed to complete it. Ask early.

3. 3

   Settle the budget

   Medicare does not pay for assisted living. Medicare's checklist suggests asking a social worker what insurance will cover and what you will pay.

4. 4

   Visit homes while your parent is still in the hospital

   Tour in person if you can. A short list of two or three is realistic in the time you have.

5. 5

   Let the home assess your parent

   The home must complete its own pre-admission appraisal. Ask whether someone from the home will come to the hospital to meet your parent, and give the hospital permission to share records with the home.

6. 6

   Agree the day and the handover

   Confirm how your parent will travel, who orders any equipment, and that prescriptions are filled before discharge so the first evening's medications are in the home.

Homes differ in what they ask for, but these items come up again and again. Collect them in one folder and ask the home which it wants sent directly.

• The completed and signed medical assessment. The state's form is the LIC 602A, and a home may use its own version.
• The result of the tuberculosis exam, which is part of that assessment.
• The updated drug list. Medicare's checklist says to review it with the staff and ask which drugs and doses continue after discharge.
• Written discharge instructions and a summary of current health status, which Medicare tells patients to ask for.
• Any new prescriptions, and the name of the pharmacy that will fill them.
• The equipment plan: Medicare suggests asking whether a walker or other equipment is needed, whether Medicare covers it, and who arranges delivery.
• Follow-up appointments, with dates, and who will take your parent to them.

This is common, and there are more than two choices. Ask the discharge planner what the options are for the gap. If your parent qualifies for a Medicare-covered stay in a skilled nursing facility, that can provide therapy and time. If not, some families arrange a short stay in a licensed home while they keep looking. Our guide to emergency assisted living placement explains what can and cannot be hurried.

Whichever route you take, the home's paperwork is the same. The move-in requirements guide lists it in full.

Hamssa Benrekia is a senior living placement specialist in Torrance with a background in hospice, palliative care and home health. She helps families in the South Bay and Harbor area of Los Angeles County find licensed assisted living, board and care and memory care homes, and she has coordinated with case workers and social workers during discharges. She does not place people in skilled nursing facilities and does not arrange home care.

She is not part of any hospital, and the home decides whether it can accept your parent. Her part is the short list, the tours and helping you talk terms. Contact Hamssa as soon as a discharge is mentioned. More on every stage is in the California Assisted Living Placement Guide.