When a Parent May Not Be Able to Go Home After the Hospital

If your parent is in danger right now, or their condition suddenly gets worse at home, call 911. If they are already in the hospital, these steps help in the first day or two:

1. 1

   Ask to be named the family caregiver

   California Health and Safety Code section 1262.5 says each patient admitted as an inpatient must have the chance to name one family caregiver. The hospital must notify that person of discharge or transfer as soon as possible, and no later than when the doctor writes the discharge order.

2. 2

   Ask about status every day

   Medicare.gov advises patients or caregivers to ask the hospital or doctor each day whether the patient is an inpatient or an outpatient. The answer affects costs and later coverage.

3. 3

   Meet the discharge planner early

   Ask for the social worker or discharge planner on day one. Tell them your concerns about home, who lives with your parent, and what help is realistic.

None of this commits your family to a move. It keeps choices open while the medical team works out what your parent needs.

Medicare.gov explains that a person is an inpatient starting when they are formally admitted to the hospital with a doctor's order. Observation services are hospital outpatient services given while the doctor decides whether to admit the patient. A person under observation is an outpatient even if they spend the night in the hospital. The hospital must give a Medicare Outpatient Observation Notice to a patient who gets observation services for more than 24 hours.

This matters if your parent might need a short stay in a skilled nursing facility for rehab. Medicare says it covers skilled nursing facility care only after a qualifying inpatient hospital stay of at least 3 days in a row, counting the day of admission but not the day of discharge. Time spent as an outpatient before admission, including observation, does not count toward those 3 days. The person generally has to enter the skilled nursing facility within 30 days of leaving the hospital and need skilled care related to the hospital stay.

If your parent has a Medicare Advantage plan or other coverage, ask the plan which rules apply to them. Medicare.gov also says a fast appeal is available while still in the hospital if a person was admitted as an inpatient and the hospital then changed their status to outpatient getting observation services.

Under section 1262.5, every California hospital must have a written discharge planning process. For patients likely to suffer harm without a plan, the hospital must arrange appropriate care after discharge, which the law says includes care at home, in a skilled nursing or intermediate care facility, or from a hospice. The patient and family caregiver must be told what care will be needed after discharge, including about medications, in a language they can understand, with a chance to ask questions.

Hospitals must also give patients who are expected to need long-term care at discharge contact information for at least one public or nonprofit agency offering information on community-based long-term care, such as the area agency on aging. Medicare's discharge planning checklist suggests asking:

• Where will my parent get care after discharge, and what are the options?
• Will they need medical equipment, such as a walker, is it covered by Medicare, and who will arrange delivery?
• Can my parent bathe, dress, use the bathroom, climb stairs, cook and manage medications on their own now?
• Which medications should continue, stop or change, and can we have an updated list?
• Can you show the family caregiver how to do any skilled tasks, such as changing a bandage?
• What will insurance cover, how much will we pay, and is there help with costs?
• Can we have written discharge instructions we can read and understand?

If your parent's first language is not English, ask for an interpreter at the discharge meeting. Our guide to interpreters and language rights in senior care explains what hospitals must offer.

Families usually weigh a few paths: home with more help, a skilled nursing facility for rehab if your parent qualifies, or a move to an assisted living community or board and care home, licensed in California as a residential care facility for the elderly (RCFE). Some families use a short skilled nursing stay first and decide on longer-term care after. Our overview of senior care levels in California compares each one.

Money shapes these choices. Medicare says it does not pay for long-term care, also called custodial care, whether in a nursing home or in the community. A skilled nursing stay for rehab is a different, time-limited benefit with the rules above. Ask the hospital social worker or your parent's health plan what your parent's coverage would pay for each option.

If the hospital plans a discharge you think is too soon, Medicare says patients should get a notice called the Important Message from Medicare within 2 days of admission. To ask for a fast appeal, follow its directions no later than the day of discharge. An independent reviewer decides, and the patient can stay in the hospital while waiting for the decision.

A move straight from the hospital to an RCFE is possible, but the home has its own steps. Before admission, California's Title 22 rules require the home to interview your parent and their responsible person, complete a pre-admission appraisal, and obtain a medical assessment signed within the last year (sections 87456 to 87458). A home may accept only people whose needs fit the state's acceptance and retention limits (section 87455). The steps, papers and timing are covered in hospital discharge to assisted living.

Start early. A family that has visited a few homes before the discharge date has far more choice than one that starts the day before.

Hamssa Benrekia has worked with families whose relative was in a hospital or skilled nursing facility, and has coordinated with case workers and social workers during discharge. She helps families in the South Bay and Harbor area of Los Angeles County find licensed assisted living communities and board and care homes through hospital discharge placement. She does not place in skilled nursing facilities. To talk it through, contact Hamssa. More topics are in the California Assisted Living Placement Guide.