Hospital Discharge to Assisted Living or Board and Care

Medicare's discharge planning checklist says the doctor and staff will work with you to plan the discharge, and that you and your parent are members of that planning team. The staff member you deal with may be called a discharge planner, a case manager or a social worker. That person is your main contact for what happens after the stay.

Use them. Medicare suggests asking where your parent will get care after discharge and what the options are, telling the staff what you prefer, and asking for written discharge instructions, a summary of current health status and an up-to-date drug list. Ask a social worker what insurance will cover and what you will have to pay.

Hamssa is not part of the hospital. She has worked with families whose relative was in a hospital or a skilled nursing facility at the time, and has coordinated with case workers and social workers during discharge. If you work in discharge planning, there is a page for social workers and discharge planners.

These rules come from Medicare. Medicare Advantage plans follow somewhat different appeal rules, so read the notice your parent is given.

• In a hospital, your parent should receive a notice called An Important Message from Medicare about Your Rights within 2 days of admission and before discharge. If you have not seen it, ask for it.
• If you think the discharge is too soon, your parent may have the right to ask for a fast appeal. An independent reviewer, called a Beneficiary and Family Centered Care Quality Improvement Organization, decides whether covered services should continue.
• In a hospital, the request must be made no later than the day of the scheduled discharge. Medicare says that if you ask in time, your parent can stay while waiting for the decision without paying for the stay, apart from any coinsurance or deductibles.
• In a skilled nursing facility, the notice is called a Notice of Medicare Non-Coverage. It should arrive at least 2 days before covered services end, and a fast appeal must be requested by noon the day before the end date on the notice.

The hospital may be talking about one kind of place while you are picturing another.

In California, a licensed care home must obtain a medical assessment before it accepts a person as a resident. Board and care homes and assisted living communities hold the same state license, called an RCFE, the state's category for residential care homes serving older adults, so the rule is the same for both.

The state's courtesy form for this is the LIC 602A, its Medical Assessment form for RCFEs. Until 2025 it was called the Physician's Report, and hospital staff may still use that name. It must be signed by a licensed medical professional, such as a physician, physician assistant or nurse practitioner, and the assessment must have been made within the last year.

The form covers physical health, capacity for self-care, cognitive conditions, behavior, whether the person can walk, and how medications are managed. The home also does its own pre-admission appraisal to decide whether it can meet your parent's needs. Ask the discharge planner early who at the hospital can complete the form, because the move cannot happen without it.

Nobody outside the hospital and the home can promise a date. This is the usual order.

1. 1

   Call as soon as you hear the word discharge

   Tell Hamssa where your parent is, what the staff say he or she needs, and your monthly budget. She will ask about care needs, health conditions, preferences and lifestyle.

2. 2

   Ask the hospital to start the medical assessment

   Give the discharge planner the form request the same day.

3. 3

   Review a short list

   Hamssa suggests homes that fit. She refers families only to homes licensed by the State of California that she has toured herself, after checking each one’s licensing record for citations and complaints. If a small home looks like the match, see board and care placement.

4. 4

   Tour, in person if you can

   She schedules the tours and goes with you.

5. 5

   The home appraises your parent

   The home reviews the medical assessment and does its own appraisal. Hamssa helps you talk terms with the home.

6. 6

   Move day, then a check-in

   Confirm with the discharge planner how your parent will travel and that medications and equipment arrive the same day. Hamssa checks in after the move.

A hospital deadline is a hard time to make a long-term decision. Ask Hamssa whether a short stay makes sense while you look further: see respite care placement. If your parent is going home on hospice, or the hospital has raised it, read board and care for someone on hospice. Background: assisted living in California.

Call or text 310-594-0694, or use the contact page and say that a discharge is coming.