Hospital Discharge Checklist for Elderly Parents: What to Ask

A good hospital discharge checklist for an elderly parent covers five things before anyone signs the papers: a medication list that says what's new, stopped and changed; follow-up appointments that are actually booked; any test results still pending and who will call about them; equipment and home services lined up before your parent gets home; and a name and number to call at 2 a.m. If your parent has Medicare and you think it's too soon, there's also a fast appeal, and it has a deadline.

This guide starts where the first 48 hours of a hospital stay leaves off: the team is talking about "going home tomorrow," and you're wondering what you're supposed to have ready.

The checklist at a glance

If you only have an hour, skip to the checklist for the day before.

What the hospital has to do (and what you can ask for)

Hospitals that take Medicare have to follow a federal discharge planning rule, 42 CFR 482.43. Few families ever read it, which is a shame, because it spells out what you're entitled to ask for. In plain English, the hospital must:

• Run a discharge planning process that treats the patient and their caregivers as "active partners" and fits the patient's own goals and treatment preferences.
• Identify early in the stay which patients are likely to have trouble after discharge without good planning, and evaluate them. You can ask for that evaluation yourself. The rule says it must also be done when the patient, the patient's representative or the patient's doctor requests it.
• Look at what your parent will likely need after the hospital (home health, a skilled nursing facility, hospice, even non-medical community help) and whether those services are actually available to them. The results have to be discussed with your parent or their representative.
• Have the plan done by, or supervised by, a registered nurse, social worker or similarly qualified person, and update it when your parent's condition changes.
• Send the necessary medical information to whoever takes over care after discharge, including the doctors responsible for follow-up.

If your parent is being referred to home health, a skilled nursing facility, an inpatient rehab facility or a long-term care hospital, the rule adds more:

• The hospital must give a list of Medicare-participating options that serve your parent's area (for a facility, the area your parent asks about, which helps if they'd rather recover near you) and note in the chart that the list was presented.
• It must tell your parent they're free to choose among them, and it can't steer them to particular providers.
• The plan must flag any home health agency or nursing facility your parent is referred to where the hospital has a disclosable financial interest.
• If your parent has a Medicare Advantage or other managed care plan, the hospital must tell you to check which providers are in the plan's network, and share what it knows about that.
• It must help you compare options using quality data. You can check the same data yourself on Medicare's Care Compare tool.

Many states also have a version of the CARE Act. The Family Caregiver Alliance's hospital discharge planning guide says it requires hospitals to record the family caregiver's name in the medical record, tell that caregiver when the patient will be discharged, and teach them any medical tasks they'll be doing at home. It's law in the majority of states, so ask whether yours is one.

Where is your parent going after the hospital?

Settle this first, since everything else depends on it. The usual options:

If it's home health, know what Medicare covers

Medicare.gov's home health services page says Medicare covers part-time or intermittent skilled nursing, physical and occupational therapy, speech therapy and some aide help, if your parent is "homebound." That means two things are true: leaving home isn't recommended because of their condition, or they can't leave without help (a walker, special transportation, another person); and they normally can't leave home, and doing so takes a lot of effort. Trips to the doctor and short, infrequent outings like church don't disqualify them. A doctor or other provider has to see them in person, confirm the need and order the care, and a Medicare-certified agency has to provide it.

What families are often surprised by is the list of things Medicare doesn't pay for: 24-hour care at home, meal delivery, homemaker services like shopping and cleaning, and personal care like bathing and dressing when that's the only care needed. If your parent will need someone there overnight, that's a family or private-pay question, so raise it with the case manager now, not at the curb.

If it's a skilled nursing facility, check the stay

Medicare.gov's skilled nursing facility care page says Medicare covers skilled nursing facility care only after an inpatient stay of at least 3 days in a row (the admission day counts, the discharge day doesn't), and your parent has to enter the facility within a short time (generally 30 days) of leaving the hospital. Observation days don't count toward the 3, which is why the first-48-hours guide linked at the top suggests asking about status every day. There are exceptions: some Medicare Advantage plans waive the 3 days, and so can a doctor in an Accountable Care Organization with a waiver, so ask. If the 3 days aren't met, Medicare.gov suggests asking about other settings like home health, or whether Medicaid or veterans' benefits could cover the stay.

The discharge checklist: the day or two before

Medicare's own discharge planning checklist (CMS product 11376) is a good printable. The list below follows it and adds pieces from AHRQ's Re-Engineered Discharge (RED) toolkit, a hospital program Boston University researchers developed that was shown to reduce readmissions. Hospitals use it from the inside; you can use it from the visitor's chair.

Medications

• Get the final medication list in writing, including over-the-counter drugs, vitamins and supplements.
• Go line by line: which are new, which were stopped, which had a dose change. The RED toolkit points out that patients often stop their regular medicines in the hospital and start new ones, and confusion afterward can lead to missed doses or duplicates.
• Ask what each new medicine is for and how long to take it.
• Confirm the allergy list, including what the reaction was.
• Decide which pharmacy, who picks up the prescriptions, and whether anything will be hard to afford. RED's discharge educators are told to ask exactly those questions, so it's fair for you to ask them too.
• Fill new prescriptions before your parent gets home. Medicare's checklist suggests running errands like this before discharge so you aren't making extra trips.

Bring your parent's medication list and update it on the spot. Ask the pharmacist what to do with home medicines that were stopped.

Tests and appointments

• Ask: "Are any test results still pending?" The RED toolkit says results that come back after discharge are frequently not followed up, and many of them need action. For each one, write down the test, when results are expected, and which doctor will review them.
• Get follow-up appointments booked, not just recommended, with dates, times and addresses.
• Figure out how your parent will get to each appointment.
• Ask how their regular doctor will find out what happened. The federal rule requires the hospital to send the necessary information; it doesn't hurt to call the office yourself and ask whether it arrived.

Equipment and services

• Ask whether your parent needs equipment (walker, commode, shower chair, hospital bed, oxygen), who orders it, and when it will be delivered. Medicare's checklist asks this too.
• Check that the equipment supplier is enrolled in Medicare and accepts assignment. Medicare.gov's durable medical equipment page says Medicare pays only for equipment from enrolled suppliers, and a supplier that doesn't accept assignment may charge more.
• If home health is ordered: get the agency's name and phone number and the date of the first visit.
• Ask about supplies like gloves, dressings or incontinence products, and who pays for them.

Training and warning signs

• Have the nurse or therapist show you any hands-on task (a dressing change, an injection, helping your parent from bed to chair) and then do it yourself while they watch. Medicare's checklist says to practice, not just observe.
• Ask which symptoms mean "call the doctor" and which mean "call 911," and write them down in plain words.
• Get a phone number for questions that works nights and weekends. The Family Caregiver Alliance lists this as a basic part of any discharge plan.
• Repeat the plan back. The RED toolkit uses "teach-back," where the patient explains the plan in their own words until it's right, and says to check the caregiver's understanding the same way. If you can't explain it, it wasn't explained well enough yet.

The Medicare notice

• If your parent is a Medicare inpatient, make sure you have "An Important Message from Medicare about Your Rights." Medicare.gov's fast appeals page says it comes within 2 days of admission, and if it was given more than 2 days before discharge, the hospital has to give your parent a copy of the signed one, or a new one, before they leave. If you don't see it, ask.

If you think it's too soon: the Medicare fast appeal

Start by telling the discharge planner, specifically and in writing if you can. The Family Caregiver Alliance suggests an email or text, since the planner will take your concerns to the doctor, who makes the call.

If that doesn't change anything and your parent has Medicare, here's how the fast appeal works, according to Medicare.gov:

1. Find the Important Message from Medicare. It has the instructions and the contact for your state's Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO), the independent reviewer. CMS's BFCC-QIO page links to a region map showing which of the two (Acentra Health or Commence Health) covers your state, or you can call 1-800-MEDICARE.
2. Ask for the appeal no later than the day your parent is scheduled to be discharged. Meet that deadline and your parent can stay in the hospital while waiting for the decision without paying for the extra days, apart from any usual coinsurance or deductibles.
3. The reviewer notifies the hospital, and by noon the next day the hospital gives your parent a "Detailed Notice of Discharge" explaining why it thinks they're ready. You can also ask for copies of what was sent to the reviewer.
4. The reviewer looks at the records and decides within one day of getting the information it needs.
5. If the reviewer agrees with you, Medicare keeps covering the stay as long as it's medically necessary. If it agrees with the hospital, your parent isn't charged (beyond the usual cost sharing) through noon of the day after the decision. Days after that may be billed.

Two catches. Miss the deadline and you can still ask for a review, but different rules apply and your parent might owe for days past the original discharge date. And Medicare Advantage plans have their own appeal rules, so check the plan.

Discharge day

Plan for the day to run long, and bring a phone charger. Before you leave the building, have:

• Written discharge instructions you can read and understand, plus a summary of your parent's current health status (both from Medicare's checklist)
• The final medication list and any prescriptions not already sent to the pharmacy
• The appointment list and the pending-tests list
• The Important Message from Medicare (for inpatients), plus the Medicare Outpatient Observation Notice (MOON) if your parent spent more than 24 hours under observation
• Names and direct numbers: hospitalist, case manager, home health agency, equipment supplier
• Their belongings: glasses, hearing aids and chargers, dentures, phone, keys, wallet

Bring easy clothes and shoes they can step into. If they came in with a cane and are leaving with a walker, ask the therapist how to get in and out of your car.

Getting the house ready

Ideally someone does this before discharge day. The Family Caregiver Alliance's questions for a discharge home are a good walkthrough:

• Is there space for any equipment, such as a hospital bed or commode?
• Are there stairs? Will they need a ramp, handrails or grab bars?
• Are area rugs and electric cords out of the walkway?
• Is the house adequately heated or cooled?

Add one from Medicare's checklist: buy food that fits any new diet instructions before discharge day, so nobody is grocery shopping with a tired parent in the car.

The National Institute on Aging's falls and fractures page adds two that matter right after a hospital stay: conditions that cause rushed trips to the bathroom can raise the chance of falling, and socks or smooth-soled slippers don't belong on stairs or bare floors. If the bathroom is far from the bedroom, that commode on the equipment list starts to make sense.

The first week home

The first few days are where plans come apart. A page in AHRQ's RED toolkit, last reviewed in 2025, says the RED studies found that up to half of patients weren't following their discharge plan 2 to 3 days after discharge. RED hospitals call patients at that point to review health status, medications, appointments, home services and what to do if a problem comes up. The toolkit's example is a woman who had stopped taking her diuretic because the bathroom was on the other side of the house; a commode solved it.

If the hospital calls, great. If it doesn't, make that call yourself, to your parent, on day two or three:

• Are they taking the new medicines, and only the ones on the new list?
• Did the home health agency call or visit?
• Did the equipment arrive, and can they use it?
• Are they eating, drinking and getting to the bathroom safely?
• Is anything happening that's on the "call the doctor" list?

Take the discharge paperwork and the updated medication list to the first follow-up appointment. Medicare's checklist says to bring both. If the doctor hasn't seen the discharge summary yet, you'll be glad you have it.

What to keep from this hospital stay

When things settle, file the discharge summary, the final medication list, the Medicare notices, and the names of the agency, supplier and any new specialist where you'll find them next time. The next admission goes faster when you can hand over a current list instead of rebuilding one in a waiting room. Our guide to important documents for aging parents covers what else belongs in that file.

Frequently asked questions

Can a hospital discharge an elderly parent who can't take care of themselves?

The hospital decides when the medical stay is over, but under the federal discharge planning rule it has to evaluate what care your parent will need afterward and whether that care is actually available, and discuss it with your parent or their representative. Tell the discharge planner in writing if the plan isn't safe. If your parent is a Medicare inpatient, they can also request a fast appeal.

Who is responsible for discharge planning?

The plan is put together by, or under the supervision of, a registered nurse, social worker or other qualified staff member, often called a case manager or discharge planner. Only the doctor can authorize the discharge itself.

Does Medicare pay for care at home after a hospital stay?

Medicare covers part-time skilled home health care for people who are homebound and have a doctor's order, through a Medicare-certified agency. It doesn't pay for round-the-clock care, meal delivery, housekeeping, or personal care when that's the only help needed.

How long does a Medicare discharge appeal take?

The reviewer decides within one day of getting the information it needs. If your parent asked for the appeal by the planned discharge day, they can stay in the hospital while they wait.

What paperwork should we get at discharge?

Written discharge instructions, a summary of current health status, the final medication list, follow-up appointments, any pending test results and who will review them, and the Important Message from Medicare.

One folder for next time

You can run this whole checklist with a notebook, the Medicare printable and a pen. The harder part is that every hospital stay asks for the same things: medications, allergies, doctors, insurance cards, the health care proxy. Emergency Binder Now gathers those once, through about 25 minutes of guided questions, into a printable binder with a one-page Emergency Information Sheet and a list of the gaps you still need to fill. See a sample binder to decide whether it would help.

This article is general information, not medical, legal or financial advice. Ask your parent's care team about their treatment and readiness to go home, and their Medicare plan or a State Health Insurance Assistance Program counselor about coverage and appeals.