Is this an unsafe discharge? Questions to ask before your parent leaves the hospital

Short answer: families use "unsafe discharge" when a parent is being sent home without a workable plan: no one to help, a home that isn't set up, unclear medications, or no follow-up arranged. Ask the discharge planner or case manager your questions before discharge day, and write down the answers. If your parent has Medicare and you think the discharge is too soon, Medicare's "Important Message from Medicare about Your Rights" notice explains how to ask for a fast appeal, no later than the scheduled discharge day.

Discharge can come fast, sometimes with a few hours' notice. If something about the plan worries you, the time to raise it is before your parent leaves, while the people who can change the plan are still down the hall.

This page is general information to help you organize questions, not medical or legal advice. Whether your parent is ready to leave is a medical decision for their care team. Medicare's rules are summarized from Medicare.gov; your parent's notices and plan documents are the official word for their situation.

What families mean by an "unsafe discharge"

It isn't an official Medicare term. Families usually mean one or more of these:

• No one is available to help at home, and your parent can't yet manage alone.
• The home isn't ready: stairs they can't climb, no way to reach the bathroom, equipment not delivered.
• The medication instructions are unclear, or don't match what they took before the hospital.
• Follow-up isn't arranged: no appointments set, no home health or rehab plan in place.
• Your parent seems confused or unwell, and you're not sure the team knows what you're seeing.

Questions to ask the discharge planner or case manager

• What is the planned discharge date and time, and who decided?
• Where is my parent going: home, rehab or a skilled nursing facility? Why that option?
• What help will they need at home, for how long, and who is arranging it?
• What equipment do they need, and when will it be delivered?
• Which medications are new, which changed and which stopped? Can we get that in writing?
• What follow-up appointments are needed, and who is scheduling them?
• What warning signs mean we should call the doctor, and what number do we call after hours?
• Who do we call with questions after we get home?

Write the answers down, with the name of the person who gave them. Medicare also publishes its own "Your discharge planning checklist" on Medicare.gov.

Who to talk to if you're worried

• The discharge planner or case manager: say specifically what worries you, such as "No one can be with her overnight for the first week."
• Your parent's doctor or the hospital team, about whether they're medically ready.
• The hospital's patient advocate or patient relations office, if your concerns aren't being heard.

Medicare's fast appeal: what Medicare.gov says

If your parent has Medicare and was admitted as an inpatient, Medicare.gov explains:

• The hospital should give a notice called "An Important Message from Medicare about Your Rights" (the IM) within 2 days of admission and before discharge. If you don't get it, ask for it.
• The IM explains how to ask for a fast appeal if you think the discharge is too soon. An independent reviewer, the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO), decides whether covered services should continue.
• Timing matters. Medicare.gov says to follow the IM's directions no later than the day of the scheduled discharge. If you ask within that time frame, your parent can stay in the hospital while waiting for the decision without paying for the stay, except applicable coinsurance or deductibles.
• Missed the deadline? You can still ask the BFCC-QIO for a review, but different rules and time frames apply, and your parent might be responsible for the cost of the stay past the original discharge date.
• Medicare Advantage plans have their own appeal process, with different rules.

Whether to appeal is your parent's decision, with their care team's input. If you have questions about the notice, ask the hospital or call the number on the notice itself.

Get organized before discharge day

Most of the stress of a discharge is information arriving all at once. Bring a notebook, collect every paper they hand you, and update the medication list before you leave. The Coming Home from the Hospital Kit gives you organizers for the discharge papers, medications, contacts, follow-ups and family tasks, with a filled-in example ($29, 30-day refund). The free medication list below is a good place to start.