You have been told they are being discharged. Now what?

Most families arrange home care for the first time under a deadline set by someone else. The hospital has a discharge date, the person is medically stable, and nobody at home is ready. What follows is the order that wastes the least time.

The first day

1. 1

   Ask for the discharge planner by name

   Every unit has one, sometimes titled care coordinator or social worker. They control the referral to Ontario Health atHome and can tell you what has already been requested.

2. 2

   Ask what home care has been approved, in hours

   Do not ask whether home care has been arranged. Ask how many hours per week of what service, starting which day. The answer is often smaller than families assume.

3. 3

   Say plainly what is not possible at home

   Discharge planning weights what family can provide. If nobody can be there overnight, or nobody can lift, say so explicitly and early. It changes the plan.

4. 4

   Ask whether this is a short-term or ongoing package

   Post-discharge hours are usually time-limited and taper after a few weeks.

The second day

• Work out the gap in hours between what was approved and what the week actually needs.
• Get quotes from two or three private agencies that serve the municipality. Most can start within 24 to 48 hours for personal support.
• Ask the hospital occupational therapist what equipment the home needs before discharge. Grab bars, a raised toilet seat and a bed rail are cheap and prevent readmissions.
• Confirm who is collecting medications and who is doing the first grocery run.

The first two weeks at home

Readmission risk is highest here. The things that cause it are mundane: missed medication, a fall on the way to the bathroom at night, not eating, and an infection nobody noticed. Front-load help into mornings and evenings rather than spreading it thinly through the day, and keep the first fortnight over-supported. It is easier to reduce hours than to recover from a fall.