The 72 hours after discharge decide whether they go back

Discharge feels like the end of the emergency. It is closer to the start of the risky part. Your parent leaves a building where someone checked on them every few hours and arrives somewhere nobody does.

Before anybody leaves the hospital

1. Get the medication reconciliation in writing, and compare it line by line against what is in the cabinet at home. Ask specifically which medications were stopped, which were changed, and which are new. The dangerous case is a drug that was discontinued in the hospital while the old bottle sits at home.
2. Book the follow-up appointment before you leave the building, with a date on the calendar, not an instruction to call.
3. Ask for the discharge summary and the name of the physician who signed it.
4. Ask for training on anything you will be doing. Many states have adopted CARE Act laws requiring hospitals to record a family caregiver and offer instruction on the tasks that person will perform at home. If you will be handling a wound, an injection, oxygen, or a transfer, ask to be shown before you leave.
5. Ask what would make you call, and who to call. Get a number that reaches a person after five o'clock.

What to have ready at home

• A clear path from the bed to the bathroom, at night, with a light
• Nothing on the floor between those two rooms, including the rug everyone forgets
• Food that requires no standing and no cooking for the first three days
• A phone within reach of the bed, charged
• One written page taped where you will see it: medications, doctors, and the number to call

The first 72 hours

Set a rhythm rather than hovering. Check in the morning, at midday, and in the evening, and watch for four things:

• Confusion that is new, which is often the first sign of infection, dehydration, or a medication problem, and is easy to mistake for tiredness
• Not drinking, which sends more people back than almost anything else
• Pain that is not controlled, because people stop moving, and stopping moving starts the next problem
• Any fall, near fall, or unsteadiness, reported to the doctor even if nothing was hurt

If the discharge feels too early

You can say so, and there is a formal path. Medicare beneficiaries have the right to a fast appeal of a discharge decision, explained in the notice hospitals are required to give, often called the Important Message from Medicare. Ask the case manager for that notice and for the phone number of the review organization. Filing on time generally keeps coverage in place while the case is reviewed.

You do not need to be certain to ask. You need to be uneasy.