12 questions to ask before your parent leaves the hospital

The discharge conversation is one of the highest-stakes ten minutes in healthcare, and it usually happens while your parent is tired, you are relieved, and the nurse has four other patients to discharge before shift change. Preparation is the only defence. Print this, or keep it on your phone, and do not let the door close until you have answers.

1. 1.What was the diagnosis, and what actually changed during this stay? Ask for it in plain words, and ask for the discharge summary to be sent to the primary care doctor and, if permitted, to you.
2. 2.Which medications are new, which were stopped, and which changed dose? Ask for a single reconciled list, and ask specifically about anything that was in the cabinet at home and is not on the list.
3. 3.Which follow-up appointments are needed, by when, and who is scheduling them? “Follow up with cardiology in one week” is not an appointment. Ask whether the hospital will book it or the family must, and get the phone number either way.
4. 4.Has home health been ordered? If so, which agency, when is the first visit, and what will they be doing? Ask the agency’s name and number, and confirm they have received the referral.
5. 5.What equipment does she need at home, and who is supplying it? Walker, commode, shower chair, hospital bed, oxygen. Ask whether it will be delivered before or on the day of discharge, and from which supplier.
6. 6.What warning signs should we watch for, and which ones mean call the doctor versus call 911? Ask for the specific signs for her condition, written down.
7. 7.Who do we call at 9pm on Saturday? Get a number that will be answered after hours, not just the clinic line.
8. 8.Was this stay inpatient or observation? It affects whether Medicare will cover a skilled nursing facility afterwards. If observation, ask why, and ask whether the status can be reviewed. The hospital must give a written notice (the MOON) if observation lasted more than 24 hours.
9. 9.What are the diet and activity restrictions, and for how long? Low sodium, thickened liquids, no lifting, no driving, no stairs. Each one changes what the family has to arrange.
10. 10.Has her primary care doctor been told she was here? Often the answer is no. Ask that the summary be faxed today, and call the office yourself tomorrow.
11. 11.What do we need to do in the first 48 hours? Ask the nurse to list it: which pills tonight, who is coming tomorrow, what to check.
12. 12.If we do not think she is ready to go home, what are our options? You have the right to an expedited appeal of a Medicare discharge. Ask for the Important Message from Medicare notice and how to contact the Quality Improvement Organization (QIO). The hospital must tell you.

The discharge nurse can answer most of these. The case manager or discharge planner handles home health, equipment, facility placement and appeals. The hospitalist or attending physician is the one for medical questions and for the medication rationale. If the answers you get are vague, ask to speak to the case manager by name, and ask the nurse to page the physician before discharge. That is allowed. Families are often reluctant to slow things down. Slowing down by an hour is worth it.

Put them in one place: a folder, a shared note, a document the family can see. The discharge summary, the medication list, the appointment dates, the agency and supplier names and numbers, the warning signs and the after-hours number. Then, over the next 72 hours, check each one: did the agency call, did the equipment come, are the appointments booked, do the pills at home match the list. Most readmissions in the first month come from one of these quietly not happening.