Coming home from the hospital

The safest hospital discharge starts before you leave the building. Know the medicines, warning signs, equipment, follow-up plan and who is responsible for the first night home.

The fuller answer

"Discharge" is a strange word for the moment when professional care becomes a household's job.

In the hospital, someone checks the blood pressure. Someone knows which pill is due and what it's for. Meals arrive, the bed moves with a button, and when something seems wrong there's a person in scrubs to ask. Then the doors open and it's the family's turn, with a folder of papers, a new list of medicines, an appointment to make, and someone who was trying hard to listen while they were frightened.

The ride home is where a lot of good medical care succeeds or fails. The federal agency that studies patient safety builds its discharge advice around the family for exactly this reason: the plan only works if it survives the trip.

Before you leave the building

Ask these while the nurse is still in the room. It's the last easy chance. - Which medicines changed? Which are new, which stopped, and which have a different dose? Get it in writing, and ask what to do with the old bottles still at home. - When is the follow-up, and with whom? Is it actually scheduled, or are you supposed to schedule it yourself? If you don't have a doctor to follow up with, say so now. Finding a doctor can help. - What should make us call, and what should make us come back? Ask for the specific signs. - Who do we call tonight if we have a question? - Is equipment coming? A walker, oxygen, a hospital bed, supplies? Who's bringing it, and when? - Does anyone at home need to learn a skill first, like a dressing change or an injection? Ask to be shown, and to try it once while someone watches.

If you think it's too soon

On Medicare, you have a right to say so. The hospital must give you a notice called An Important Message from Medicare about Your Rights within two days of admission and again before discharge, or a new signed copy before you leave. If you disagree with the discharge, follow the directions on that notice no later than the day you're scheduled to go. An independent reviewer, called a Beneficiary and Family Centered Care Quality Improvement Organization, asks why you think care should continue, looks at your records, and is supposed to decide within a day of getting what it needs. If you asked in time and the reviewer sides with the hospital, you are not responsible for the hospital charges, other than any coinsurance or deductibles, through noon of the day after the decision. Ask the nurse or case manager for the notice if you weren't handed one.

The first night home

Hospitals have bright hallways and a nurse call button. Homes have dark hallways and a spouse asleep down the hall.

Before bedtime, walk the route the patient will take at 2 a.m., from the bed to the bathroom. Move the rug. Turn on a night light. Put the walker where a hand can reach it. Set the new medicines apart from the old ones so no one reaches for the wrong bottle in the dark. Put the discharge papers where they'll be found, with the phone number on top.

The ride home is where a lot of good medical care succeeds or fails.

Much of good medicine is dazzling technology. Much of good recovery is somebody moving a rug. The CDC's home checklist for older adults reads like a to-do list for that first evening: keep objects off the stairs and the floor, remove throw rugs or secure them with double-sided tape or a non-slip backing, coil or tape cords beside the wall, put a lamp close to the bed and a night light along the way, and add grab bars next to and inside the tub and next to the toilet. The reason to take it seriously is that the CDC counts falls as the leading cause of injury death for adults 65 and older, with more than 43,000 deaths in 2024.

The next few weeks

• Get the prescriptions filled on the way home, if you can. The first dose is often due before the pharmacy opens tomorrow. In our listings, the Walgreens at 4849 N Highway 146 is open 7 a.m. to 11 p.m. every day, and the CVS Pharmacy at 1514 N Alexander Dr has store hours of 8 a.m. to 10 p.m. with the pharmacy counter open 9 to 9 Monday through Saturday and 10 to 6 on Sunday. Counter hours can be shorter than store hours, so check before you drive. The Baytown Clinic Pharmacy at 1602 Garth Rd fills prescriptions weekdays 8 to 5.
• Keep the follow-up appointment. The weeks after a hospital stay are a vulnerable time, and that visit is where problems are caught early.
• Bring every medicine to that visit, in a bag, so the doctor sees what's actually being taken. See The medicines in the house.
• Rides: if the patient has Medicaid and no other way to get to appointments, Texas's Medical Transportation Program books rides to covered care, arranged through your Medicaid plan or the program's website. Harris County's RIDES program subsidizes trips for eligible riders; ask the county whether it serves your address.

If equipment is needed

Ask the discharge planner which company is delivering and when. Duke Medical Equipment, 4306 Hugh Echols Blvd, lists home delivery, home setup and equipment service, with weekday hours of 9 a.m. to 5:30 p.m. Inhealth Medical Equipment is at 1715 N Alexander Dr. Under Medicare, you pay 20% of the approved amount for durable medical equipment after the Part B deductible.

If care is needed at home

Medicare covers home health care, with part-time skilled nursing or therapy in the home, when a doctor or other provider sees you in person, confirms you need it and orders it, and you're homebound. A Medicare-certified agency has to provide it. Medicare defines homebound as leaving home being hard, or not recommended, because of your condition. You pay nothing for covered home health services. Ask the hospital's case manager about it before discharge, not after. Bayview Home Health Services (1300 Rollingbrook Dr, Suite 310) and Enhabit Home Health (1300 Rollingbrook Dr, Suite 500) are two agencies in town. Ask whether each takes your coverage.

The person doing the caring

If you're the one who brought them home, you're allowed to be tired. Read When you're taking care of someone.

Before you go

• Ask the nurse for the discharge papers, the new medicine list and the follow-up date before you leave the room.
• Fill the prescriptions the same day, and check pharmacy counter hours before you drive.
• Walk the route from bed to bathroom in the evening light and again in the dark, and fix what you trip on.
• Ask who is delivering any equipment, and when it will arrive, so the first night doesn't depend on a truck.
• If you are on Medicare and the discharge feels too soon, ask for the Important Message notice and act before the day you're scheduled to leave.

Sources

AHRQ, IDEAL Discharge Planning; AHRQ, Brown Bag Medicine Review (Tool 8); Medicare.gov, fast appeals of hospital discharge and home health services; CDC, older adult falls and Check for Safety home checklist; Texas Medical Transportation Program (TMHP); Harris County RIDES.