Navigating the Hospital Discharge Process: What Caregivers Need to Know

When a loved one is hospitalized, it’s easy to feel overwhelmed, especially when navigating the hospital discharge process. “My loved one is being discharged from the hospital already? Now what?” is a common question asked of the Hurley Elder Care Law team.

Here are key pieces of advice that can help make navigating the hospital discharge process smoother and less stressful for families:

Start Planning Early

Begin discharge planning as soon as your loved one is admitted. While it may feel too soon, early planning gives you more time to coordinate care, explore resources, and make informed decisions.

Appoint a Family Point Person

Designating a single family member as the primary communicator can reduce confusion and ensure consistent information sharing with hospital staff and your family.

Catch the Doctors on Morning Rounds

It’s often challenging to speak directly with your loved one’s physician. Arriving at the hospital early—around 8:00 a.m.—increases your chances of catching the doctor during morning rounds.

Understand Medicare Requirements

If a discharge to a skilled nursing or rehab facility is likely, make sure your loved one is admitted under “inpatient” status—not “observation.” Medicare requires a minimum three-day inpatient hospital stay to qualify for sub-acute rehab coverage. Observation status doesn’t count, which can lead to unexpected out-of-pocket costs.

Know What Your Insurance Covers

Review Medicare policies and Medicare Advantage plans carefully before enrollment. Many Advantage plans have stricter coverage limitations for post-acute care, and families are often surprised by what’s not included.

Communicate with the Therapy Team

The hospital’s therapy team determines discharge to a rehab facility based on the patient’s progress and needs. Keep open communication with them and the hospital’s care coordinator to advocate for your loved one’s best outcome.

Home Health vs. Home Care—Know the Difference

Not all discharges lead to a facility—many patients go directly home. That’s when understanding your options becomes especially important.

Kelsie Scott, LCSW and Care Coordinator at Hurley Elder Care Law, explains:

“Home health care and home care are not the same. A physician prescribes home health and includes skilled services like nursing, physical therapy, or speech therapy—usually for a short period after discharge. On the other hand, home care includes non-medical support like help with meals, light housekeeping, and companionship, and Medicare does not cover it.”

Knowing which services are needed ensures a safe and seamless transition home.

The Bottom Line:

Hospital discharges can be fast-paced and emotionally taxing. But with the proper knowledge and preparation, caregivers can better advocate for their loved ones and ensure the next step—home, rehab, or another care setting—is as smooth as possible.

Do you need help navigating a complex hospital discharge or long-term care plan? Our team at Hurley Elder Care Law is here to support you. Call our intake specialists at 404-843-0121 for a complimentary phone consultation. Virtual appointments or in-person meetings at our four convenient locations (Atlanta, Duluth, Peachtree City, or Woodstock) are available with our experienced elder law attorneys.