From Hospital to Home: Helping your elderly parent transition successfully


Everyone dreads that call from a sibling, parent or other family members saying “Mom fell and is in the hospital”, or “Dad had a heart attack; it looks like he will be okay, but he is in the ICU.”

Now what?  Too often we passively wait for the hospital staff to tell us what to do, and they can to a point.  However, there are things you can and should be doing to ensure that your loved one has a successful transition home.  Here are some tips from a discharge planner at a local hospital:

  • Be an advocate for you elderly parent or loved one from day one, or if you can’t, hire a Geriatric Care Manager to advocate for them.
  • Immediately find out who your social worker is.  Discharge planning starts at admission!  They need to know:
  1. What is the senior’s “baseline” or normal function at home?
  2. What equipment do they use, including hearing aids, canes, eyeglasses, lift chair etc.?
  3. Are there caregivers involved?  Who are they; family, friend or neighbor or paid professional?
  4. What other support are they getting? (Meals on Wheels, housekeeping help, other)
  • Appoint a family spokesperson or professional Care Manager as the point person or “go to” person for the hospital to be in regular contact with.  Be sure to have correct contact information for this person.
  • Have the family spokesperson (or professional Care Manager) touch base with the hospitalist daily regarding where the patient is in their progress toward discharge.  If the hospitalist is not available, talk with the nurse.
  • Have a family notebook in the patient’s room.  As family members come to visit have them record observations or pertinent knowledge of the patient.  (for example: “mom seemed more confused today”, or “Dad likes honey with his tea”; anything that will help the staff know your elderly loved one better.)
  • Make sure the hospital know who the Primary Care doctor is, and be sure they fax that doctor all records from the hospital stay on the day of discharge!  It is critical to a successful transition to home that this step is not overlooked.
  • Make and keep an appointment with the Primary Care doctor for the senior within 2 weeks of discharge from the hospital.  This is important follow up, and again, should not be overlooked.
  • If you do not understand something, ask questions!
  • Ask the hospitalist or social worker for referrals to community programs, if appropriate.  If you have hired a professional Care they will have many resources to share with you.

At Sound Options we believe that people enjoy more successful outcomes when they have an advocate and guide on their side to promote plans that address their unique needs, beliefs, and desires. We are here to help you!

Published on March 30, 2012.