The Safe Discharge Checklist

The discharge clock starts the moment a patient is admitted. About 20% of Medicare patients are readmitted within 30 days — most often because of inadequate discharge planning (CMS, 2023). Families who engage on day one get safe discharges. This is how.

Day one or two — meet the case manager and ask:

• "What's the current clinical thinking about discharge — when and to where?"
• "What insurance coverage is available for post-acute care, and for how long?"
• "What level of care will be needed — home, home health, skilled nursing, or higher?"
• "What do you need from us about the home situation to plan a safe discharge?" — then be complete and honest: who lives there, stairs, bathroom access, what the family caregiver can actually handle. A plan built on incomplete information falls apart at home.

If a skilled nursing facility is proposed:

• Know what the list you're handed is: available beds that take this insurance — not a quality ranking. You may choose any Medicare-certified SNF with a bed; you don't have to take the first one offered.
• Check every candidate at medicare.gov/care-compare — inspections, staffing, quality measures — before agreeing.
• Ask the case manager: "Which of these would you choose if it were your family member?" The honest ones will tell you.

If discharge feels too soon — your appeal right (Medicare):

1. The hospital must give written notice when it decides coverage ends (HINN). That notice triggers your appeal right — the QIO phone number must be on it.
2. Call the QIO the same day — before the discharge date. Timely appeals freeze costs while the review runs (about one business day).
3. If the QIO agrees with you, Medicare keeps covering the stay. If not, you owe costs only from the day after the decision. Appeals succeed in roughly 35–45% of cases; filing is free (OIG, 2022).

Do not leave the building until all six are confirmed:

1. Medication reconciliation — a complete written list: new, discontinued, changed doses. Ask the pharmacist to walk it with you.
2. Follow-up appointment booked — within 7 days; 48–72 hours for high-risk patients.
3. Equipment ordered and delivery confirmed — walker, wheelchair, oxygen, wound supplies.
4. Home health agency named — with phone number, and confirmation they received the orders.
5. Teach-back done — the patient or family repeats the care plan in their own words. If they can't, there's a gap to close before leaving.
6. Emergency criteria in writing — exactly which symptoms mean "call the doctor" and which mean "call 911." Vague instructions don't count.

Discharge planning isn't something that happens to your family. It's something you participate in — from day one.