A Home-Readiness Checklist Before Hospital Discharge

Walk the house before you promise the house

Discharge planners ask whether the person can go home. Adult children hear a yes-or-no. The better question is whether this home, this week, can hold this body. Love is not a grab bar. A sister in another state is not a night shift. This checklist is meant to be printed, argued over with siblings, and carried back to the case manager with empty boxes circled. Home is named more often because more families are older. The Administration for Community Living 2023 Profile of Older Americans reports 57.8 million Americans age 65 and older in 2022. Census Bureau QuickFacts for California (2025 vintage) reports that 17.5 percent of Californians are in that age group. Growth in the older population is not the same as a ready house.

It sits beside the hospital discharge checklist, which tracks inpatient versus observation, Medicare home health, Medi-Cal, and SOC 295. This page is the physical and family side. Use both. The care-path tool is the decision tree if the house fails the walkthrough. When home care is not enough is the honest next read.

Caregiver time

1. Name the person who will be in the home the first night, and the person who covers if they cannot.
2. Write a 24-hour sketch: who is there at meals, at toileting, at 2 a.m., at the first clinic visit.
3. Count the helpers who actually live nearby. A group chat is not a shift board.
4. If a family member will seek IHSS pay, start provider enrollment talk with the county. Paid hours still wait on authorization.
5. If you plan to hire a licensed agency, ask about minimum shifts and whether they can start the day of discharge. Staffing can lag. Ask what is typical.
6. If you work, say so. A job is not a moral failure. It is a scheduling constraint the hospital needs to hear.

California Caregiver Resource Centers exist for family caregivers. They do not replace a night of hands. They can help you name respite and education. Find services in my county is the California Department of Aging door.

Housing stability and safety

1. Confirm the address the person will sleep at, and that it is the county you will give IHSS.
2. Stairs, bathroom access, entry steps, lighting, and clutter: walk them with the same eyes a therapist would use.
3. Heat, water, electricity, and a working phone. Hospital at Home and ordinary home care both fail without utilities.
4. Pets, roommates, and whether medical equipment will fit through the door.
5. Lease status, landlord permission for ramps or hospital beds, and whether the home is at risk of a move.
6. If the home is a licensed community care facility, it is not “own home” for IHSS. Ask before you file.

If housing is the problem, say that plainly. A skilled stay can be a bridge while a safer apartment is found. Do not send someone home to a place that will not exist next month and call it a care plan.

Transportation

1. Who drives to the follow-up visit, and what happens if that person is at work?
2. Can the person transfer into a car, or is a wheelchair van required?
3. Is there a Medi-Cal transportation benefit to ask the plan about, or a hospital shuttle, or only family cars?
4. Pharmacy pickup the first week: who does it, and is delivery available?
5. If the person is homebound for Medicare home health, ask the agency how medical appointments fit that definition.

Missed follow-up is one of the ordinary ways a discharge unravels. Put the first three appointments on a shared calendar before the ride home. If no one can do the Tuesday draw, tell the case manager Tuesday.

Durable medical equipment and supplies

Medicare DME coverage is the federal sketch. A clinician orders. A supplier delivers. Coverage rules and coinsurance are theirs to explain. Ask for the supplier name, the delivery window, and where the equipment will be signed for. A commode that arrives at the hospital after the patient has left is not a commode.

• Walker, wheelchair, or rollator, sized to this person
• Hospital bed, overlay, or lift if transfers are unsafe
• Oxygen, if ordered, with backup power considered
• Toilet riser, shower chair, grab bars if the landlord allows them
• Wound or incontinence supplies for the first week, with a reorder plan
• Who teaches the family to use each item before the truck leaves

Out-of-pocket costs you should name out loud

Public programs leave gaps. Medicare skilled home health does not become a full-time attendant. IHSS hours, when authorized, follow the notice. Private agency minimums can surprise a family that thought they were buying a short visit. Equipment coinsurance, parking, time off work, and food for extra people in the house are real. Open costs for CareScout 2025 California statewide medians (non-medical caregiver, assisted living, nursing-home rooms). Open pay for coverage questions. Do not paste a wage into this checklist. County IHSS rates live on the CDSS wage page.

1. Which payer is being asked for the skilled episode, if any
2. Whether Medi-Cal is active or still on BenefitsCal
3. Whether a share of cost may apply; ask the county, do not guess an amount
4. Whether a private agency will be used, and the weekly floor they quoted you
5. Who holds the credit card for pharmacy and supplies this week

If the numbers only work if nobody sleeps, the house is not ready. That is the moment to reopen when home care is not enough and leaving the hospital. Print checklists. Skim conditions if a diagnosis is shaping the equipment list. Spanish readers can use alta hospitalaria. Ask for help if you want someone on the paperwork. The county, the supplier, and the hospital still decide their parts.