Questions to Consider When You Have Concerns About a Safe Transition

Being told that your loved one is ready to leave the hospital can be stressful—especially when you don’t believe they can safely manage at home.

You may be wondering:

“What am I supposed to do now?”

If you have concerns about a hospital discharge, speak up before your loved one leaves whenever possible.

A safe discharge should consider the patient’s condition, medications, follow-up care, ability to function, needed services, equipment, and the support available at home. The Centers for Medicare & Medicaid Services (CMS) requires hospitals to have discharge planning processes designed to help patients transition safely to their next care setting. (cms.gov)

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Start With the Most Important Question

Ask the healthcare team:

“What does my loved one need to be able to safely do at home?”

Then consider whether they can actually do those things.

For example:

• Can they safely walk?
• Can they get to and from the bathroom?
• Can they eat and drink adequately?
• Can they take medications correctly?
• Can they communicate their needs?
• Can they manage stairs?
• Can they get in and out of bed?
• Do they require wound care?
• Do they need oxygen or other equipment?
• Do they need supervision?
• Can someone provide the necessary care?

If the answer is no, explain specifically what your concerns are.

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Questions to Ask Before Discharge

Ask the healthcare team:

“Why is my loved one considered ready for discharge?”

“What care will they need at home?”

“Who is going to provide that care?”

“What happens if our family cannot provide it?”

“Does my loved one need home health or therapy?”

“Does any medical equipment need to be arranged?”

“Are all medications available?”

“Are follow-up appointments scheduled?”

“Are any test results still pending?”

“What warning signs should we watch for?”

“Who do we contact if something goes wrong?”

“What alternatives are available if home is not safe?”

Recommendations are involving patients and families in discharge planning and addressing medications, warning signs, test results, follow-up care, and the practical realities of returning home. (ahrq.gov)

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Be Specific About Your Concerns

Instead of simply saying:

“I don’t think Mom is ready.”

Explain why.

For example:

“She cannot walk to the bathroom without assistance.”

“She cannot manage her medications.”

“I work during the day and cannot provide 24-hour supervision.”

“We don’t have the equipment needed at home.”

“There is no one available to provide the wound care she needs.”

Specific concerns give the healthcare team information they can use when evaluating the discharge plan.

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Ask to Speak With the Appropriate Team Member

If you’re confused or concerned, ask whether you can speak with someone involved in discharge planning, such as a:

• Case manager
• Social worker
• Nurse
• Physician
• Care coordinator
• Other appropriate healthcare professional

Ask them to explain the discharge plan and available options.

CMS’s discharge-planning resources encourage patients and caregivers to participate in discharge planning and identify concerns about the patient’s ability to safely transition to the next care setting. (cms.gov)

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Remember: Your Concerns Matter

You know your loved one in ways the hospital staff may not.

You may know that your parent:

• Normally needs assistance walking
• Gets confused at night
• Cannot manage medications independently
• Lives alone
• Has difficulty using stairs
• Has no reliable transportation
• Has limited caregiver support
• Cannot safely perform basic activities

Tell the healthcare team.

Being involved in discharge planning doesn’t mean you’re being difficult.

It means you’re advocating for your loved one’s safety.

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What If the Discharge Still Doesn’t Feel Safe?

Continue asking questions and documenting your concerns.

Write down:

• Who you spoke with
• What you were told
• What concerns you expressed
• What services were recommended
• What equipment was ordered
• What follow-up was arranged

Keep copies of the discharge paperwork.

If your loved one is being discharged to another facility, ask questions about the receiving facility and the care that will be provided there.

If you believe your loved one is experiencing an emergency or a significant change in condition, seek immediate medical attention.

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How a Patient Advocate Can Help

Hospital discharge can become especially complicated when family members are overwhelmed, disagree with the plan, or don’t understand what needs to happen next.

A patient advocate can help you organize questions, understand healthcare information, prepare for conversations with providers, coordinate information, and navigate a complicated transition of care.

At Our Father Patient Advocacy, we help patients and families better understand and navigate the healthcare system.

We may be able to help with:

• Hospital discharge preparation
• Healthcare navigation
• Care coordination
• Medical record organization
• Appointment preparation
• Caregiver support
• Provider communication support
• Healthcare education

We do not replace your healthcare providers or make medical decisions. Our role is to help you become a more informed, organized, and confident participant in your loved one’s healthcare.

Concerned About Your Loved One’s Discharge?

You don’t have to navigate the healthcare system alone.

Visit ourfatherpa.org and use the Contact Form or send us a message 815-912-0202 to learn more about how Our Father Patient Advocacy may be able to help.

Your concerns deserve to be heard. Your loved one deserves an advocate.

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Related Resources

• Hospital Discharge Checklist for Family Caregivers
• What Questions Should I Ask Before My Loved One Leaves the Hospital?
• What to Do When Your Parent Comes Home From the Hospital
• Hospital to Home: A Caregiver’s Guide
• How a Patient Advocate Can Help With Hospital Discharge

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Last reviewed: August 2026

Disclaimer

This information is provided for general educational purposes only and is not medical advice, diagnosis, or treatment. Every patient’s situation is different. Discuss concerns about your loved one’s discharge with the healthcare team. If your loved one is experiencing a medical emergency, call 911 or seek emergency medical care immediately.