Hospital to home in Ontario: a discharge-day checklist for families

Get the discharge summary in paper and ask for it to be emailed. You will need it for the family physician, for any home care nursing order and for insurance.

Ask for a medication reconciliation written out: what changed, what stopped, what is new, and what interacts with what. Bring every bottle currently in the house so the pharmacist can compare. Ontario hospitals discharge patients with new prescriptions that regularly conflict with what is already in the cupboard.

Ask three specific questions and write down the answers: what should be better by day seven, what should make you call, and what is the follow-up appointment, with whom, and where. You will not remember them in the parking garage.

Confirm whether a home care referral has been made and to which Home and Community Care Support Services office. If nobody has made one, ask for it to be made before you leave — it is far harder to arrange from home three days later.

Clear the path from the door to the bed and from the bed to the washroom. Remove every loose rug, coil every cord, and move anything that requires reaching or stepping around.

Set up a recovery station on one floor: water, phone charger, medication list, something to call for help with, snacks and the discharge paperwork.

Check the washroom. A non-slip mat in the shower or tub, a grab bar if there is not one, and a raised toilet seat if standing from a low height is difficult. These three inexpensive items prevent a large share of post-discharge falls.

Watch for the red flags rather than the obvious ones: new confusion, fever, increasing redness or drainage at an incision, calf pain, shortness of breath, or a sudden drop in how much they are drinking.

Keep a written log of intake, output, medication taken and any symptom for the first three days. Clinicians trust a written log far more than a recollection, and it shortens every subsequent phone call.

Confirm who is actually coming into the house and when. Home care nursing visits are often scheduled several days out — and that interval is exactly the gap private personal support exists to cover.

The family caregiver is the part of this system most likely to fail, and they almost always fail silently. Arrange respite before you need it, not after. A standing Wednesday afternoon is a plan; a crisis on a Sunday is not.

If you are in Ontario and struggling, your local Home and Community Care Support Services office can also assess the caregiver, not only the client. Ask — most families do not know that is available.