Hospital to Home Care

When a loved one is in the hospital, you know they’re in good hands. But what happens when it’s time for them to be discharged? Will they be going straight home or are they transitioning to another facility? How can you be sure they’ll receive the follow-up and rehabilitation care they need?

Unfortunately, leaving the hospital can be stressful, confusing, and rushed. Often, family caregivers may be handed a list of facilities or home care agencies and then told they only have a few hours to make decisions.

Safely transitioning from the hospital to home—and getting the care you need once you’re there—can speed your recovery, reduce the risk of readmission, and lower health care costs.

LivHOME can coach you and your loved one through the discharge process, helping with decision making and facilitating access to all needed services, including arranging non-medical care at home and getting durable equipment supplies.

The First 3 Days After Hospital Discharge are Most Critical

Studies have shown that the first 72 hours returning home after hospital are the most critical. Without the proper home care arrangements and professional recovery assistance, patients could be at risk of hospital readmission. In fact, patients between the ages of 75 and 84 accounted for 35.6% of all hospital readmissions in 2015, and research found that hospital readmissions that occur within 30 days of discharge cost Medicare approximately $17 billion.


After a hospitalization, it’s not unusual for a senior to be at an increased risk of falling. Our home care aides can help with preventing falls after hospital by:

  • Assisting with transitions from bed to standing, from standing to sitting, etc.
  • Helping with personal care, including showering and toileting
  • Decluttering and removing fall hazards around the home


To enjoy a full and healthy recovery, it’s essential the patient gets the proper nutrition after hospital discharge. However, maintaining a well-balanced diet can be difficult, especially if medical conditions and/or medications prohibit certain foods or ingredients.

LivHOME can help with meal planning and even prepare meals for the day or the week, paying particular attention to any dietary restrictions. Healthy meals will improve the patient’s recovery and bring the family the peace of mind that comes from knowing they’re loved one is eating well.

Hospital to Home Care Services for Post-Hospitalization

Returning home post-hospitalization or rehabilitation can be challenging. It’s likely that a loved one will not be able to return to their daily routines immediately, and they may need follow-up care, as well.

Since 1999, LivHOME has been providing in-home care services to help seniors recover safely and comfortably in the familiar surroundings of their own home. Our hospital discharge team can help:

  • Understand all discharge instructions and service orders
  • Schedule and monitor an in-home caregiver as needed
  • Drive you or your loved one home from the hospital if requested
  • Pick up prescriptions
  • Reconcile old and new medications with you or your loved one’s physicians
  • Perform a home safety evaluation
  • Confirm all home nursing and therapy services and equipment
  • Schedule follow-up doctor appointments
  • Clean out the refrigerator
  • Buy groceries
  • Prepare meals and clean the kitchen
  • Follow-up with family members or significant others
  • Put clean sheets on the bed and fresh towels in the bathroom
  • Do laundry and light-housekeeping
  • Provide services and integrated care 24/7 as needed

Frequently Asked Questions about Hospital Discharge Planning

If your elderly loved one is being discharged from a hospital or rehabilitation facility, you may be wondering where you can turn for more information about making a safe and smooth transition back home. LivHOME is here to answer your questions and will work with you and your elderly loved one to find the best possible solution to their in-home care needs post-hospitalization or rehabilitation.

Q: What is a Hospital Discharge Planner?

As your elderly loved one is preparing to leave the hospital, a hospital discharge planner will help explain the care that is needed for recovery. Be sure that you understand the discharge process and what special services may be required.

Q: Who Can Help Arrange Home Care Services?

A geriatric care manager can coach you and your loved one through the discharge process, working with the hospital discharge planner, helping with decision making, and facilitating access to all needed services, including getting help at home.

Q: How Can I Reduce the Chances of Rehospitalization?

A geriatric care manager will work with you, and your elderly loved one, to ensure their hospital discharge plan is implemented correctly. Also, your care manager will train and oversee all caregivers so that you can have peace of mind knowing that your elderly loved one has the services and support they need.

With LivHOME’s hospital discharge services, you can rest assured that your loved one will make a safe and smooth transition home post-hospitalization or rehabilitation. Our care team can help with every step of the process, from helping you understand discharge instructions and service orders to providing personal care and scheduling follow-up medical appointments.