Leaving the hospital for a care facility: your rights and what to ask

“We are planning to discharge tomorrow” can land like a shock, especially when your loved one cannot go straight home. The good news is that you have more say in what happens next than it may feel like in that moment.

Your rights during discharge planning

Hospitals that take Medicare must follow federal discharge planning rules. Under those rules:

• The patient and their caregivers are to be treated as active partners in planning.
• When rehab or other post-hospital care is appropriate, the hospital must give you a list of Medicare-participating skilled nursing facilities, home health agencies, inpatient rehab facilities or long-term care hospitals that serve your area.
• The hospital must tell you that you are free to choose among them, and must respect your goals and preferences when possible.
• The hospital must disclose if it has a financial interest in a nursing facility or home health agency it refers you to.
• The hospital must help you use quality information to choose.

If you have Medicare Advantage, the hospital should remind you to check which facilities are in your plan’s network.

The “three-day rule” in one paragraph

For Original Medicare to pay for a skilled nursing facility, your loved one generally needs an inpatient hospital stay of at least three days in a row, not counting the day of discharge. Time under observation or in the emergency room does not count, even overnight. Ask the case manager today: “Is my mother an inpatient, or under observation?” The full rules, including 2026 costs, are in what Medicare covers after a hospital stay.

If the discharge feels too soon

Medicare patients should receive a notice called the Important Message from Medicare within two days of admission and again before discharge. It explains how to request a fast appeal. If you ask by the day of planned discharge, by contacting the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) listed on the notice, your loved one can stay while the review happens, without paying for those days beyond usual coinsurance or deductibles. Medicare Advantage plans have their own appeal rules.

Choosing a skilled nursing facility quickly

You may have a day or two, not weeks. Narrow it fast:

1. Ask which facilities on the list have a bed now and accept your loved one’s insurance.
2. Check those on Medicare’s Care Compare. Look at short-stay quality measures, the staffing rating, and recent inspection results. Our guide to nursing home star ratings explains what to look for.
3. Call the top two. Ask how many hours of therapy a day residents typically receive, and how soon a therapist will see your loved one after arrival.
4. If you can, have someone visit for twenty minutes. Smell, sound and how staff speak to residents tell you a great deal.

Questions to ask the case manager

• Is my loved one an inpatient or under observation, and since when?
• What level of care do you recommend after discharge, and why?
• Which facilities have you contacted, and which have accepted?
• Does the hospital have a financial relationship with any of them?
• What equipment, prescriptions and follow-up appointments will be arranged?
• Who will send records and the medication list to the facility?
• What happens if no facility on our list has a bed by discharge day?

Think one step past rehab

Medicare covers skilled nursing only while daily skilled care is needed, up to 100 days in a benefit period. Many families use the rehab weeks to plan what comes after: home with home health, assisted living, memory care, or a long-term nursing home stay. Starting that search in the first week gives you real choices.

If your loved one is going home instead

Sometimes the plan is home with support rather than a facility. Before discharge, make sure you know:

• Which home health agency will come, and the date of the first visit.
• Which equipment is being delivered, such as a walker, commode or hospital bed, and when.
• Which prescriptions are new, which were stopped, and where they will be filled.
• Who will be with your loved one the first night home, and who to call if things go badly.

If the honest answer to that last question is “no one,” tell the case manager. It may change the recommended plan.

The day of the move

Ask what time transport is scheduled and whether a family member can ride along or meet your loved one at the facility. Bring clothes labeled with their name, glasses, hearing aids, dentures and chargers. Plan to stay for the first hour if you can, to meet the nurse, confirm the medication list matches the hospital’s, and make sure the facility knows who to call.

Common questions

Can the hospital choose the nursing home for us?

No. The hospital must give you a list of options and tell you that you are free to choose. It may not limit you to certain qualified providers.

What if no nursing home will accept my parent?

Ask the case manager why facilities are declining and widen the search area. If the hospital moves forward with discharge before a safe plan exists, ask about your appeal rights on the Important Message from Medicare.

Does observation status count toward the three days?

No. Only formal inpatient days count toward Medicare’s three-day requirement for skilled nursing coverage.