Tracy E. Bingaman, MSPAS, PA-C

When a loved one has been cared for in short term rehab and is ready to be discharged to the care of family members at home, many questions may arise. Read on for tips to make the transition from short term rehabilitation to home as smooth as possible.


Be in contact with the rehabilitation facility. Be an active participant in the care of your loved one and in the discharge planning process. The point of contact for this is usually a case manager or social worker at the facility.

It’s helpful to understand why your loved one was admitted to the hospital, and what needs he or she had that necessitated a stay in a short term rehabilitation facility. Ask what the goals are for physical therapy and recovery while he or she is at rehabilitation.


Review and understand all of the medications your loved one is taking, especially new medications or medications that were changed during his or her time in the hospital or in rehab. Understand how to administer these medications and be aware of what each of the medications are intended to treat. Ask about side effects or special administration instructions.

It can be very helpful to have a weekly or daily pill organizer, especially in elderly patients who take many medications at different times of the day.  Pill boxes can be found at local medical supply stores and pharmacies.


Prepare your home for your loved one’s arrival. What devices, adaptors, or accommodations do you need to make? Does your home have stairs? If yes, will your loved one be prepared to navigate the stairs?

Will you need a stair lift, wheelchair, or hospital bed?

Make inquiries early and reach out to your local medical supply store to place orders or obtain information on available options.


Understand with what providers and when your loved one will need to follow-up. Have appointments been scheduled, or will you need to schedule them? Do they need to see any new specialists or follow-up with any new consultant physicians who saw them in the hospital?

Home Health Services

Inquire about what home health services your loved one will require upon transitioning home. Will physical therapy services be coming to the house? Will nursing care be provided after they return home? Will your loved one need personal care assistance? Regardless of the services needed, ensure you and/or the short-term rehabilitation staff have arranged for the appropriate services prior to discharge.

When to Call

Understand your loved one’s illnesses to understand key signs and symptoms for which you should watch. What are alarm symptoms? When should you call the doctor or go to the hospital or emergency department? Ask for clear, written discharge instructions that you can post and have on-hand for easy reference.

Being involved in each stage of the discharge planning process helps to keep you informed of your loved ones needs. Anticipating timing and functional status at the time of discharge helps you to plan ahead and prepare your home for the hopefully happy return home!

Please use our Provider Locator Search to find a Home Health Agency near you.



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