New Orleans Senior AdvisorBy New Orleans Senior Advisor Care Team · October 3, 2026
Before discharge, confirm inpatient status, get the medication list and the follow-up appointments, and choose rehab, home health or a long-term setting. In the first 72 hours, watch for confusion, falls and medication errors, and call the home health agency or facility the moment something changes.
Before the discharge: three conversations
LDH's licensed roster lists 11 acute-care hospitals in the six parishes, from University Medical Center and Touro in the city to Ochsner's main campus on Jefferson Highway, East and West Jefferson, and St. Tammany Parish Hospital and Slidell Memorial on the Northshore. Wherever your parent is, the case manager is the person to find on day one.
First, ask in writing whether your parent is an inpatient or under observation, because only an inpatient stay qualifies for Medicare-covered skilled nursing facility care. Second, ask what the team recommends after discharge and why. Third, ask for the list of providers with an opening, then check them on this site before agreeing.
Choosing where to go
| If the team recommends | What to check first | Who usually pays |
|---|---|---|
| Skilled rehab in a nursing home | CMS ratings, staffing, short-stay outcomes, long-term bed if needed | Medicare after a qualifying inpatient stay |
| Inpatient rehabilitation hospital | Therapy intensity and discharge plan | Medicare, with physician approval |
| Home with home health | Agency start date and a caregiver for nights | Medicare for intermittent skilled care |
| Assisted living (ARCP) | Level, capacity and whether outside nursing is needed | Private pay |
| Long-term nursing home | Medicaid certification, CMS record, evacuation plan | Private pay, then Medicaid if eligible |
A Level 3 ARCP cannot provide nursing, but a resident can return to one with a home health agency visiting, and Louisiana allows a resident with a time-limited prohibited condition, such as wound vac therapy, to stay up to 90 days with physician certification.
Day one at home or in rehab
Bring the discharge summary and the medication list to the first appointment and to the facility or agency. Compare the new list with what is in the medicine cabinet, and remove anything that was stopped. Many readmissions start with a medication that was supposed to change and did not.
If your parent went home, make sure someone is there the first night. Confusion after a hospital stay is common in older adults and often worse in the evening.
Days two and three: what to watch
Watch for new confusion, a fever, worsening pain, swelling, falls, not eating or not drinking, and trouble with the bathroom. Call the home health agency or the facility nurse right away rather than waiting for the next visit. If your parent is in a rehab unit, ask when the first care plan meeting is and attend it; that is where the expected length of stay is discussed.
Planning beyond the rehab stay
Medicare covers a skilled nursing facility stay only while daily skilled care is needed, which often ends well before the 100-day maximum. Use the first week to plan the next step: a long-term bed in the same home, a return home with LT-PCS or Community Choices Waiver support, PACE if your parent's ZIP code is served, or an ARCP. Louisiana Options in Long-Term Care at 1-877-456-1146 is the number for Medicaid long-term care programs.
When the hospital says your parent cannot go home
Sometimes the team recommends a long-term setting rather than rehab or home. That is a hard conversation, and it usually comes with little time. Ask what specific needs drive the recommendation: continuous nursing, a feeding tube, severe confusion, an inability to transfer. Then ask whether a short rehab stay could change the picture. If a long-term nursing home is the answer, check Medicaid certification and the CMS record, and ask the case manager to send your parent's information to more than one home at once.
Returning to an ARCP after a hospital stay
If your parent already lives in an ARCP, call the director before discharge. The ARCP must reassess whether it can still meet your parent's needs, and the hospital needs to know what the ARCP can and cannot do. A Level 3 building will need a home health agency for any skilled care. A resident with a prohibited condition, such as a wound vac, can return only under the 90-day time-limited exception, which requires the physician's certification and agreement among the resident, the physician and the provider.
Keep one folder
Put the discharge summary, the medication list, the follow-up appointments and the names of the case manager, home health agency and facility contacts in one folder or one shared document. The next hospital visit, if there is one, goes faster when everything is in one place.
If your parent lives alone
A parent who lives alone needs a concrete plan for the first nights: a family member or paid caregiver staying over, a personal emergency response system, and a daily check-in call. If no one can stay, that is a strong argument for a short rehab or respite stay rather than going straight home. The risk of a fall or a medication mistake is highest in the first week.
Frequently asked questions
What if we think discharge is too early?
Follow the appeal instructions on the Important Message from Medicare notice the hospital provides, and ask for a family meeting.
Does Medicare pay for help at home after a hospital stay?
Medicare pays for intermittent skilled home health for homebound patients, not for hourly non-medical help.
How fast do we need to choose a rehab facility?
Often within a day or two. Narrow the list by location, CMS record and whether a long-term bed is available.
Who arranges home health after discharge?
The hospital usually sends the referral to a Medicare-certified agency you choose; confirm the first visit date before your parent leaves.
