Hospital Admission and Discharge for Older Adults: A Checklist

Before any admission: keep a ready folder

Have these in one place at home, and a copy on a phone; see emergency contact card and medical summary and emergency bag for a hospital visit.

• One-page summary: name, age, address, conditions, allergies, past surgeries, vaccinations, blood group if known.
• Current medicine list with doses and timings, and the packs if possible; include supplements and traditional products; see keeping a health record at home.
• Recent reports, discharge summaries, scans, ECG, and usual readings (blood pressure, sugar, weight).
• Doctor and family contacts, insurance card, policy number, identity proofs, and the name of the person who can make decisions if your parent cannot; see health insurance for senior citizens in India and legal basics: wills and power of attorney.
• Wishes: any written preferences about treatment; see advance care planning in India: wishes, documents and conversations.
• Essentials bag: glasses, hearing aids with spare batteries, dentures and case, loose clothes, non-slip footwear, toiletries, phone charger, a notebook, a familiar shawl or photo, and a copy of the daily routine.

At the emergency department or admission

• Say clearly why you came and what changed: when it began, what the person is like normally compared with now. For confusion or drowsiness, say "this is new."
• Hand over the medicine list and summary, and say which conditions, allergies and blood thinners matter.
• Tell staff about hearing or vision loss, memory problems, swallowing difficulty, dentures, continence, mobility aids and any recent falls.
• Ask: What do you think is happening? What tests are planned? What will happen next? Who is the main doctor? How will you update us?
• Costs and consent: ask about estimates, insurance pre-authorisation, and what you are signing before signing.
• Name a single family spokesperson and give the team their number, to avoid confusing messages.
• If your parent has dementia, a family member staying with them can reduce distress; see caring for a parent with dementia at home.

On the ward: what families can do

• Be present when possible, particularly at doctors' rounds and mealtimes. A written list of questions helps.
• Keep a notebook: diagnoses, test results, names of doctors, medicines started or stopped and why.
• Medicines: check that regular medicines are continued unless there is a reason, and that nothing is given twice. Ask "why was this stopped or added?" Do not bring in and give your own medicines, and do not ask staff to stop any without the doctor's approval.
• Prevent delirium: bring glasses, hearing aids and dentures; keep a clock and calendar; talk calmly; open curtains by day, quiet and dark at night; encourage sitting out, drinking and movement; report new confusion immediately; see delirium in older adults.
• Prevent falls: a bell within reach, non-slip footwear, a call for help before getting up; see falls risk assessment at home.
• Keep moving: ask when sitting out and walking can begin; lying in bed rapidly weakens muscles; see slow recovery after infection in older adults.
• Eat and drink: ask about diet and swallowing; help with meals; flag poor appetite; see malnutrition in older adults: signs and prevention and swallowing problems (dysphagia) in older adults.
• Skin and pressure care: ask about turning, mattresses and heel protection; see preventing bedsores at home.
• Toileting and continence: help with timely toilet access; avoid unnecessary catheters; see catheter care basics for families.
• Infection prevention: wash hands; follow visiting rules; see infection control for home caregivers.
• Dignity: privacy, respectful language and consent for procedures; see dignity and consent in care.
• Take care of yourself: sleep, eat and rotate with relatives; see caregiver burnout signs and prevention.
• Raise concerns early with the nurse in charge, then the doctor or patient relations team.

Start planning discharge from day one

Ask early: What needs to happen before my parent can go home? Estimated date? What will they need at home (help, equipment, nursing, physiotherapy)? A hospital social worker, nurse or physiotherapist can often help. Arrange the home while the person is still in hospital; see hospital room at home: complete setup, setting up a hospital bed at home and hiring a home attendant checklist.

Discharge checklist: before leaving

Do not leave without:

1. A written discharge summary with diagnosis, what was done, test results, and what is still pending. 2. A reconciled medicine list: which medicines are new, which have changed (with reasons), which are stopped, and which to continue exactly as before. Ask for the plan in simple writing, with timings. Confirm that each regular medicine appears on the list or has a reason for being absent. See polypharmacy and deprescribing: taking fewer, better medicines and giving medicines safely at home. 3. Prescriptions filled, or know where to get them; check that you have enough until the follow-up. 4. Follow-up: dates, doctor, location, tests due and who will chase pending results. 5. Warning signs to watch for and whom to call, with a phone number that is answered day and night. 6. Activity and diet instructions: what the person can do, what to avoid, fluid advice, and diet. 7. Wound, catheter, stoma, oxygen or other equipment training, with a demonstration, written instructions and supplies; see wound care at home for older adults and oxygen concentrator: safe use at home. 8. Mobility check: can your parent walk, transfer and use the toilet safely? Ask the physiotherapist to show you how to help; see how to lift and transfer safely and bed transfer techniques. Arrange a walking aid, wheelchair, commode or other equipment before leaving; see equipment to rent vs buy checklist. 9. Transport: safe, comfortable, with help to get in and out; see getting an elderly person in and out of a car. 10. Bills, insurance papers and reports collected, including the original discharge summary and X-ray or scan films or digital copies. 11. Home readiness: bed, bathroom, kitchen, lighting and a plan for who will be there; see monitoring a parent after hospital discharge. 12. Personal belongings returned: dentures, hearing aids, glasses, valuables.

If you do not feel safe taking your parent home, say so, and ask what other options exist, such as short rehabilitation stays, home nursing, or extending the stay; see when home care is no longer enough and choosing an assisted living or care home.

The first 72 hours and first week at home

• Settle in: a calm, warm, clean room; the person near the toilet; familiar objects; regular meals and sleep.
• Medicines: set up an organiser and reminders using the new list; discard old lists to avoid confusion; see pill organiser guide and medicine reminders for forgetful parents.
• Monitor: note temperature, blood pressure, pulse, sugar (if diabetic), weight, breathing, appetite, fluids, bowels and urine, sleep, pain, mood and confusion each day; see care diary and handover notes, how often to check vitals, digital thermometers: choosing and using them for older people and how to measure blood pressure at home accurately.
• Movement: short, frequent walks and the exercises taught; avoid long bed rest; see rehabilitation after fracture or surgery: a physiotherapy plan.
• Food and drink: small, frequent, protein-rich meals and fluids as advised; see how much protein do older adults need.
• Review by the family doctor within a few days to a week, bringing the discharge papers.
• Falls: the first weeks are high risk; see night safety for a parent alone.
• Mood: low mood, anxiety or tearfulness are common; see depression in older adults.
• Share the load: spread tasks among family; see sharing care among siblings.

Red flags after discharge

Call 112 for: chest pain, severe breathlessness, blue lips, fainting, stroke signs (face droop, weakness, speech difficulty), heavy bleeding, sudden severe pain, severe confusion or drowsiness, a fall with injury, or very low sugar that does not respond.

Call the hospital or family doctor the same day for: fever, new or worsening pain, wound redness, swelling or discharge, a swollen painful leg, vomiting, poor drinking, very little urine, new confusion, worsening cough or breathing, black or bloody stools, medicine side effects, or you are not coping.

When to ask a professional

Ask the hospital team, nurse or social worker about discharge planning; a pharmacist for medicine questions; the family doctor for follow-up; a physiotherapist and occupational therapist for mobility and home changes. Seek urgent help for red flags.