Caregiver Checklist for Hospital Discharge in Massachusetts

You are about to bring your parent home from the hospital. The discharge planner has given you a stack of paperwork, a bag of medications, and a timeline that feels impossibly compressed. This checklist keeps you from missing the steps that matter most.

Before Discharge Day

Establish your legal standing:

• Confirm you are designated as the caregiver in your parent's medical record under the CARE Act (MGL c. 111, § 236)
• If you hold Health Care Proxy or Power of Attorney, bring the original documents to the hospital and ensure they are scanned into the medical record
• Without legal authority, you may be excluded from care planning conversations — Massachusetts hospitals are required to notify and train the designated caregiver, but they need to know who that person is

Review the written discharge plan:

• Has the hospital produced a written plan in plain language (required under 105 CMR 130.343)?
• Does it name every post-discharge service provider with contact information?
• Does it include the full medication list with dosage instructions?
• Has someone verbally explained the plan to you?

Confirm services are arranged:

• Home health agency: Which agency? When is the first visit? What services are covered?
• DME delivery: Has all Durable Medical Equipment been ordered and scheduled for delivery before your parent arrives home?
• Follow-up appointment: Has a primary care visit been scheduled within 7 days?

Demand your CARE Act training:

• The hospital must provide live, hands-on instruction on every medical task you will perform at home — wound care, injections, medication administration, safe transfers
• If you have not received this training, the hospital has not met its legal obligation — tell the discharge planner before agreeing to the discharge

Discharge Day

Medication review:

• Get the complete discharge medication list and compare it to your parent's pre-hospital medications
• Ask the pharmacist or nurse to explain every change — new drugs, discontinued drugs, dosage adjustments
• Confirm all prescriptions have been sent to the pharmacy and can be filled today
• Pick up medications before leaving the hospital if possible

Equipment check:

• Walker, wheelchair, shower chair, bedside commode — confirm everything is in the car or being delivered
• Ensure you know how to operate any medical devices (oxygen concentrator, CPAP, wound vac)

Transportation:

• Does your parent need medical transport (stretcher van, wheelchair-accessible vehicle)?
• The hospital social worker can arrange non-emergency medical transportation if needed

First 72 Hours at Home

Home safety sweep:

• Remove trip hazards (loose rugs, clutter, electrical cords)
• Install grab bars in bathroom if not already present
• Ensure adequate lighting on pathways from bedroom to bathroom
• Move essentials to the floor your parent will use most

Set up the medication system:

• Fill the pill organizer for the first week
• Post the medication schedule in a visible location
• Set reminders for time-sensitive medications

Activate home health:

• Confirm the home health agency has your address and can reach you by phone
• The first skilled nursing visit should occur within 48 hours of discharge

When You Need More Help

The ASAP network: Contact your local Aging Services Access Point for a care management assessment. ASAPs coordinate the State Home Care Program (personal care, homemaker services on a sliding scale) and the Frail Elder Waiver (comprehensive home-based care for those meeting nursing facility level of care).

Geriatric care managers: Private care managers in Massachusetts charge $150–$250 per hour, with initial assessments ranging from $150–$750. They provide personalized care coordination but cannot draft legal documents or handle MassHealth planning.

Respite care: If you are the sole caregiver and heading toward burnout, Massachusetts offers respite services through the ASAPs and the Frail Elder Waiver. Even a few hours per week of relief can prevent caregiver breakdown that leads to unsafe situations and hospital readmissions.

Get the Complete Hospital-to-Home Transition Toolkit

The Massachusetts Hospital-to-Home Transition Toolkit includes the full discharge day checklist, the CARE Act demand letter template, the medication reconciliation worksheet, and the 30-day transitional care timeline — organized so you can work through it step by step from the hospital room to the first month at home.

See more Massachusetts guides →