Discharge Planning
The Facility List From the Hospital: What to Check Before You Pick One
When the hospital hands over a list of places that take patients after discharge, the list is where the choice starts, so check every name the same way.
When your parent needs care after the hospital that is more than home can provide, the discharge planner will usually hand you a list. The discharge planning rule in the eCFR (42 CFR 482.43) requires the hospital to help the patient choose among the providers available to them, and to make clear that the choice belongs to the patient. The list is the start. It should not be the decision.
Local option: New Plan Care gives families in the St. Louis area in-home help so a parent can stay home: companionship, help with bathing and dressing, meals, and overnight care. Call (314) 405-0887.
Ask the planner what the list is and is not
Ask whether the list is every facility the hospital can send to, or only the ones it works with most often. Ask whether any facility on it is owned by the hospital or by a company the hospital has a financial stake in, since the rule requires the hospital to disclose certain of those interests. Ask the planner to record which facilities you chose, so the referral goes to the ones you picked and not simply to the first name on the page.
Ask each facility the same three questions
Ask every facility on your shortlist: Do you have a bed for the day my parent is discharged? If the hospital says the day is ready, will the bed still be open? What does the therapy schedule look like in the first week? Write down each answer and the name of the person who gave it. A bed that may not be open on discharge day is not a bed you can count on.
Ask the coverage question in writing
Whether a facility stay is covered depends on your parent's coverage and on the kind of care the doctor has ordered. Ask the hospital's case manager and the facility's business office, separately, how the stay will be billed under your parent's plan and what the family may owe. Get the answer in writing before your parent is moved, and keep it with the list.
Read the public record, then ask about it
Medicare's Care Compare tool publishes facility information, including inspection results and staffing data, for nursing facilities. Look up every name on the list. Do not treat any single number as a verdict. Look for patterns across the page, and ask the facility to explain anything that stands out. Missouri's facility licensing law is in Chapter 198 of the Revised Statutes of Missouri, and the Department of Health and Senior Services oversees licensing. Ask each facility where its license is posted and what recent state inspection it can show you.
Ask what happens when the plan changes
Ask how the facility tells the family when a therapy plan changes, when a visit is moved, and when a resident needs to go back to the hospital. Ask who answers the phone after hours. These answers decide how much of the watching you will still be doing from home.
Put the facilities side by side
Make one page with the same rows for every facility: bed on discharge day, first-week therapy schedule, coverage answer in writing, license posted, after-hours contact, and what the family is expected to bring. The row left blank is the one to ask about before you choose. The Local Help After a Discharge page lists St. Louis resources that can help you work through the list.