After the Hospital STL
A grown daughter holds her mother close on a sofa at home, both of them smiling
Home again. Photo: Pexels.
The discharge folder

St. Louis, Day 0 to Day 14

They are sending her home. Here are the next two weeks, in order.

The papers say where she is going. They rarely say who is in the kitchen at 9pm, or who walks her to the bathroom at 2am. Here are the two weeks on one line, with the local numbers that pick up.

Tonight

The first 24 hours, hour by hour

Not medical advice. Just the order of the jobs, so nothing lands on you at the worst hour. Keep the discharge folder on the counter with a pen.

Two people sit and talk quietly beside a tall window in late afternoon light
The first evening is mostly sitting nearby. Photo: Pexels.
  1. Hour 0, the hospital door

    Before anyone packs a bag

    Ask the discharge planner who is with her tonight, by name, and write it in the folder. Missouri's CARE Act says being named her caregiver does not obligate any person to arrange or perform any after-care tasks.

  2. Hour 1, the ride home

    The car and the front steps

    Park close to the door. Clear a path from the car to her first chair, and from that chair to the bathroom. Rugs up, one hallway light on.

  3. Hour 2, the kitchen counter

    The fridge sheet

    Tape the hospital's medication list, the follow-up appointment and the after-hours number to the refrigerator. Medicine questions go to the pharmacist or that number.

  4. Hour 6, dinner

    A meal someone else could make

    Something simple enough that a neighbor or a hired caregiver could make it tomorrow. Note what she ate and drank.

  5. Hour 12, the first night

    Who gets up at 2am

    Decide who gets up when she does. A night light in the bathroom, a phone by the bed. Sleeping lightly on the couch covers one night, not seven.

  6. Hour 24, the next morning

    The first phone calls

    Make the calls the papers list, confirm any home health visit, and count the hours nobody covers yet.

Say this to the discharge planner"I can be there in the evenings. I cannot be there overnight or during the workday. Please write that down, and tell me who covers those hours on this plan."

The reads, laid on the strip

Every article, filed under the day it answers

Nineteen reads. Find your day and start there.

Day 0Still in the bed

The hospital says she is ready

The notice, the appeal clock, and the hours someone must cover.

Day 1The car pulls in

The ride home and the first night

The house before she walks in, and the overnight.

Day 2 to 3The first full days

When the house shows its gaps

Something seems different, or the walker sits in the corner.

Day 3 to 7The week

Visits, and the hours between them

Home health comes as visits. These reads cover the rest.

Day 8 to 14The follow-up

The follow-up visit

Take the folder and a list of the hardest hours, and ask whether the plan still fits her house. If coverage is wearing thin, call the lines below now. Hire Caregiver STL covers hiring; Paying for Care STL covers the money. New here? Start here.

Visits, not presence

What non-medical help in the house looks like

Medicare home health is skilled care that comes as visits: in most cases up to 8 hours a day combined, for a maximum of 28 hours a week, and Medicare does not pay for 24-hour-a-day care at home.

Private duty is a person in the house for a shift, paid privately or by insurance, with no physician order needed for personal care, respite or companion care, per Missouri DHSS.

The overnight

The 2am bathroom trip and a steady arm back to bed.

The morning block

Washing, dressing, breakfast, the first walk to the chair.

The long afternoon

Lunch, laundry, company and an errand.

A break for you

A few hours so you can sleep, or go back to work.

None of this is nursing: medicines and recovery questions stay with her care team. A plan can start with only the hours family cannot cover.

A caregiver tucks a soft pink blanket around an older woman resting in bed at home
Rest and company are part of the job. Photo: New Plan Care Solutions.

Local help

Who to call in St. Louis, and what for

Each number was read on the organization's own page on September 12, 2026. None is connected to this site.

WhoWhat the call is forNumber
Her discharge plannerWho covers tonight, and questions once she is home.The West County hospital mapOn her papers
The Medicare appeal reviewerA fast appeal, requested no later than her scheduled discharge day.Medicare.gov, fast appealsOn the notice
Aging Ahead, Community OptionsCase managers for family caregivers in St. Louis, St. Charles, Franklin and Jefferson counties.Aging Ahead, I'm a Caregiver(636) 207-0847
Aging Ahead, main lineMeals, senior centers and caregiving services for adults 60 and older.Aging Ahead, About Us(800) 243-6060
St. Louis Area Agency on AgingIf she lives in the City of St. Louis.City of St. Louis(314) 612-5918
Missouri Senior Resource LineEnter her ZIP code and you are transferred to her local aging agency.Missouri DHSS1-800-235-5503
Adult Abuse and Neglect HotlineSuspected abuse or neglect. Daily, 7:00 a.m. to 8:00 p.m.Missouri DHSS1-800-392-0210

Emergencies: 911. More lines, including 211 and Medicaid in-home services, are on the local help page.

Asked in the hallway

Five questions, the way they get asked

The hospital says she can go home tomorrow, but she can't be alone. What do I do first?

Ask the planner who covers each block of hours, by name. If you think it is too soon, follow the directions on the Important Message from Medicare no later than her scheduled discharge day to ask for a fast appeal.

Will Medicare send someone to stay with Mom?

Not to stay. Home health comes as visits, in most cases up to 28 hours a week combined, and Medicare does not pay for 24-hour-a-day care at home. A person in the house overnight is private duty care. More in the Medicare read.

Do I have to be her caregiver just because the hospital wrote my name down?

No. Missouri's CARE Act says being named does not obligate any person to arrange or perform after-care tasks. Tell the planner which hours you can cover.

She seems confused since she came home. Who do I call tonight?

Call the after-hours number on her papers or her doctor's office and describe what you see. If it looks like an emergency, call 911. This site does not diagnose.

How fast can I get someone in the house, and do I have to sign up for a lot of hours?

Ask when you call, because it depends on the week. New Plan Care Solutions, the paid placement on this site, says its support can start with a few hours.

A caregiver walks arm in arm with a smiling older woman who uses a cane in a bright living room
A steady arm for the first walks. Photo: New Plan Care Solutions.

Recommended local provider

The first two weeks are the hard ones. You do not have to cover every hour.

Tell New Plan Care Solutions which hours are empty, the first night, the mornings, and a person will reply the way you ask.

New Plan Care Solutions is independently owned and operated in St. Louis by Stacie Postol. Non-medical support only: help while someone recovers at home, personal care, meals and household help, companionship and respite, across St. Louis and St. Charles counties. Background-checked caregivers, plans built together, and support that can start with a few hours.

Disclosure: New Plan Care Solutions is a client of this site's publisher and compensates us for this placement. It is the only provider featured here, and the guides on this site are educational, not medical advice.

Call or text (314) 405-0887 or visit newplancare.com

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