Checklists for every stage

When the hospital says your parent can't go home, or is ready for discharge.

• Ask: was my parent formally admitted as an inpatient, or kept under observation?Original Medicare only covers rehab in a nursing facility after 3 inpatient days. Get the answer in writing if you can.
• Ask to meet the discharge planner or case manager, and ask for the discharge plan in writing.
• Ask what level of care the team recommends, and why: home with help, rehab, assisted living or a nursing home.
• If it's rehab, ask which facilities have a bed and accept your parent's insurance. You can choose; you don't have to take the first one offered.
• Read the 'Important Message from Medicare' notice. It explains how to ask for a fast appeal if you think discharge is too soon.
• If your parent has Medicare Advantage, call the plan about prior approval for rehab or home health.
• Get a list of every medication, with changes from before the hospital stay.
• Schedule the follow-up appointment before you leave.
• Make sure equipment (walker, hospital bed, oxygen) is ordered and will arrive in time.

As soon as possible, while your parent can still understand and sign.

• Durable financial power of attorneyLets a named person pay bills, sign contracts and deal with banks. Many banks want their own form too, so ask.
• Health care proxy (health care power of attorney)Names who makes medical decisions if your parent can't.
• Advance directive / living willRecords the care they want or don't want. Use your state's form.
• HIPAA authorizationLets doctors share information with you.
• POLST or similar form, if seriously illA medical order signed with their clinician.
• A current will, and where the original is kept
• A list of who has copies of each document
• If there's no power of attorney and your parent can no longer sign: talk to an elder law attorney about guardianship

Before applying for Medicaid or VA benefits, or signing admission papers.

• Photo ID, Social Security card, Medicare card and any other insurance cards
• Birth certificate, and marriage or death certificates for a spouse
• Proof of every source of income: Social Security, pensions, annuities, VA
• Bank and investment statements, often for the last 60 months for Medicaid
• Life insurance policies, with cash values
• Long-term care insurance policy and the claims phone number
• Deed to the home, mortgage statements, property tax bills
• Vehicle titles
• Military discharge papers (DD-214), for VA benefits
• Power of attorney and health care proxy
• Medication list, doctors' names and a recent physical
• Records of any gifts or transfers of money or property in the last five years

Once you have a shortlist.

• Confirm the license on the state lookup, and read the last two or three inspection reports
• Ask for the full price list: base rent, care levels, medication management, and what triggers an increase
• Ask what happens when needs increase. When would they ask your parent to move out?
• Ask about staffing: how many caregivers per resident on nights and weekends, and staff turnover
• Ask which payers they accept: private pay only, Medicaid, VA, long-term care insurance
• Visit at a mealtime, and come back unannounced at a different time
• Talk to residents and families if you can
• Read the residency agreement before signing. Ask about deposits, refunds and notice periods
• For memory care: ask about dementia training, secured exits, and how they handle distress without medication

The weeks around the move.

• Measure the new room and plan furniture before packing
• Bring familiar things: photos, a favorite chair, bedding, a clock
• Label clothing and belongings with their name
• Bring the medication list, and hand over medications the way the community asks
• Change the address with USPS, Social Security, Medicare, banks and the pharmacy
• Share the health care proxy and power of attorney with the community
• Go to the first care plan meeting, and put the next one on your calendar
• Expect a hard adjustment. Many people need a month or more to settle
• Get to know the aides by name; they're the people who'll call you

Any time. Trust your gut.

• Unexplained bruises, falls, weight loss or dehydration
• Soiled clothing or bedding, poor hygiene, bedsores
• Medication errors, or your parent seeming newly sedated
• Calls not returned, or staff who seem to change every visit
• Missing money or belongings, or new 'friends' with access to their finances
• Your parent seeming afraid of a particular person
• If you see these: raise it with the director in writing, call the long-term care ombudsman, and report abuse or neglect to adult protective services. If someone is in danger, call 911.