Honolulu Senior AdvisorBy Honolulu Senior Advisor Care Team · September 23, 2026
In the first day, confirm admission status and the level of care. In the second, line up the paperwork care homes need. In the third, visit or video-tour the finalists and confirm payment. Start a Med-QUEST application at the hospital if savings are limited.
Hours 0 to 24: get the facts
The moment someone mentions discharge, ask for the discharge planner or social worker by name. Ask three questions and write down the answers. Was my parent formally admitted, or under observation? What level of care does the team think they need after discharge? What does the team think the options are?
Admission status decides whether Medicare's skilled nursing benefit applies; it needs a three-day inpatient stay, and observation days do not count. The level of care decides the setting: home with home health, a skilled nursing stay, an expanded ARCH or foster family home at nursing level, or a regular care home.
Hours 24 to 48: assemble the paperwork
Care homes cannot admit without documents, and the paperwork, not the bed, is often what delays a move. Ask the hospital to prepare these before you need them.
| Document | Who provides it | Why the home needs it |
|---|---|---|
| Physician's report with diagnosis and functional status | Hospital physician | Required at admission (HAR 11-100.1-84 for E-ARCHs) |
| Signed orders for diet and medications | Hospital physician | The care giver cannot give medications without them |
| Tuberculosis clearance | Hospital | Required for every resident |
| Immunization records (pneumococcal, influenza) | Hospital or primary doctor | Required for expanded ARCH residents |
| Level-of-care determination | Physician, for nursing-level placements | Decides whether an E-ARCH or CCFFH can admit |
| Insurance and Med-QUEST details | Family | Decides who pays |
At the same time, call homes. Use the OHCA roster to find expanded ARCHs on your side of the island, and if your parent is on Med-QUEST, ask the health plan's service coordinator to start a placement.
Hours 48 to 72: choose and confirm
By the third day you should have two or three homes that can take your parent at their level of care. If you can, visit; if family is on the mainland, ask a local relative to visit or ask for a video walk-through. Read each home's most recent OHCA inspection report, which takes ten minutes online. Meet or call the primary care giver.
Confirm money before the move: the monthly rate in writing and what it covers, or confirmation from the health plan that the placement is authorized. Ask about the first week: who picks your parent up, when medications arrive, when the case manager visits.
If no home is ready in time
Sometimes the right home will not have an opening by the discharge date. Options include a short skilled nursing stay if your parent qualifies, a few days at home with extra help, or a temporary placement with a planned move later. Tell the discharge planner what you are doing; hospitals on Oahu work with families on this every day.
If savings are limited, ask the social worker to start a Med-QUEST application before discharge. The Elderly Affairs Division at (808) 768-7700 and the Hawaii ADRC at (808) 643-2372 can help with what comes next.
If family is on the mainland
Many Oahu discharges involve adult children in California, Washington or farther away. If that is you, make one local person the point of contact for the hospital and authorize them in writing if your parent agrees. Ask the hospital to include you on calls with the discharge planner. Use video tours to screen homes and ask the local person to visit the final choice. Plan to fly in for the first week if you can; the first days in a new home are when questions come up.
Common snags and how to avoid them
The three most common snags are a missing tuberculosis clearance, medication orders that do not match what the home can manage, and a payment question that surfaces on the morning of the move. Ask the hospital on day one to order the TB test. Ask the home to review the medication list before accepting. And get the rate or the health plan's authorization in writing before the transport is booked.
If your parent is going to a skilled nursing facility first, start the search for the longer-term setting in the first week of that stay, not the last. Medicare coverage ends when skilled care is no longer needed, sometimes with only a couple of days' notice.
One habit that helps
Keep one notebook or shared document with every name, number, and promise made, with the date. Discharge planning involves many people across shifts, and a written record keeps the plan from slipping between them.
Frequently asked questions
Do observation days count toward Medicare's three-day rule?
No. Only inpatient days count, so ask whether your parent was formally admitted.
What paperwork does a care home need?
A physician's report, signed orders for diet and medications, tuberculosis clearance and, for expanded ARCHs, immunization records and a care plan.
Can we start Med-QUEST from the hospital?
Yes. Ask the hospital social worker to help start the application and request a long-term care assessment.
What if the hospital wants to discharge before a home is ready?
Tell the discharge planner what you are doing and ask about short skilled stays, a few days at home with extra help, or a temporary placement.
