Fill in the answers to these questions:

• What is my loved one's health condition?

• What can I expect once he or she is at home?

• Are there any symptoms or signs that I should watch for?

• Will he or she need a special diet? If so, what type?

• Will he or she have limits on activity? If so, what are they?

• Whom should I call if I have problems or questions?

• Whom should I call in case of emergency?

 Preparing your home

 Yes

 No

 Will my loved one need help with:

• Bathing
• Eating
• Getting dressed
• Using the bathroom
• Walking
• Cooking and cleaning
• Shopping
• Getting to appointments
• Other _________________________________________________ 

• Will we need any special supplies such as syringes or disposable gloves?   

  List: __________________________________________

• Will I be taught how to use them?
• Do I know where to get supplies?

 Supply source:

• Will we need any special equipment at home?

  List: _______________________________________________________

• Will it be ready at discharge?
• Will I get training in how to use it?
• Is there someone I can call if I have questions about the equipment?

  Name/phone number:

 Support services

 Yes

 No

 Will my loved one need follow-up care such as:

• Nurse visits
• Physical therapy
• Occupational therapy
• Speech therapy
• Other _________________________________________________ 

Are we eligible for support services such as:

• Meals on Wheels
• Home health aide
• Respite care
• Transportation assistance
• Other _________________________________________________ 

 Medication management

As a caregiver, you may play a major role in managing your loved one's medications. If so, you will need to become familiar with them. One way to do this is to make a chart. The hospital may be able to provide one. For each medication, list:

• What its name is
• What it is for
• What the dose is
• How often it is taken (number of hours between doses)
• How it is taken (for example, with food or only water)
• What side effects to watch for  

Compare this list to medications taken before hospitalization. Ask health provider about any medications that do not appear on the new list.