Care Transition
Checklist
Navigating Changes in Care Settings
A comprehensive guide for transitioning your loved one between care settings, whether moving to assisted living, returning home after hospitalization, or changing care levels.
Hospital → Home
Home → Assisted Living
Hospital → Rehab
Home → Nursing Home
Rehab → Home
Other Transition
Transition Date: _______________
From: _______________
To: _______________
ParentCareGuide.com
Before the Transition
Proper preparation makes transitions smoother and safer.
Research & Decision Making
Researched options (toured facilities, interviewed agencies)
Discussed transition with parent (if possible)
Discussed with healthcare team about care needs
Held family meeting to discuss decision
Considered financial implications and payment options
Checked reviews, licensing, inspection reports
Medical Preparation
Obtained complete medical records/summary
Complete medication list with dosages and schedules
List of all treating physicians with contact info
Recent test results, imaging, lab work
Advance directive and POLST form (if applicable)
DNR status documented (if applicable)
Vaccination records
Legal & Financial Documents
Healthcare Power of Attorney
Financial Power of Attorney
Insurance cards and policy information
Medicare/Medicaid information
Long-term care insurance policy
Social Security information
Signed admission agreements/contracts
Personal Information to Share
Life history/biography summary
Daily routine preferences
Food preferences and restrictions
Sleep habits
Favorite activities and hobbies
Behavioral patterns (especially if dementia)
Calming techniques that work
Transition Day
Items to Bring
Medications: All current medications in original bottles
Medical equipment: Walker, wheelchair, oxygen, CPAP, etc.
Clothing: Comfortable, easy-to-dress clothes (labeled with name)
Toiletries: Toothbrush, dentures, glasses, hearing aids
Comfort items: Favorite blanket, pillow, photos
Documents: All paperwork listed on previous page
Personal items: Photos, small mementos, books
Electronics: Phone, TV, radio (check what's allowed)
💡 Labeling Tip
Label all clothing, glasses, hearing aids, and personal items with your loved one's name. Use permanent markers, iron-on labels, or engraving for valuables.
What NOT to Bring (Usually)
Expensive jewelry or large amounts of cash
Medications in unlabeled containers
Throw rugs or items that create fall hazards
Space heaters, candles, or fire hazards
Alcohol (unless permitted)
Day-Of Checklist
Confirm arrival time with receiving facility
Arrange transportation (ambulance, wheelchair van, car)
Have someone meet you at the new location
Bring a meal or snack (may be hungry during transition)
Stay calm and reassuring, transitions are stressful
Take photos of room setup and personal items
Meet key staff members (nurse, aide, social worker)
Review care plan with staff
Confirm medication list with receiving team
Leave emergency contact information
Get phone numbers for nurses station, direct line
⚠️ Medication Safety
Medication errors are common during transitions. Before leaving, confirm:
- New facility has complete, accurate medication list
- Compare their list to yours, flag any differences
- Ensure first doses are scheduled appropriately
First Week After Transition
The first week is critical for catching problems and helping with adjustment.
Day 1-2
Call to check how first night went
Visit if possible, presence helps adjustment
Confirm all medications were given correctly
Check that personal items are in place
Note any concerning behaviors or complaints
Day 3-4
Meet with care team to review initial assessment
Discuss any adjustments needed to care plan
Ask about eating, sleeping, and participation
Address any homesickness or anxiety
Day 5-7
Attend care conference if scheduled
Review and sign care plan
Confirm all doctors have been notified of transition
Set up regular visit/call schedule
Join family council or support group if available
Things to Monitor
Mood and emotional adjustment
Appetite and eating
Sleep patterns
Pain levels
Skin condition (check for pressure sores)
Weight changes
Participation in activities
Interactions with staff and residents
Cleanliness and grooming
💡 Adjustment Takes Time
It's normal for your loved one to take 2-4 weeks (sometimes longer) to adjust to a new environment. Expect some resistance, sadness, or confusion initially. Consistent visiting and patience help. If concerns persist beyond 4-6 weeks, discuss with the care team.
Ongoing Monitoring
Stay involved to ensure quality care continues.
Regular Check-In Schedule
Weekly: Visit or video call, check on care quality
Monthly: Review care plan, meet with staff
Quarterly: Attend formal care conferences
Annually: Reassess placement, review contract
Quality Indicators to Watch
Staff know your loved one by name
Call light answered promptly
Clean, odor-free environment
Residents appear well-groomed
Meals are served on time and look appetizing
Activities are engaging and offered regularly
Staff turnover is reasonable
Your concerns are addressed promptly
Red Flags to Watch For
⚠️ Contact administrator or ombudsman if you observe:
- Unexplained bruises, injuries, or skin breakdown
- Sudden weight loss or dehydration
- Unwashed, soiled clothing or linens
- Medication errors or missed doses
- Frequent falls
- Significant decline in condition
- Fear or reluctance to speak around staff
- Unattended for long periods
- Belongings missing
- Staff rudeness or dismissiveness
Key Contacts at Facility
Communication Log
Document all significant communications with the facility.
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Spoke With |
Topic/Notes |
Follow-Up Needed |
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📝 Documentation Tips
- Always note the date, time, and name of person you spoke with
- Put concerns in writing and request written responses
- Follow up verbal conversations with an email summary
- Keep copies of all correspondence
- Take photos if you observe concerning conditions