Senior Hospital and Rehab Discharge Planning Matters

In the video, we see how someone can go from the hospital to rehab and then end up back in the emergency room when there is no real plan for what happens after rehab. This is a common issue in senior care and it shows why strong hospital discharge planning and rehab planning are so important. The health care system is starting to move away from fee for service and toward value based care, where providers are rewarded for keeping people healthy and avoiding readmission. Because of this shift, the time after a hospital or rehab stay will receive much more attention in post acute care and care transitions. It will not be enough to simply go home or move to any available place. Seniors and their families will need to make sure the next long term care setting is the right fit and has the proper support. In this new model, having a solid long term care plan is essential for recovering well, preventing readmission, and staying safe.

Uwe Ross

Dec 9, 2025

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2 min read