When to call 911 after discharge
Call 911 immediately for:
Worsening symptoms, difficulty breathing, chest pain, severe pain, sudden confusion, loss of consciousness, uncontrolled bleeding, or any condition that feels like a medical emergency.
For non-emergency discharge planning and home support coordination, continue through the checklist below.
The highest-risk window after leaving the hospital
Hospital readmission rates in Maine and nationally are highest in the first three days after discharge. This is when medication errors are most likely to occur, when follow-up care is most commonly missed, and when families discover that the plan made at the hospital does not fully account for the realities of home.
Maine's geography adds additional complexity. Families in rural areas — including western Maine, Downeast Maine, and northern Maine — may have limited access to same-day in-home support, pharmacy services, or urgent care. Confirming the care plan before leaving the hospital is particularly important in these regions.
This checklist covers seven areas that families should confirm during the first 72 hours after discharge.
Seven things to confirm before and after returning home
Confirm that written discharge instructions were provided before leaving the hospital. This document should be your primary reference during the first week home.
- Summary of the hospital stay and reason for admission
- Condition at the time of discharge
- The care plan for home — what to do, what to watch for
- Complete and current medication list
- Wound care or activity restrictions if applicable
- Follow-up appointment instructions
- Who to call if questions arise
Medication errors are among the most common causes of readmission after hospital discharge. Confirm the following before leaving — or within the first 24 hours at home.
- All current medications are listed, including dosages and timing
- Any discontinued medications are clearly identified — do not continue taking them
- New or changed medications are explained and understood
- A pharmacy has been identified and prescriptions have been sent or filled
- You know who to contact with medication questions
A follow-up with the primary care provider or specialist is typically recommended within 7–14 days of discharge. Confirm this is in place.
- A follow-up appointment has been scheduled, or written instructions on how to schedule one were provided
- Appointment details — provider, date, location — are documented
- Transportation to the appointment has been arranged
- If at a hospital or specialty practice, parking and check-in procedures are known
If medical equipment was ordered — walker, wheelchair, hospital bed, oxygen concentrator, wound care supplies — confirm it is in place before or immediately after returning home.
- Supplier contact information was provided
- Delivery has occurred, or timing and delivery date are confirmed
- Basic use instructions were provided or demonstrated
- A backup plan exists if equipment malfunctions
If home health nursing, physical therapy, occupational therapy, or speech therapy was included in the discharge plan, confirm the referral was received and a start date is known.
- The home health agency received the referral from the hospital
- A first visit or start date has been communicated
- Contact information for the agency is available
- Insurance coverage has been confirmed with the agency
Identify who will provide support at home and ensure they understand their role during the recovery period.
- A designated support person understands their role and responsibilities
- Written instructions were shared with the person providing care
- Coverage is planned for higher-risk periods — overnight, mealtimes, medication times
- You know who to contact if care needs exceed what can safely be managed
Confirm that the home environment supports a safe recovery before or immediately upon returning.
- Food and essential supplies are available for at least several days
- Heat, electricity, and water are functioning
- The living environment is accessible given any new mobility limitations
- Trip hazards have been addressed — rugs, cords, poor lighting, stairs
- Transportation for non-emergency medical needs is available
- Written contact information for questions is accessible
In-home care providers across Maine's five regions
If new care needs arise after returning home, or if the discharge plan does not fully account for the realities of home, in-home care providers are listed by region across Maine. These providers offer non-medical supervision, personal care assistance, companion care, and daily support services.
When home is no longer the right setting
Sometimes what was planned at the hospital does not reflect what is actually manageable at home. If the situation becomes unsafe or unmanageable after discharge, contact the primary care provider or the hospital discharge office to discuss next steps. Do not wait for a scheduled appointment if safety is a concern.
What Maine families commonly face after discharge
Discharge planning in Maine's rural regions
Hospital discharge planning in Maine often reflects the pressures of short inpatient stays and the reality that many Maine families live at significant distance from hospitals and specialty care. Families in Oxford County, Washington County, Aroostook County, and rural Hancock County may have particular difficulty arranging home health services, transportation, and pharmacy access within the first 72 hours.
Maine's MaineCare program may cover home health services for eligible individuals. Medicare covers certain skilled home health services following a qualifying hospital stay. Contact the discharging hospital's social work or discharge planning department for assistance navigating coverage options.
Maine's Area Agencies on Aging serve older adults by region and can help connect families with local resources including transportation, meal delivery, and caregiver support. Dial 211 for local referrals statewide.
Registry boundary statement
- Not a hospital discharge program or care coordination service
- Not a clinical advisory or referral management service
- Not a guarantee of provider availability or insurance coverage