Find a starting point
What is making the next step difficult?
Choose a topic to explore. This is a planning tool, not an eligibility test or a placement decision.
Option 1 · No available caregiver
Explain the gap without blame.
Describe which tasks, hours, and supervision are unavailable. A relative may be unable or unwilling to provide care; the team needs an accurate picture, not an assumed caregiver.
Can we document the care gap and hold a discharge-planning meeting?
Hospital social worker, case manager, patient, and chosen support people.
Option 2 · Care needs are too complex
Match the setting to the actual needs.
Ask the clinical team to describe nursing, respiratory, behavioral, equipment, and accessibility needs. Ask which receiving providers can review those needs and what support would be required.
Has a potential receiving team reviewed the current care needs?
Treating clinicians, discharge staff, and potential receiving providers.
Option 3 · Funding or placement is unclear
Separate the questions that need answers.
Clinical fit, an available opening, and payment approval are separate issues. Ask who is contacting the health plan, APD, and any current waiver support coordinator. Record what is pending and the next follow-up date.
What is pending, who owns each step, and when will we hear back?
Case management, the health plan, APD, and the waiver support coordinator when involved.
When Home Is Not an Option
Watch the video.
Choose a narration language in the player. Translations still being prepared are clearly marked.
Explore the video seriesTake a guide with you
Your next conversation, on one page.
Keep these six questions with you. Download a fillable PDF to type and save private notes, or print a copy for your meeting.
Person & care needs
- What does the person want, and what care is needed?
- Which care tasks or hours cannot be covered at home?
Options & review
- Which providers have reviewed the current needs?
- What funding, service, or placement approvals are pending?
Coordination & follow-up
- Who is coordinating the plan and the next meeting?
- How do we raise an unresolved safety concern?
Kreyòl ayisyen
Your notes stay in your saved file; they are not sent to Excellent Care. Share sensitive records only through the secure process your team provides.
Trusted information
Go further when you are ready.
Sources checked September 28, 2026. Processes and availability can change; confirm details with the responsible agency or care team.
