The plan is a short stay at a skilled nursing facility to get stronger before home. Expected around T-24h · 9:00 AM. Your team updates this every day — nothing happens without talking with you first.
We started this from what your team already knows — please check each answer and fix anything that's changed. Your care team sees updates right away, and your plan adjusts.
Home & supportPRAPARE · CARE Act
Where you live and who can help shapes the safest plan.
Do you have stable housing to go back to?
Who do you live with?
Will someone be able to help you at home after you leave?
About how much can they be there?
Daily life & moneyPRAPARE
These are some of the biggest reasons recovery gets harder at home.
Has a lack of transportation kept you from appointments or medications?
In the last year, were you worried food would run out before you could buy more?
Trouble paying for heat, electricity, or your phone?
Do you feel safe where you live?
Getting aroundFunctional self-report (ADL)
How you moved before this stay helps us set up the right support and equipment.
Before this hospital stay, which could you do on your own?Check all that apply.
Do you use any of these to get around?
Have you fallen in the last 6 months?
Your home setupHome-environment screen
A few details about your home so equipment and safety are ready before you arrive.
Steps to get into your home?
Is a bathroom on the same floor as where you sleep?
Do you already have any of these at home?Check all that apply.
What matters to youPreferences · PREPARE (ACP)
Your goals guide the plan — there is no wrong answer.
Where would you most like to recover?
What matters most to you right now?
If you couldn't speak for yourself, who would you want to make decisions?PREPARE advance-care-planning — optional, but it helps.
What language do you prefer for your care?
What this means for your plan
Your answers shape what your care team sets up. Right now that's:
Rides arranged
We'll set up medical transport (NEMT) to your appointments and the pharmacy.
Drives: Logistics
More support at home
With limited help and some tasks that are hard right now, we'll set up home health and personal care — or talk through a short rehab stay.
Drives: Functional · Support
Therapy & equipment
PT/OT will help rebuild your strength and order the equipment you need at home.
Drives: Functional
Preventing falls
A home-safety check plus grab bars or a walker so you stay steady at home.
Drives: Functional
Your preference
You'd prefer a facility first — we'll match a place your insurance covers and your family likes.
Drives: Preference
Explore places near you
Browse skilled nursing, home care, pharmacies and benefits in your area — your picks come back to your care team.
Questions? Message your care manager, or call (650) 555-0199. This view is shared only with the family you've approved.