El Paso Senior AdvisorBy El Paso Senior Advisor Care Team · October 28, 2026
In the first 72 hours, confirm inpatient status, get the therapists' recommendation, choose a rehab facility or home health agency from the hospital's list, reconcile medications and set up the first follow-up visit. You have the right to choose the provider.
Hour 0 to 12: the discharge conversation
Ask the case manager whether your parent is an inpatient or on observation, because Medicare covers skilled nursing facility rehab only after three inpatient days. Ask what the physical and occupational therapists recommend and request the list of facilities or agencies with openings.
Hour 12 to 24: choosing where to go
Check each nursing facility's CMS ratings, short-stay quality and staffing on our pages. In El Paso, 10 of 22 rated homes currently sit at one star overall, so look at the detail. If home is the plan, choose a Medicare-certified home health agency and confirm the first visit date.
| Decision | Who helps | What to confirm |
|---|---|---|
| Inpatient or observation | Hospital case manager | Medicare coverage for rehab |
| Rehab facility | Case manager, admissions office | Bed, insurance, therapy schedule |
| Home health | Agency intake | First visit date, services |
| Equipment | Therapists, supplier | Walker, shower chair, bed |
Hour 24 to 48: medications and records
Get the discharge medication list and compare it with what your parent took before. Ask which medications stopped, started or changed. Fill new prescriptions before arriving home or confirm the facility has them.
Hour 48 to 72: settling in
At a rehab facility, attend the first care meeting and set goals. At home, make sure someone is there for the first nights, remove trip hazards, and keep the home cool. Schedule the primary care follow-up within a week.
What to ask the therapists
Physical and occupational therapists see how your parent walks, transfers, dresses and uses the bathroom. Ask them directly: could your parent go home safely today with help, and how much help? What would make home safer? Which goal, if reached in rehab, would make home possible? Their answers shape whether rehab, home health or a different setting makes sense.
If the recommendation is home, ask for a written list of equipment and a home exercise plan, and ask whether home health therapy has been ordered.
Medicare Advantage and prior authorization
Many El Pasoans have Medicare Advantage plans, which often require prior authorization before covering a skilled nursing facility stay and have their own networks. Ask the case manager to confirm authorization before transfer, and ask which facilities are in network. If authorization is denied, ask about an expedited appeal. HICAP at 1-800-252-9240 can explain your rights.
Heat, home and the first night
El Paso summers can be dangerous for someone just out of the hospital. Before your parent comes home, confirm the air conditioning or evaporative cooler works, stock easy meals and water, and arrange for someone to stay the first night or two. Put a night light between bed and bathroom, clear rugs and cords, and set out the medications in a simple organizer.
If things go wrong
Watch for new confusion, fever, shortness of breath, falls or refusal to eat in the first days at home or in rehab, and call the doctor or home health nurse promptly. Many readmissions happen in the first weeks. Keep the discharge papers, medication list and doctors' numbers in one place where everyone can find them.
Choosing between El Paso rehab options
Location matters for rehab as much as ratings: a parent who sees family often tends to do better, and family members can join therapy sessions to learn how to help at home. Ask each facility how many therapy sessions a patient usually receives, whether therapy runs on weekends, how discharge planning works, and whether a therapist visits the home before discharge. Our nursing home pages show each facility's short-stay quality rating, staffing hours and recent inspection results, so you can compare the options on the hospital's list in a few minutes.
If no bed is available at your first choice, ask to be called if one opens, and remember that you can request a transfer later if the first facility does not work out.
Who to call for help
If you need help sorting out options during a discharge, the Rio Grande Area Agency on Aging at (915) 533-0998 can explain local services, HICAP at 1-800-252-9240 can explain Medicare coverage and appeals, and an advisor can check which facilities have openings. Veterans can ask the hospital to contact the El Paso VA about coordinated care. Keep a notebook with every name, number and decision; in a fast discharge, it becomes the family's single source of truth.
Keeping family informed
Pick one family member to talk with the hospital and share updates with everyone else. It reduces confusion and keeps the case manager's time focused on the plan.
Planning beyond rehab
Start thinking about the next step early: home with help, assisted living, or long-term care. Tour options during rehab rather than after.
Frequently asked questions
Can the hospital choose the rehab facility for us?
No. You have the right to choose from the available providers.
Does observation status affect Medicare rehab?
Yes. Medicare requires three inpatient days before covering skilled nursing facility care.
What if the discharge feels unsafe?
Say so in writing and ask about Medicare's discharge appeal rights.
