The journey from hospital to home after a medical episode or surgical procedure can be challenging for patients and their families. It’s a time when post-acute care – like short-term rehab, skilled nursing, and other support services – is pivotal in ensuring a smooth recovery.

At The New Jewish Home, we understand the importance of this transition and offer comprehensive care services to make the process as seamless as possible. In this blog, we’ll guide you through key steps in navigating the path home from hospitalization, including planning your discharge, post-hospital care, and other support services that can improve your or your loved one’s recovery.

Start Planning Your Discharge from the Hospital

Leaving the hospital can be a huge relief, but it also comes with decisions to make and responsibilities to handle. Here’s how you or a loved one can safely transition out of the hospital and on to the next phase of the healing journey.


Before leaving the hospital, patients undergo a thorough evaluation where several healthcare professionals and specialists will assess their condition and determine the next steps in their care plan. The evaluation will assess the patient’s medical condition, functional abilities, and support system at home. It may include physical assessments and identifying special requirements, such as assistive devices or modifications to living spaces.

Care planning

Based on the evaluation, a care plan will be developed to ensure you receive the appropriate support. In some cases, you may be cleared to go home and continue with outpatient services like physical therapy and specialist follow-ups.

In other cases, especially after an orthopedic surgery, major illness, or cardiac event like a stroke, patients will likely be referred to in-patient short-term rehabilitation or post-acute care. Here, recovery continues at a specialized facility under supervised care, ensuring you have 24/7 access to medical services and support.

Medication plan

Managing medications is critical in post-hospital care; it can protect against potential infection, alleviate pain, enhance recovery, and more. Your healthcare team will provide a medication plan that includes instructions on when and how to take medications, potential side effects, and any necessary adjustments to the patient’s current medication regimens or lifestyle.

With in-patient short-term rehabilitation, post-acute, and skilled nursing care, a healthcare professional like a certified nursing assistant (CNA) will administer and monitor medications.

If post-hospitalization care takes place at home, a home health aide can help you or a loved one manage their medication plan.


Depending on your condition and needs, your healthcare team may provide referrals to various specialists and services. This may include physical, occupational and speech therapy, dietitians, telemetry-based rehabilitation, and more. These referrals are essential to your recovery plan and can help you regain strength, mobility, and independence, enhancing your overall well-being.

Many of these therapies and specialized services are available under the same roof at in-patient rehabilitation facilities – making it easy and convenient for you to get the care you need to get well and go home confidently.

Consider Adult Day Care

Adult day care can be a valuable resource for individuals seeking support during their recovery from a hospital stay. It provides a structured environment for socialization, therapy, and support while allowing you to return home in the evenings.

Here’s how adult day care can benefit you or your loved one:

  • Rehabilitation with physical, occupational, and speech therapy, helping you continue your recovery journey in a supportive environment.
  • Social interactions and the opportunity to connect with others reduces feelings of loneliness and improves emotional well-being.
  • Medication management and other personalized care services ensure you have the support you need as you transition back to home life.

Prioritize Healing

Recovering from hospitalization or a major surgery takes time, patience, and commitment. To prioritize healing during your transition from the hospital to home, remember to:

  • Follow treatment plans: Adhering to the care plan created during your hospital stay or by your healthcare team is essential to regaining strength and independence.
  • Make healthy choices: A well-balanced diet, regular exercise, and proper sleep are crucial for a successful recovery. Be sure to follow any dietary and lifestyle recommendations from your healthcare team.
  • Prioritize emotional well-being: Healing isn’t just physical; it’s emotional as well. Seek support from loved ones, engage in relaxation techniques, and consider counseling or support groups.
  • Keep lines of communication open: If something changes with your or your loved one’s condition or you have concerns or questions about their care plan, don’t hesitate to ask your healthcare team.

At The New Jewish Home, we’re committed to providing the support and resources you and your loved ones need to make a successful transition from the hospital to home. We understand the challenges patients may face after hospitalization, and we’re proud to offer renowned short-term rehabilitation programs and post-acute care services across both Manhattan and Westchester. Our mission is to encourage patients on the road to recovery so they can get well, go home, and get back to what matters to them.

In Manhattan, we offer a range of specialty rehabilitation centers, including the Orthopedic Rehabilitation Center in partnership with Mount Sinai Health System, the Cardiac Rehabilitation Center with NYU Langone Medical Center, and the Center for Speech, Language, and Swallowing Disorders. Learn more about The New Jewish Home’s services and locations, including skilled nursing and adult day care, or contact us for additional information.