We can usually have somebody in the house the day she comes home, including a weekend. There is no assessment visit to schedule first, no minimum contract to sign and no assessment fee, which is the whole reason a Friday discharge is workable.

Before you book anything, get four facts out of the case manager, because they change what you need to buy.

What do I ask the case manager today?

• Is she getting Medicare home health? If a doctor orders it and she is homebound, Medicare may send a nurse or therapist for a limited period. That is visits, not coverage. A nurse coming twice a week does not help at 7 in the evening, but it does reduce what you pay for privately, so find out what is already ordered before you buy hours.
• What is the weight bearing status and the transfer plan? One person or two, with equipment or without. This decides whether one aide is enough.
• What equipment is being sent, and when does it arrive? A hospital bed, commode, walker or wheelchair that shows up Monday is a problem if she lands Friday.
• What time is the discharge, really? Ask for a window and expect it to move. Discharges slip to late afternoon constantly.

Does she need somebody overnight or just during the day?

Ask one question: if she needs the bathroom at 2 in the morning, what happens. If the answer is that she gets up alone on a new hip, a walker she has used for three days and an unfamiliar route in the dark, that is the fall that sends her back.

The usual pattern that works: one overnight on the first night home, which is $540 for a 12 hour night, and then four hours each morning, which is $180 a day at $45 an hour. That covers the window when most readmissions start without buying a month of care you may not need.

Can she even get into the house?

Go look at the steps today, before Friday. This is the single most common thing nobody checks, because the person planning the discharge has never seen the house. Count the front steps, look at whether the staircase to the bedroom turns, and measure the narrowest point if it does.

If she cannot manage the stairs, two trained staff with a motorized stair chair is $200 a visit, and that can happen at the same appointment as the ride. If the staircase is too narrow or the turn has wedge shaped steps, we will tell you on the phone rather than send two people to fail in your stairwell. Send a photo from the bottom looking up.

What about getting her home in the first place?

Insurance paid for the stay, not the ride out, and families discover this on the morning of discharge. A wheelchair accessible van is $115 each way or $230 round trip within five miles of one of our offices, then $2 a mile. If she can walk to the car you do not need the van, you may just need somebody to go with her.

One warning worth hearing: do not plan on a sedan if she has a new hip or a leg amputation. The seat is too low and the transfer in a parking garage is where people get hurt. We cover who pays for what on who pays for the ride home from rehab.

What goes wrong in the first 72 hours?

Four things, in this order of frequency.

• The prescriptions are not filled. Nothing is waiting at the pharmacy. Somebody has to physically go, and it should not be her.
• There is no food she can actually eat or reach. Three days in a fridge that was emptied before the hospital stay.
• The follow up appointment gets missed because nobody could get her there.
• Nobody writes anything down. Which pill changed, what the discharge summary said, who to call. By Monday nobody is sure.

An aide handles the food, the shopping and getting her to the appointment, and can be present while she takes her own medication. Our aides are trained, background checked and insured but they are not nurses and cannot administer medication, so if the plan calls for injections or wound care, say so now and we will tell you whether you need nursing instead.

What does 48 hours of coverage actually cost?

A worked example for a Friday discharge with stairs and a van: the ride home at $230 round trip if you need us both ways, stair assistance at $200, the first night overnight at $540, and four hours on Saturday and Sunday morning at $180 a day. Then you decide on Monday whether to continue, without having committed to anything.

That is the point of no minimum contract. You are buying a weekend, not signing up for a schedule, and if she turns out to be steadier than anyone expected you stop.

Is there anything free we should check first?

Yes. Ask the case manager for the Medicare home health order if one has not been written. Call her town's Council on Aging about meals and rides. And if she is on MassHealth Standard or CommonHealth and needs physical help with at least two daily activities, ask about PCA hours, which cost the family nothing. None of those will be in place by Friday, but they change what you pay in week three.

How do we book it?

Call with the discharge day, the address and the floor, and an estimate of the time. An estimate is enough. We hold the slot and move it when the hospital firms up, because discharge times always move.

Care Remedy serves eastern and central Massachusetts from offices in Woburn, Brockton and Springfield. Call 781-957-8076 .