Leaving hospital: discharge planning in Ontario
Planning for discharge starts soon after a hospital admission. Families who know who to talk to and what to ask can get help at home in place before the day comes, instead of scrambling on the day itself.
By ParentCare Ontario Editorial, published by Otonabee Marketing. Updated November 2, 2026. General information, not medical, legal or financial advice.
Who plans the discharge
- The hospital team: doctor, nurses, and often a physiotherapist, occupational therapist and social worker. They decide when a patient is medically ready to leave.
- The discharge planner (sometimes called a patient flow or transition coordinator) organizes what happens next.
- An Ontario Health atHome care coordinator, based in or linked to the hospital, arranges publicly funded home care, equipment and applications to long-term care.
Ask on day one: "Who is the discharge planner, and when can we meet?" Give the team the name of one family contact and, if your parent can't decide for themselves, the person named in their power of attorney for personal care.
Questions to ask before discharge
- What is the expected discharge date, and what has to happen first?
- What help will my parent need at home, and how much will Ontario Health atHome provide?
- When will home care start? Can it begin the day they arrive home?
- What equipment is needed, and who arranges it? Ask about the Assistive Devices Program.
- What follow-up appointments are booked, and who do we call with questions after discharge?
- Are there new medications, and has the old list been reviewed?
- Is a short stay for recovery an option? See convalescent and transitional care.
Help at home after discharge
Ontario Health atHome can provide nursing, therapy and personal support at no charge if your parent qualifies. The hours are often less than families expect, so many add private help for the first few weeks: overnight care, meals, cleaning, or rides to appointments. Line it up before the discharge date. More on how public home care works.
If home isn't safe any more
If the team thinks your parent can't safely go home, they may suggest a retirement home, a short stay, or applying for long-term care from hospital. The care coordinator handles the long-term care application. You still choose up to 5 homes, but different rules apply to patients who wait in hospital.
Waiting in hospital for long-term care
A patient who no longer needs hospital care but is waiting for another bed is called an alternate level of care (ALC) patient. Under the More Beds, Better Care Act (2022), a placement coordinator can apply to long-term care homes for an ALC patient even if they weren't chosen, within 70 km of home in southern Ontario or 150 km in Northern Ontario. A patient who has been discharged and refuses that bed can be charged $400 a day to stay in hospital. Talk with the care coordinator early about which homes you would accept.
See how applying for long-term care works and retirement home vs long-term care.
If you disagree with the discharge
- Ask for a family meeting with the doctor and discharge planner. Explain exactly what worries you, for example that no one will be home at night.
- Ask what services will be in place on the discharge date, and put your questions in writing.
- Contact the hospital's patient relations office if you can't agree. Every Ontario hospital has one.
- Call the Patient Ombudsman at 1-888-321-0339 if the hospital's response doesn't resolve it. The Ombudsman takes complaints about hospitals, long-term care homes and Ontario Health atHome after the organization has had a chance to respond.
A patient who is capable of making their own decisions can refuse a discharge plan, but can't stay in hospital indefinitely once medically ready to leave. This is general information, not legal advice.