Coming home is the good news. Managing it is the part nobody prepares you for.

In the ward, someone was always watching. Then the discharge summary is in your hand, and the watching is yours: the medicines, the wound, the machine they showed you how to use once.

So before we put anyone in your home, our doctor comes and sees the patient himself. He reads what the discharge summary actually says, checks how the medicines are working together, and thinks about what's likely to go wrong in the next two weeks. Then he tells you what level of care that needs from an ICU-trained nurse who can manage a tracheostomy or a feeding tube, basic nursing for dressings and vitals, or sometimes less than you were bracing yourself for.

After that, it's the same people who keep coming. Nobody has to be told the history twice, and nobody misses the small change in your family member's condition that only shows up if you saw them yesterday. You'll know your coordinator's name before you see your first bill.