In my own practice I have always believe that discharge planning does start from the moment you are in hospital. I have always encouraged my patients to do as much for themselves as they could and naturally help them if need be. On the surgical floor where I used to work we would chuckle when the docs would write "discharge planning" a number of days in advance but it makes sense. The more you get folks ready to go out the door the better they will do afterwards. (In my opinion anyways) For us it was mostly self driven, but we worked closely with community resources and they connected with the patient in the hospital and set up what the patient needed- here in BC (Canada) each patient is entitled to 2 weeks of home care support following their surgery free of charge. I believe most people take that offer I think it is always a good thing to start identifying things from the getgo so that when a patient is dicharged suddenly you have the framework to develop a plan for their safe return home.