Everything that matters in the first weeks, in one place. Four situations, four short action lists — each links to the deeper guides when you're ready. You don't have to read everything today.

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Here for someone you love? If you're the spouse, parent, partner, or friend stepping in to help, start at the Caregiver Hub — the practical and emotional realities of caregiving, paying for care, and protecting your own health so you can last. The Family / caregiver tab below is your quick-start.

In the ICU & acute hospital

Right now the medical team is stabilizing the spine, breathing, and blood pressure. Your job is smaller than it feels: take notes, ask questions, and take care of yourself enough to last. New words flying at you? Keep the plain-language glossary handy. Full guide: The First 72 Hours & First 30 Days and The Hospital Phase.

Checklist

  • Start a notebook (or phone note): every doctor's name and role, what they said, every procedure and date.
  • Identify the attending physician and ask who is coordinating overall care.
  • Ask for a case manager / social worker assignment — they drive insurance and rehab placement.
  • Get the official injury description in writing: level (e.g., C5), complete vs incomplete (what that means and what to expect at that level), surgery performed.
  • Designate one family spokesperson so the team isn't repeating updates to five people.
  • Print or save our First 30 Days Packet — contact sheets, logs, and scripts.
  • Eat. Sleep in shifts. This is a marathon — collapsing helps no one.

Questions to ask the team

  • "What level is the injury, and is it complete or incomplete?" (It may be too early to say — spinal shock can mask function for days or weeks.)
  • "Was surgery done to decompress the cord? When?"
  • "What complications are you watching for — breathing, blood clots, blood pressure, skin?"
  • "When will you start talking about inpatient rehab, and who refers us?"
  • "Who is doing daily hand range-of-motion and splinting?" (For a cervical or incomplete injury this should start in the ICU — it's how you prevent hand contractures before they set in.)

Red flags — speak up immediately

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Fever, new trouble breathing, pounding headache with flushed skin (autonomic dysreflexia — emergency at T6 and above), one swollen leg (possible clot), or any new redness over bony areas (pressure injury — these can start in the first days, in the hospital bed). Don't assume the nurses saw it. Say it out loud, ask what's being done, write down the answer.

Choosing rehab

Where you do inpatient rehab matters more than almost any early decision — specialized SCI rehab measurably changes outcomes. You usually get days, not weeks, to choose. Full guides: Choosing a Rehab Facility · Rehab Finder tool · the 18 SCI Model System Centers.

Checklist

  • Ask the case manager today: "Which inpatient rehab facilities are you considering, and are any SCI-specialized?"
  • Check candidates in our Rehab Finder and against the Model Systems list.
  • Push for a facility that treats many SCI patients per year, not a general rehab floor that sees a few.
  • Ask how many therapy hours per day (3+ hours, 5–6 days/week is the inpatient standard).
  • If insurance pushes a weaker facility, appeal — use the call script in the First 30 Days Packet.
  • Distance matters less than specialization. Six weeks somewhere excellent beats six weeks somewhere close.

Questions to ask each facility

  • "How many spinal cord injury patients did you treat last year? Do you have a dedicated SCI unit and SCI-experienced physiatrists?"
  • "What's the average length of stay for an injury like this, and what decides discharge?"
  • "Do you train family/caregivers before discharge?" (Why this matters.)
  • "Do you have peer mentors, a urologist on staff, wheelchair seating specialists, and a day program or outpatient follow-up?"

Red flags

  • Nobody can tell you how many SCI patients they see.
  • "Rehab" that's mostly bed rest with under an hour of therapy a day.
  • No plan for bladder/bowel education — that's core SCI rehab, not optional.
  • Pressure to discharge to a nursing home without exploring inpatient rehab first — appeal it.

Going home

Discharge is the most dangerous transition in the whole journey — supports vanish overnight. Plan it like a project, starting at least two weeks before the date. Full guide: What to Ask Before Discharge.

Checklist

  • Work through the complete discharge question list with the care team — who manages bladder, bowel, skin, meds, equipment, and follow-ups after you leave.
  • Order equipment early — wheelchairs and cushions can take weeks; insurance denials take longer. (Equipment guide.)
  • Get home modifications started: ramp, doorway widths, bathroom. (Home modifications · accessible housing.)
  • Schedule follow-ups before leaving: physiatrist, urology, primary care — get dates on a calendar, not "call later."
  • Fill every prescription before discharge day, and confirm who refills them after.
  • Confirm caregiver training happened: transfers, skin checks, catheter care, bowel program, AD response.
  • Build your emergency plan: Emergency Preparedness After SCI.
  • Start benefits paperwork now if you haven't — SSDI/SSI take months. (Disability & Benefits guide.)

The first weeks home

  • Daily skin checks, no exceptions — pressure injuries are the #1 preventable readmission.
  • Keep the bladder/bowel logs from the packet — patterns are how you and your team troubleshoot.
  • Know your two emergencies cold: autonomic dysreflexia and blood clots.
  • Expect a mental dip when the structure of rehab disappears. It's normal, it's common, and it's treatable: mental health after SCI.

Family & caregivers

You're not a visitor in this — you're part of the care team, and your stamina is a medical resource that needs protecting. Full hub: Caregiver Hub.

Checklist

  • Pick one spokesperson for medical updates; rotate hospital shifts so no one burns out in week one.
  • Say yes to specific offers of help: meals, rides, laundry, childcare. Keep a list of what people can do.
  • Demand hands-on training before discharge: transfers, skin inspection, catheter care, bowel program, AD response. Practice with supervision until you're confident. (Training guide.)
  • Learn body mechanics now — caregiver back injuries are epidemic. (Protecting your body.)
  • Ask about being paid as a family caregiver through Medicaid waiver programs — most families don't know this exists. (How it works · Benefits hub.)
  • Get the survivor connected to peers who've lived it — and get yourself a caregiver community too: our caregiver forum.

What nobody tells families

  • Grief and hope coexist for months. You can mourn the old life and still believe in the new one.
  • Don't do everything for them. Independence is rebuilt one frustrating, slow task at a time — taking over steals the rep.
  • Recovery timelines are unknowable, even to the doctors (an honest look at prognosis). Beware anyone selling certainty — in either direction. (Miracle-cure warning signs.)
  • Your own checkups, sleep, and mental health are not luxuries. A collapsed caregiver is the fastest route to a nursing home placement nobody wants.

Red flags for the person you care for

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Pounding headache + sweating/flushing above the injury = autonomic dysreflexia — treat as an emergency. One swollen/warm leg = possible DVT. Any skin redness that doesn't fade in 30 minutes = early pressure injury. Fever + cloudy/smelly urine = possible UTI. Withdrawal, hopeless talk, giving things away = get mental-health help; in crisis call or text 988.

Three things to do today, whatever stage you're in

SCI.help articles are information, not medical advice. Practice varies by injury level, provider, and institution — always confirm specifics with your own care team.