Why it's missed
Escalation looks sudden from the hospital. From the home, it was visible for days.
Discharge planning treats caregivers as logistics. Necessary — and not the problem. The person now running the medication schedule and absorbing every fluctuation is operating with a nervous system under chronic load. That load is silent until it isn't.
Early-warning signals in a caregiver's daily patterns precede an escalation event by 3–7 days. Nobody is measuring the right thing. That window is the opportunity.