Providing medical care and making relevant discharge planning recommendations is critical to minimize risks, reduce hospital readmissions, and promote optimal functioning among the elderly population. Occupational therapists have an important role in making discharge recommendations to facilitate ongoing occupational engagement and adaptations. The purpose of this study was to examine the perceptions of the experienced occupational therapist in acute care on the key factors that are considered when making discharge recommendations for the elderly. Interviews with occupational therapists and field notes revealed the following five themes: Looking at the total picture; prioritizing client-centered collaborations; emphasizing cognitive functioning; enhancing occupational engagement; and framing assumptions about elderly discharge planning. Emphasizing a comprehensive, client-centered, and occupation-based assessment process that highlights client's values, self-care status, and cognitive functioning are the foundations of experienced occupational therapy practice with the elderly.