AND HOW TO ENSURE THE EXPERIENCE IS A PLEASANT ONE
By Nancy Kriseman
You get the call you have always hoped you wouldn’t get — your 80 year old father has fallen, broken a hip, and will need surgery. Unfortunately, a sudden change in health status among elders occurs far more frequently than most people expect. Falls are one of the most common reasons elders end up in the hospital. Other reasons include pneumonia, heart attack or stroke. However, be aware that a urinary tract infection or dehydration can be serious for the elder and be a need for hospitalization. And more times than not, the event that caused the hospitalization can lead to a whole series of events, which could require rehab, in-home care, nursing home or assisted living care and in some circumstances, hospice care.
Over the years, my clients have shared that the hospital experience was one of the worst experiences they have had to face with their loved one. Being an advocate for your family member can help ensure that this does not happen to you. Hospitals can be scary places for elders, and especially so for individuals with major health issues or dementia. Depending on their medical situation, surgery or new medications can complicate their hospital stay. The following are tips to help you advocate for your loved one.
The ER can be a busy, noisy, and crowded environment. This unfamiliar and over-stimulating atmosphere can cause an elder to experience confusion, agitation and even combative behavior. It can be even worse for a family member with cognitive impairment. If this is happening or you’re concerned it could happen, be assertive and ask the ER staff if he could go into a room instead of sitting in the waiting room.
If your elder family member is hospitalized, make sure you find out if her status is considered hospital admission or observation. Observation is classified as outpatient. Many families have been confused by this, as they report their loved one was “in the hospital.” Your loved one can receive medical services, lab tests, X-rays, and even spend the night at the hospital. But if the doctor hasn’t written an order to admit her to a hospital as an inpatient, she will be considered outpatient. Keep in mind that Medicare and many insurance policies reimburse differently for observation verses in-patient hospitalization. Plus, if your loved one requires rehab care after his hospital stay, he must be admitted and have a three night in-patient stay in order for Medicare to pay for his rehab care.
If your loved one is admitted, designate one family member to communicate with the hospital staff. This decreases confusion and misinformation and helps to ensure that family that the elder’s care is properly coordinated. If there is a Power of Attorney (POA) for health care, I usually suggest that person be the designated advocate.
Another area to be mindful of has to do with medication management while your elder loved one is in the hospital. Most elders are on an average of 4-6 medications before they even enter the hospital. Whenever possible, bring a list of your loved one’s current medications. Once hospitalized, an elder’s medications may be changed, stopped or added to. If any medications were changed during the hospital stay, ask the hospital nurse why and ask what medications should be continued, stopped or changed after discharge. Compare the new medication list with the old one and make sure you understand what has changed and why.
Many of my clients have reported that their elders were given psychotropic medication to calm down anxiety, confusion or agitation. If your elder family member is placed on psychotropic medication, ask why he is being prescribed the medication, what is the dose, and how long will they keep him on it. I prefer that they be used as a last resort, as my clients and I have seen that these medications can sometimes cause more problems.
As surprising as it may sound, plan for the discharge to begin as soon as your elder loved one is admitted. First, ask to speak to the social worker or discharge planner assigned to your family member. Ask how long your loved one will remain in the hospital. Keep asking until you know the discharge day. Then find out what care is needed or recommended. If your loved one is going home, make sure that everything is in place for a safe return home. If your loved one needs a rehab care center, don’t rely just on the discharge planner’s suggestions. I strongly encourage that you visit the facilities, check them out and ask questions. On the day of discharge, ask for a discharge summary, any discharge prescriptions and a copy of discharge medications.
There is no doubt that the hospital experience can be stressful. My hope is these tips will be helpful and can at least ease your way.
Please send your questions, ideas and topics of concern to this paper. I will do my best to respond to the most common questions and issues posed. You can also visit my Geriatric Consulting Services website at www.nancykriseman.com, my Facebook page, or follow me on twitter @GeriatricMSW.