Yesterday, mom was living independently at home and you were going about your own life. Today, you get a call that changes your life. Your aging loved one is in the hospital and in immediate need. Below you will find some tips on how to manage the hospital stay, and discharge plan.
AgingPro Tips for managing a hospital stay for your loved one…
THINGS TO BRING WITH YOU, or not TO THE HOSPITAL
1- POWER OF ATTORNEY / CONFIDENTIALITY
Make sure the hospital has copies of the patient’s healthcare durable power of attorney that states who will make decisions if the patient can no longer do so for themselves. Know that since the start of HIPPA (Health Insurance Portability & Accountability Act of 1996, Public Law 104-191), protecting patient confidentiality is a serious matter for hospital and healthcare organizations (there are severe penalties for non-compliance). The agent stated in the power of attorney will be the one with whom the healthcare professionals will be able to discuss the patient’s care. Anyone else who needs to talk with nurses or doctors will need to fill out a release of information form (available at the hospital or doctor’s office), have the patient sign the form, and ask that it be kept it on the patient’s chart.
2- CONTACT INFORMATION
Make sure the hospital has the contact information for involved family or loved ones. Also, if there is someone you don’t want to visit or call for updates, let the nurse know that.
3- MEDICATION LIST
Make sure the hospital has the patient’s current list of all the medications your loved one takes.
4- MEDICAL HISTORY
If possible, bring a list of surgeries, doctors, previous tests run (and results) and diagnoses. The more detailed information you can give the doctors, the easier it will be for them to treat the patient properly. Consider that the hospital staff has no previous knowledge of your loved one.
5- REMOVE ALL VALUABLES
Do not leave valuables with your loved one at the hospital. Take off valuable or priceless jewelry, take home valuable clothes or belongings. Don’t leave wallets or cash in the hospital room.
6- PERSONAL ITEMS
Things that are good to have are glasses, hearing aids and dentures, but be careful with them! If you leave items such as glasses, a cane, a walker, or dentures, make sure they are labeled and also listed in the patient’s chart on the “personal belongings” sheet. Socks and slippers with non-slip soles, toiletry items (toothbrush, deodorant, razor, lotion, lip balm), ear plugs, non-perishable snacks (crackers, nuts, dried fruit), and a phone card to use for outgoing calls if needed are also good to have.
BEING AN ADVOCATE
1- PEOPLE TO MAKE FRIENDS WITH
Make friends with the discharge planner. This is usually a social worker or nurse who works to coordinate things between the doctor, the hospital, and the family. The discharge planner is informed by the doctor when it is time for a discharge, and they are required to ensure that the discharge is safe - that the patient will be going somewhere that will offer them the appropriate care. If your loved one is going to need to move after discharge, the discharge planner will help prepare for the changes and services involved (medical equipment, home care, rehabilitation therapy, nursing home, etc).
Get to know the nurses. They can keep you informed of the patient’s status, or get important messages to the doctor. The director of nurses is also a good person to talk to if you need more assistance. Find out the chain-of-command on the floor you are on, and use the appropriate personnel to assure your loved ones needs are met.
When talking with the nurses or hospital staff, ask questions, provide them assistance and information that would help them know how to treat your loved one. Be appreciative, and be respectful. There is a saying “you attract more bees with honey.” Try being nice first. If you don’t get the service or care you want, then go up the chain of command until you get your loved one’s needs met.
2- HAVE A PATIENT ADVOCATE PRESENT
Hospitals are busy places, the staff is handling many patients, and errors can be easily made. We’ve all heard the horror stories. One way to get the best care is to have a family member or advocate present with your loved one as much as possible. If you can’t spend as much time as you’d like, you could hire a caregiver / companion from an agency to be with them, offering personal care assistance, asking questions, watching that the correct procedures and medications are administered. Be clear with them what your expectations are. When you’re not on advocate duty, take the time to go home and rest or do something fun and nurturing so you can rejuvenate.
If you feel the hospital experience is too much for you, or you want to be assured that your loved on it getting the best care, Professional Geriatric Care Managers can assist with all aspects of what you need at the hospital. Often times, the doctors and hospital staff will talk to Care Managers before family. This may be because the Care Manager can speak their language, or maybe that they are less emotionally charged in the situation. The AgingPro directory will help you find the nearest Care Manager.
3- TAKE CARE OF YOURSELF
Make sure the caregivers / advocates are taking good care of themselves during the hospital stay. Get as much rest as possible, and time away to do something enjoyable. Eat nutritious food. Most hospitals have special meals, such as vegetarian, diabetic, or kosher that may be more appealing. This may mean asking a friend to bring food to the hospital (as the cafeteria’s sometimes have a lot to be desired). Getting the proper nutrition can help you cope with the strain of the hospital experience. There is nothing like a home cooked meal!
DISCHARGE FROM THE HOSPITAL
Remember to be in contact with the discharge planner during the entire hospital stay, as they are responsible for planning the patient’s exit from the hospital – either back home or to a new living arrangement.
It is not unusual for doctors to discharge patients in less than desirable condition or at a terrible time of day or week. If the patient is going to a new living facility, the core staff is usually there Monday through Friday 9am- 5pm. If a patient is discharged on a Friday at 3pm, the chances are pretty good that the proper staff is not going to have the time or attention to offer proper care for all the details that are required. The same goes for discharges to home. Does the patient need medications that night? Is the pharmacy open? Do they have the medications that are required, and is there someone available to pick up the medications? Usually, the hospital does not dispense medication, but sometimes there will be a pharmacy in the hospital where you can have medication prescriptions filled. If there is special care needed (for example, oxygen, inhalers, wound treatment) is the proper equipment ready and are the people trained on how to administer care?
Do not rely on the hospital staff to think of everything to tell you before you leave the hospital. That is usually not the case. You must ask the proper questions, write things down, and try to think three steps ahead.
Consider that your loved one may likely overestimate their capabilities about what they can and cannot do on their own. Have a nurse or doctor assess your loved one to determine how much care they will need immediately after discharge and over the next couple of weeks. After the assessment, ask for the information to be discussed with the family and your loved one, so everyone understands the plan.
If you feel the patient is being discharged prematurely and they are not well enough to go home, you can appeal the decision. Before filing an appeal with the Quality Improvement Organization (QIO), consult with your doctor or the discharge planner to see if they will extend your stay. If your stay is not extended, ask the hospital for a written notice that explains why you are being discharged and gives the exact date that your Medicare coverage ends. This notice will be called a “Hospital-Issued Notice of Noncoverage” (HNN). If you are enrolled in a Medicare Advantage plan, this notice will be called a “Notice of Discharge and Medicare Appeal Rights”. Once you receive the notice, call the Peer Review Organization (PRO) or Quality Improvement Organization (QIO) (ex: Lumetra in California) immediately or by noon of the next business day. If you call by noon of the business day after receiving the notice, you will be able to remain in the hospital while your case is being reviewed. It may take 1-3 days, but you should not be sent home or billed by the hospital until the review of your case is completed.
Be assertive, persistent, realistic and prepared. It might take some work to get what you want for your loved one. Remember that a Professional Geriatric Care Manager specializes in things like creating a successful discharge plan, and knows the community resources. If you need extra support, or want to know you have done everything possible for your loved one, consider hiring a Care Manager to assist in negotiating the hospital discharge. They can work with the hospital staff to assure the best plan is created.
The discharge planner can assist you with things such as:
- Referrals to community-based agencies that provide services such as transportation, adult day care, meals, activities, volunteers, respite care, and home health care.
- Educational materials such as books and websites
- Support groups in the community to assist both caregivers and patients
INFORMATION TO LEAVE THE HOSPITAL WITH
Before your loved one leaves the hospital, make sure you have:
- An understanding of your loved one’s condition and diagnosis, results of any tests, and any changes that have happened as a result of treatment during the hospital stay
- A written medication list (including dosage and potential side effects)
- A written list of any needed follow-up physicians visits
- An understanding of any problems or symptoms that may occur when the patient gets home – what to look for and when to call for help.
- A written care plan with next steps
- Any special equipment to prepare the home for your loved one’s return (hospital bed, home modification, rental equipment)
- Arrangements for home health care or home care aid services- find out what services insurance will and will not cover
- Education on any special needs your loved one may have when she arrives home
- Transportation home, or wherever your loved one will be going. Find out if insurance will pay for an ambulance, if necessary.
If follow-up treatment is necessary, find out what insurance will pay for. It continually surprises people what insurance will and will not cover for services and items needed at home that are routinely paid for in the hospital. Remember, many home care needs will not be covered, like companion and home care aides. Some of the coverage will depend on your loved one’s progress at home, needs, and other factors. The discharge planner should refer you to home health companies and community resources.
To find out whether something is or is not covered by your insurance, contact your local State Health Insurance Assistance Program (SHIP) online at http://www.medicare.gov/contacts/static/allStateContacts.asp, www.MedicareRights.org, or by calling 212-869-3850.
Remember to keep a written record of who you talked to, when you talked to them, and what they said.
Make a list of everything that needs to happen when your loved one gets discharged from the hospital. Assign people to each job, including family caregivers and those things that you need to hire a professional to do.
FIXING PROBLEMS / SOLVING DISPUTES
If there are problems with individual hospital staff, try talking with the person individually. Tell them your concerns and give specific examples. If you don’t get resolution, go to the director of nursing (DON) for the floor, and then the DON for the hospital. If it is a medical issue, go to the medical director of the hospital.
If the problem you are experiencing continues, go directly to the hospital administrator. Tell them what the problem is, and let them know that if it doesn’t get resolved you will be talking to a lawyer.
For Medicare recipients, if you believe your loved one is not getting necessary treatment in the hospital, is being prematurely discharged, has been injured by a doctor, or is being unfairly denied coverage, contact your state’s Quality Improvement Organization (QIO). QIO is a group of physicians and health care professionals that are contracted by the federal government to make sure Medicare patients receive proper treatment from hospitals, nursing homes, doctors, and home-health care agencies. For example, Lumetra.com, 1-800-841-1602, handles Medicare complaints in California. You can contact them for the name of the QIO in your state, call Medicare (1-800-MEDICARE), go online to www.medicare.gov, or call the American Health Quality Association (www.ahqa.org) at 202-331-5790.