1. Everyone needs a hospital advocate.
When you’re ill, you can’t necessarily advocate for yourself. Or, even communicate the necessary information for medical staff to do the best job. Someone needs to be there to make sure information is provided, questions answered and asked. Elderly patients, in particular, need an advocate when hospitalized.
We’ve had this very experience with Mom in the past when she was sent to the ER. The doctor asks why she’s there. She replies “I don’t know. I’m fine.” He asks where she lives, she tells him her old home, not the assisted living where she really lives. The ALF sent some basic information in the ambulance with her, so he will know or find out that’s not true. But, beyond that he’s left with little information. Doctors are used to that, but just imagine the difference if someone was there to give him history and background. Mom might avoid unnecessary tests and get more targeted care. This is just what we found by having an advocate.
Hospital medical errors are the third leading cause of death in the United States. 700 people per day die from them when hospitalized.
A patient advocate can spot problems, provide oversight and improve coordination. Obviously, with the statistic above it’s clear hospitalized patients are vulnerable. Your hospital advocate will be observant, picking up on possible errors and asking the questions to make sure they don’t occur. This might include asking what medicine the nurse is giving or questioning staff who don’t use gloves.
Even seemingly minor things can make all the difference. For example, the advocate talks to the staff about how agitated Mom is likely to get before they take her for testing so they can plan accordingly, preventing a serious incident. Or, she explains Mom hasn’t eaten since the night before. She asks if Mom can have a snack or meal (and, most importantly, explains her special diet so they don’t give Mom something that could harm her).
A family caregiver may serve as the advocate, but many times a professional patient advocate can be helpful even to the family caregiver. They know the system and what questions to ask. They can anticipate concerns. A patient advocate knows how to do a chart review and who to go to for questions and needs.
2. It’s worth having someone present around-the-clock when hospitalized.
We discovered just how important this is when Mom fell in the middle of the night when she had to use the bathroom.
700,000 to 1 million hospitalized patients fall each year. More than one-third of in-hospital falls result in injury, including serious injuries such as fractures and head trauma.
When she was first hospitalized, we had to alert the staff to Mom’s altered mental status and dig into what was going on. We were caught off guard and learned how common this issue is.
Delirium is strongly associated with worse health outcomes. Short-term problems linked to delirium include falls and longer hospital stays. Longer-term consequences can include speeding up cognitive decline, and a higher chance of dying within the following year.
The second time, we had learned about delirium and worked with the doctors to take certain precautions. Having someone familiar there around the clock was a big part of that, along with working closely with doctors on medications and interventions to reduce confusion. It was difficult for family members to be there for her whole hospital stay, so we alternated with a hired hospital sitter.
3. Mom’s usual doctor may not be the one seeing her while she’s hospitalized.
Some doctors will visit their hospitalized patients. But, be aware the visiting hours may be at odd times to work around their other responsibilities. The practice may split up hospital duties, so one of her doctor’s colleagues may be the one visiting. And, many times it will be a “hospitalist” managing Mom’s care. Hospitalists work in the hospital, overseeing care while patients are there.
None of these options is inherently good or bad. But, we weren’t aware of how this all worked ahead of time and the coordination involved. We kept waiting for Mom’s doctor to come by to discuss her situation. This leads to the next thing we learned...
4. You need to find out who’s who and establish key points of contact.
Who’s the doctor in charge and who are the various specialists consulting? Who’s Mom’s nurse? When she needs help to the bathroom who assists? Often, hospitals write this information on boards in the patient’s room so you know the names of those caring for Mom on this shift. If you’re calling in to check on Mom, you’ll want to ask for her nurse to get a report. Your loved one will typically be assigned a case manager who can be your point of contact for the care plan and discharge planning. Ask around and don’t be shy if you aren’t sure who to go to for what.
5. Start preparing for discharge right away.
The last thing on your mind might be Mom leaving the hospital. However, with an average length of stay of five days (2016 stats for Florida) and many much shorter, planning for the next step should be done early. At EasyLiving, we often get distressed phone calls from family members who have been told Mom is being discharged tomorrow. They’ve just visited and Mom’s in bad shape. The family’s in panic mode.
What can you do? First, establish contact with her providers early on, particularly finding out who the case manager is. Communicate with them, so they understand Mom’s history, current living situation and needs. Express that you want to ensure a safe discharge and discuss possible plans. If you have a hospital advocate, they can lead this process for you. In case you don’t and you have concerns, contact a patient advocate to find out how they can help. They know the ins and outs of transition resources, from home care to rehabilitation. You can get an understanding of pros and cons of different options, as well as insurance/Medicare coverage rules.
Our patient advocates put together a basic discharge planning checklist for when your parent is returning home. Click Here to download it.
Prevention and Preparation
Research indicates that nearly half (48.5%) of hospitalizations could be avoided if the proper preventative steps are taken.
Good care coordination can prevent unnecessary hospitalizations. Why does this matter? Hospitals serve a necessary purpose but are not ideal places for elderly people in particular.
A large body of literature documents that elderly patients lose mobility and functional status rapidly during hospitalizations, and that this loss of functional status has long-term consequences.
Other major hazards associated with hospitalization for older adults include: weight loss and nutritional decline, dehydration, delirium and cognitive/mental health decline, and polypharmacy (increased/multiple medications). An advocate can help minimize these risks. Better yet, they can provide oversight and coordination so your loved one only goes to the hospital when absolutely necessary. Preventative care, home safety and supportive care can all play a role in keeping elders out of the hospital.
Also, be prepared by organizing important documents and creating an online personal medical record. Make sure all the information is accessible to caregivers. You need to be able to get documents like Mom’s power of attorney and living will to providers immediately. Of course, first you need to have these documents executed. And, beyond that, you should discuss decision making and wishes. Having one point of contact for medical coordination will save you and your providers a lot of hassle.
If you know your loved one is having surgery or going to the hospital here are a few other resources to help: