Being a Pro-Active Advocate When An Elder Goes in the Hospital

How to be proactive patient and advocate

You get the call you have always hoped you wouldn't get -- your 85-year old mother 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 seniors end up in the hospital.

Other common causes include pneumonia, heart attacks or strokes. Be aware that a urinary tract infection or dehydration is dangerous for the person and can precipitate hospitalization. In some cases, the event that caused the hospitalization can trigger a whole series of events, which could require rehab, in-home care, nursing home or assisted living care and in some circumstances hospice care.

Prepare to be a Proactive Advocate

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 a proactive advocate for your family member can help ensure that you have a more positive experience.

Hospitals can be overwhelming places for elders, and especially for those with dementia. Depending on their medical situation, surgery or new medications can complicate their hospital stay.

Tips to Help You Advocate a 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 someone with cognitive impairment.

If you are in the ER and it seems to be overwhelming your loved one, be assertive and ask the ER staff if your family member could be placed in a room instead of sitting in the waiting room.

If your elder family member is hospitalized, make sure you find out if your family member's status is considered hospital admission or observation. Observation is classified as an 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 that does not guarantee he/she has been admitted to the hospital.

If the doctor hasn't written an order to admit her to a hospital as an inpatient, she will be considered in observation. Keep in mind that Medicare and many insurance policies reimburse differently for observation versus in-patient hospitalization. Plus, if your loved one requires rehab care after his hospital stay, she must be admitted and have a three-night in-patient stay in order for Medicare to pay for her rehab care.

Designate One Person to Communicate with Hospital Staff

Primary caregiver

When your loved one is admitted, designate one person to communicate with the hospital staff. It will decrease confusion and misinformation and help to coordinate the elder's care.

If there is a Power of Attorney (POA) for health care, I usually suggest that the person be the designated advocate.

Manage Medications

Another area to be aware of is medication management while your elder loved one is in the hospital. Most elders are on an average of 6 to 12 medications before they even enter the hospital.

Whenever possible, bring a list of your loved one's current medications.

Once hospitalized, a person's medications can change. A physician may add drugs or delete a few from a patient's regime. If changes occur with the drugs during the hospital stay, ask the hospital nurse why. 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 while in the hospital, their family members were given psychotropic medication to calm down anxiety, confusion or agitation.

If prescribed psychotropic medication, ask why, what is the dosage, and how long will he need to take it. Psychotropic medication should be used as a last resort, as they can cause more problems, such as confusion, slurring of speech and falls.

Plan for Discharge Early

As surprising as it may sound, plan for the discharge to begin as soon as your elder loved one is admitted. Here's how:

  • 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 release, ask for a discharge summary, any discharge prescriptions and a copy of discharge medications.

I am convinced the hospital experience is stressful. My hope is these tips will be helpful and can at least ease your way.

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