One of the most stressful moments for any caregiver comes when an elderly loved one is hospitalized. The hospital can be a scary place. The fear that people feel when entrusting the care of someone dear to the vagaries of a large hospital are not unfounded. It is well documented that older patients are at risk for a whole host of complications when hospitalized. Some of these include confusion, infections, bed sores, weakness and falls.
The following are some tips for avoiding complications and getting better care.
1) Avoid the hospital altogether if possible!
Sometimes it is unavoidable – and can provide life-saving care. At other times, particularly for patients with advanced dementia or other severe disease, it may not be what the patient needs or wants. Clarifying advance directives (i.e. living wills or health care proxy) will give you a better sense of what your loved one would like. A good first question for a doctor who advises you to take a loved one to the ER is “what will they be able to do for him or her”. For example, a woman I met told me about her mother-in-law with advanced dementia living in a nursing home. The home had called the woman’s husband because his mother had a bit of a droop in her face and they wanted to send her to the ER to see if she was having a stroke. When the son posed the question “Will going to the ER make her better?”, the doctor at the nursing home said “No, it would just give us a diagnosis”. In this case the son knew his mother would not want to go to the ER and he was OK with not having a definitive diagnosis. As long as his mother was not suffering, he felt she would be happier staying home rather than enduring a lengthy and confusing visit to the ER.
2) Find out which doctor will be in charge of your loved one’s care.
Nowadays many primary care doctors do not take care of their patients in the hospital. Instead they rely on Hospitalists – internists who specialize in the care of hospitalized patients. If admitted through the emergency room, ask the doctor there who the “attending physician” will be. Once admitted, the patient’s nurse should be able to provide this information as well. If no one seems to know who is in charge, see if there is a “patient representative” office in the hospital. They will help you advocate and get what you need.
3) Create (and update) a simple medical record.
Until we have a universal electronic medical record (or chips embedded in our skin!), it is wise to keep a simple and up-to-date medical record for aging parents. This document should include: medical conditions, surgeries, medications (which should include medications that have been stopped and why), test results (colonoscopies, x-rays, mammograms etc, if available), allergies, contact information for doctors and next of kin, advance directives. This simple document will help the doctors know more about their patient and could be life saving when a loved one is in the Emergency Room. It can also prevent unnecessary testing and procedures. Creating this document sends the message that the patient is cared about and has concerned family.
4) Make sure family and friends visit as much as possible.
If patients have mental or physical impairments that limit their ability to express what they need, make sure they have someone to speak for them as much as possible. Whether it is to make sure they are cleaned and fed or that they are not being taken for a procedure that was meant for a roommate – try not to leave them alone. Family members or friends can take shifts, or for those who can afford it, hire a nurse or nurse’s aide. If no one can be there in person, designate someone to be the family representative and make sure that person calls in for each nursing shift to get an update on how the patient is doing and what is planned.
5) Find out who will be in responsible for discharge planning.
This is generally done by a social worker, though on occasion it may be a nurse. Make yourself known to this person early on. With hospitalizations becoming shorter, it is important that this person be aware of any concerns you have about discharge. Let them know if there are safety concerns at home. Also, if your loved one is too weak or sick to be home, the discharge planner can help you find a rehab facility as a transition to going home.
6) Ask for a second opinion.
If a treatment or procedure is being offered and you feel unsure if this is in the best interest of the patient, ask for a second opinion. Medicare will cover this.
7) Ask for a Geriatrics consult.
If your loved one is over 65 and has multiple medical problems, asking for a geriatrics consult can be helpful. These doctors are specifically trained to care for older patients and are skilled in end-of-life care as well.