1. Get to Know the Staff
- Will one nurse be consistently in charge of your elder’s care? If not, find out who will be coordinating care and the best time to call or meet with that person. While the physician manages the medical treatment, the physician doesn’t coordinate all aspects of hospital care.
- Who will be planning for care upon discharge? Some hospitals have social workers, or in some cases, “discharge planners”. They are planning for discharge very soon after admission and so should you. Get in touch with this staff person to give you enough time to consider options:
- Will my elder be able to be discharged to home?
- Will my elder require and be eligible for home health care through Medicare upon discharge, including nursing care and physical, occupational or speech therapy?
- Make sure that any equipment or services are put in place before discharge to home to provide for a smooth transition.
- If my elder needs care in a nursing home, what are our options?
- Contact the doctor to determine:
- What is my elder’s prognosis/chance for full recovery?
- What treatments/tests are being considered and what are the benefits and risks of these treatments/tests?
- What happens if the treatment/test is not done?
- Are there alternative treatments or measures that can be tried?
- What are the costs? Will the costs be covered by Medicare?
- Make sure the MD has a good sense of the pre illness functioning and all medications and treatments in place prior to hospitalization.
- Can therapy be put in place to prevent loss of function due to inactivity
- Designate one family member as the spokesperson and information gatherer for the family. Having more than one spokesperson can lead to misunderstanding and miscommunication.
2. Help the Staff Care for Your Elder
- Provide information about your elder that will help the staff better care for him/her:- food preferences, ability to hear or see well.
- Bring a picture of your elder during healthy, active days to post on the wall – it helps staff get to know the person behind the illness.
- Ask questions. Research shows that when individuals are involved in care, recovery is improved.
- Request that your elder be allowed out of bed, even if in a chair, if the physical condition allows. Inactivity and bed confinement can lead to complications and prolong recovery.
- Bring up concerns respectfully. Most staff members want to do their best to care for your elder, but working conditions can be difficult. While protecting your elder, treat the staff as a partner in recovery. If you have concerns, bring them to managers and people in authority who can resolve them.
3. Take a Hands-On Approach
- Offer to assist with little tasks- get water for your elder, help with eating and bathing, if possible – it makes you feel useful, provides an extra measure of caring and helps the staff.
- Use touch to communicate. Your elder may be too ill or tired to talk. Silence can be golden. Sitting quietly at the bedside can bring great comfort. Try a gentle hand massage. Don’t let tubes and machines get in the way of human contact.
4. End of Life Decisions
- Make the physician and staff aware of documents regarding health care decision making. A copy of the Power of Attorney for Health Care should be provided so all staff are aware of the wishes of the elder regarding use of measures to sustain life.
- Despite the fact that hospitals deal with life and death on a daily basis, discussions about end of life and the elder and family’s wishes don’t automatically occur. If an elder is very frail and/or gravely ill, it is appropriate for the family to initiate a conversation with the physician and staff about measures that may be employed, such as resuscitation, to keep your elder alive.
5. Discharge From the Hospital
- Before discharge, request written instructions for home care, goals of any home care services being prescribed, use of medication and follow-up treatment.
- If you believe discharge is premature, talk with your doctor. If your elder is covered by Medicare, you do have the right to appeal a discharge decision. The steps for appealing a discharge decision:
- Request a formal “notice of non-coverage” from hospital personnel, before discharge;
- Once you receive the notice you have until noon the following day to contact Medicare (1-800-647-8089) and request an immediate review of the discharge decision. A review typically takes 24 to 48 hours — your elder will not be charged for the stay during the appeal process, regardless of the appeal decision.