Aging Parents: Hospital Discharges

Hospital discharge planning is the process of developing a plan post hospitalization for an individual to receive appropriate services {think home health, rehab or nursing home}. The hospital by law must identify, at an early stage of hospitalization, all patients who are likely to suffer adverse health consequences upon discharge. For our purpose, this identification begins at the time of admission when your parent presents their Medicare card. The nuts and bolts list of what is required of the discharge plan process is very lengthy {dare I say boring} but what you need to know is this:

  •  The doctor following your parent in the hospital is the one driving the discharge time frame. If your primary care physician is not following in the hospital they cannot write orders regarding your treatment or hospital discharge.
  • That physician is very aware of the Medicare A guidelines in terms of billing and believe it or not their hands may be tied. This all relates to diagnostic related groups which you can read more about here…
  • If your hospital says to you: “I’m sorry but we’ve assessed your mother and believe she does not need a discharge plan” you can have your physician request one.
  • A discharge planner is responsible for arranging the services your parent will need at the time of discharge. Your discharge planner may be referred to as a care manager, social worker or registered nurse.
  • You have the right to appeal your discharge and there are very specific steps in place to do this. Speak with your physician, discharge planner or patient advocate for specifics.
  • The hospital indication that it’s time for discharge does not mean mom is ready to live at home independently but that the condition she was admitted for is stabilized and her time under Medicare A has come to an end.
  • Your hospital discharge planner will provide you with a list of available services i.e. home health agencies, skilled nursing facilities and can provide you with education but cannot give an opinion or recommend a specific organization.
  • Be open and honest with your discharge planner. If your dad was struggling at home before this hospital admission, he will probably need additional help {either at home, rehab or nursing home, companion care} at the time of discharge.
  • In order to receive skilled Medicare A services following the hospital admission, your mom or dad needs to be in the acute care setting for a minimum of 3 DAYS! This means that if discharge to skilled rehab happens on the 2nd day your parent will not receive inpatient Medicare A coverage for their rehab. Be aware, ask questions and advocate!

A discharge planner’s job is a pressure cooker type job with high expectations and huge case loads. I recommend that within 48 -72 hours of your parent being admitted to the hospital {depending on the situation: if it looks like a short term stay move quicker} YOU ask to speak with your discharge planner. The RN on the floor or someone at the nurses’ station should be able to provide you with the name of your discharge planner and how to get in contact with that person.

I’m happy to answer any questions you may have! Leave a comment…

Aging Parents: Frightening Hospital Psychosis

It’s not uncommon for aging parents to suffer what is referred to as hospital psychosis in the acute care setting {think hospital, emergency room, ICU}. If your mom or dad already suffers from dementia or memory impairment, the chances are even higher. Signs and symptoms include disorientation, paranoia, hallucinating, delusional thoughts and nightmares.  They may become agitated, combative, try to pull out IVs, or climb out of bed unassisted. You may hear the staff refer to this as delirium, altered mental status or hospital psychosis. Your parent could seem fine the day before a hospitalization then quickly become someone you don’t recognize.   It can be disturbing and downright frightening to watch.  Being aware will help you navigate the situation!

Tips for navigating hospital psychosis

Communicate with staff so they know this is “not normal” behavior for your mom or dad

Visits from family and friends may help

Stay open to the possible use of medication to help in the short term

In severe cases, you may need to camp out as a family to provide comfort and advocacy

Sometimes it helps to have 1:1 companions available to provide support and prevent injury

Providing a quiet consistent routine may help

Report any history of depression or other mental illness as this may be an important factor in the big picture of what’s happening.

Hospital psychosis is usually temporary but if your mom or dad experience a decline in cognition or just don’t “seem like themselves” following an episode of hospital psychosis, be sure to report this to your primary care physician.  Hospital psychosis is one of those things where you are going to need to tie a knot at the end of your rope and hold on for dear life. It can be a bumpy ride but usually a temporary one. If your aging parent has experienced hospital psychosis, please leave a comment about your experience!

For more ways to navigate your aging parent’s hospital stay, go here!

Aging Parents: Navigating Acute Care Hospitals!

For many, the first realization that mom or dad needs help is admission to the acute care hospital. It can be a stressful and disheartening experience for many aging families. Acute hospital settings are not designed to help you and your aging parent find long term solutions to life’s challenges. The role of the acute care setting or hospital is to stabilize your parent’s medical condition and discharge them.  It’s not uncommon for families to be ignored and left out of conversations.  Discharge happens with little or no notice and you have to make quick decisions about issues you know little or nothing about. It’s not that hospitals don’t care or do a good job but as you know there is more to your mom or dad’s life than what  the hospital staff sees in the hospital bed. There’s no way we are going to change the system today but there are some things you can do that will help you navigate the insanity of the hospital stay…

Connect: Refer to staff by their name, whether it’s the doctor or the nurse. Immediately connecting with staff by calling them by their name will go a long way in establishing an immediate relationship. Along with this, say please and thank you!

Take notes: Information is going to be coming at you really quick and there is no way on God’s green earth you will remember it all. Purchase a little note book  at the hospital gift shop so you can document who said what and when.  Write down questions as they pop in to your head.   When you see your physician (if you are lucky enough) his or her time will be limited so don’t waste it.

Lower your expectations: It pains me to say this but don’t expect too much in terms of hand holding or education. It’s probably not going to happen in the acute setting.  Look for support elsewhere!

Paperwork: If you have power of attorney for your mom or dad get copies in the chart immediately! Same with advance directives or living wills. Don’t assume that these documents will be read so be sure to advocate and assert yourself as the decision maker, if indeed, you have the legal authority to do so.

Long Distance: If you travel to care for your parents, chances are you’ll need to take time off from work. Keep in mind you may qualify for unpaid leave via the Federal Family Leave Act so check with your human resource director at work if you are worried about the time off.

If you’ve experienced the traumatic experience of helping your parents navigate the acute hospital setting, you may have some tips that can help others. If so, leave a comment with your tip!