Have you gotten that call in the middle of the night telling you that your mother who is 2,000 miles away has fallen and is in the hospital? Has your father come for a visit and had a slight stroke? These circumstances can interrupt your everyday life and send you into a state of panic and fear. THE MOST IMPORTANT THING TO DO WHEN YOUR PARENT IS HOSPITALIZED IS TO PUT YOUR PANIC AND WORRY ASIDE AND SHIFT INTO WARRIOR MODE. Here’s what you need to do.
1. Don’t panic. It is natural to be fearful and overwhelmed when your mother or dad is rushed to the hospital. Accept your feelings as natural, but put them aside right away. YOU ARE YOUR PARENT’S BEST ADVOCATE. If you live far away, immediately call a friend who can go to the hospital and be your liaison on the ground until you get there. You will quickly get frustrated and angry trying to get information about what’s happening with Mom or Dad unless you have someone on the scene looking out for YOU and letting you know what’s going on. If you can’t get to the hospital, there are also elder care advocates like myself who can be your eyes and ears and fight through the system so your parent gets the best care.
2. Contact your mother or dad’s physician immediately. As a side note here, it is very important that your parent have a general internist physician (preferably a gerontologist if you can find one) WHO IS WILLING TO FOLLOW YOUR PARENT TO THE HOSPITAL IF NECESSARY. This is obviously something to arrange now, before any unforeseen hospitalization occurs.
Many hospitals now promote to patients a new system of “hospitalists” — these are physicians who only work at the hospital and don’t have a private practice. The problem with this is that your parent will be a new patient to the hospitalist and you might not have the same hospitalist every day. WHAT YOU WANT IS YOUR PARENT’S PHYSICIAN WHO KNOWS YOUR PARENT’S HISTORY TO VISIT THE HOSPITAL EVERY DAY AND DIRECT YOUR PARENT’S CARE! This is very important for the continuity of care for your mom or dad and for your comfort. A hospitalist might not pick up on something about your parent that his or her own physician would because of their history together.
3. Don’t be intimidated by the hospital system. The reality is that hospitals have their own protocols and systems which may work for them, but may not necessarily work for you! You land in a place that’s all new to you — and they’ve got the advantage. Do not be afraid to ask questions of the nurses, other staff or the physicians. Hospitals tell us that their mission is to take the best care of their patients, but the reality is the only person who will be looking out for the best interests of your parent is YOU or YOUR ADVOCATE.
When my mother was in the hospital, I walked up to the nurses’ station behind which about 10 people were chatting away, and the one who was sitting at the desk right in front of me refused to look up. I finally called out, Hello, anybody home? And they all turned in disbelief, but I got what I needed.
4. If possible, keep your parent in the hospital for THREE OVERNIGHTS. True, you do not have complete control over this, that’s why the presence of your parent’s own physician can be so important, but if your parent will have to go to a rehab facility or go home for therapy, and he or she is on Medicare, Medicare will only pay for follow-up treatment if your parent has spent three full overnights in the hospital. Not days, but overnights.
Don’t let them try to push Mom or Dad out too early. If it’s legitimate for them to stay in the hospital, make sure they stay. I had a friend who unfortunately did not know the three-day rule at the time, and her mother wanted to leave the hospital early. She needed therapy at home as the doctor prescribed but had to pay for it herself because she did not meet the three-overnight rule.
5. Manage the hospital’s discharge planner. Within a day or two of your parent’s admission, you will meet the discharge planner, whose job it is to arrange for where Mom or Dad goes and what help they need after the hospital. THIS IS VERY KEY — if your parent is going to have to go to a rehab facility, a skilled nursing facility, and the three-day rule is met, Medicare will pay for the best or worst facility. IT IS YOUR JOB AS ADVOCATE TO FIND OUT THE BEST FACILITY AND GET MOM OR DAD IN THERE! This will make a world of difference in their aftercare.
The discharge planner will give you a list of facilities in the area. They are not ethically allowed to tell you what the best ones are. Typically, they will ask you to pick three, and then whichever of those three facilities has a bed on the day Mom or Dad is discharged from the hospital, that’s where they’ll go.
BUT HERE’S THE CATCH — THERE MAY ONLY BE ONE GREAT FACILITY IN THE AREA. SO HOW TO GET THERE? First, you have to find it. Ask friends, families, colleagues. If you’ve hired an advocate, they’ll be able to guide you. If you’re on the ground, go visit the facilities. Ask for a tour of the skilled nursing facility. Talk to the admissions officer at the facilities you like. If one stands out above the rest, keep talking to the Admissions officer at that facility (you won’t know exactly what day your parent will be discharged) and tell the hospital’s discharge planner that you want your parent to go there.
This is so important and the trickiest part. When you find out (usually the day before) when Mom or Dad is to be discharged, call the facility (or facilities if you’re blessed to have several you like) and ask if they will have a bed open the next day. Some hospital discharge planners are wonderful, others are annoying and territorial. They may see you as interfering with “their” job. But put any concerns about that aside, and recognize that they are treading on YOUR territory, where Mom or Dad goes will make no difference to them, it will make all the difference to you. If there’s a bed open where you want to go, tell the discharge planner that day — tell them you’ve talked to the admissions representative at the facility, there’s a bed available, and you want Mom or Dad to go there. DO NOT GIVE IN AT ANY POINT AT THIS STAGE. YOU’VE DONE THE HARD WORK, IT’S TIME FOR MOM OR DAD (AND YOU) TO REAP THE BENEFITS OF YOUR INVESTIGATIONS AND ADVOCACY!
Remember, regardless of your past history, fighting for your parent at this time in his or her life when they may need you most, can become the most rewarding time of togetherness for both of you and lead to great healing, if needed, and joy. It won’t be easy, but it will be worth it. Hopefully, with these tips in mind, you can focus on loving your parent to the best of your ability and not on the frustrations that come from navigating unknown waters.