When a Loved One is an Inpatient
As readers know, we typically address topics on coverage and Medicare but occasionally we include other topics related to healthcare because of their practical value. And, of course, we frequently hear our client’s distress when they or a loved one is in a hospital or nursing home and find various aspects of the experience difficult. As a result, we’d like to offer some practical advice.
In our last video, we discussed factors which have affected staffing levels in our hospitals and nursing homes. Most recently, those are directly attributed to workers leaving the field during the COVID pandemic and greater difficulty recruiting and relocating qualified workers from other countries. And, of course, working in an inpatient hospital or nursing home is important work but it is very difficult, challenging work.
But, even under ideal staffing environments, family members and/or close friends can be proactive in managing aspects of a loved one’s inpatient stay. And this is very important because most of us would not choose or cannot afford to hire private aides or private duty nursing staff to ensure that someone is with our loved one 24-7. Here are some pointers.
Plan Ahead: In our opinion, anyone who is not a minor should at least have an executed healthcare proxy and living will, and the location of these documents should be known to the listed proxy. This takes one step out of any planned hospital admission and removes any questions about who the decision-maker is for unplanned, emergency situations.
Presence: When someone is coming out of surgery, has undergone some other procedure, or is medically unstable, presence, even if you are not a clinical person, is critical. Someone should be with the patient. Introduce yourself to those who are in charge and caring for your loved one. Don’t waste their time but make your interest known. If you have questions, be organized and try to make sure they are good questions.
To underscore this point, I often provide the example of my husband’s hip replacement. He was discharged from recovery and admitted to a hospital room but no one came by to check on him for some time. He seemed fine, all things considered, but then abruptly became unconscious. Perhaps I should have used the nurse call button but I called the nursing station with the phone in the room (this was years ago) and was told someone would be right down. That didn’t happen so after a couple of minutes, I ran to the nursing station and got someone’s attention and at that point half a dozen people descended. The point is to anticipate problems and to plan your reaction. Again, perhaps I should have used the nurse call button but at least I followed up.
Awareness: Be aware of what’s going on and ask questions and intervene as appropriate. Going back to my husband’s admission, he is not supposed to take iron. That information was included in patient instructions and in the chart. Nevertheless, the day of his surgery, a staff person brought in a medication for him to take and when I asked what it was, I was told it was an iron pill. A more important issue is that he couldn’t participate in therapies because he was lightheaded and he was lightheaded due to blood loss. What could be done and when? When might a transfusion be considered? Who would order it? I called the surgeon’s office but he chose not to get involved so it seemed no one was in charge. Hospital policy was that if certain lab tests reached a low enough level, a transfusion was mandated so that’s what happened two days after the surgery. I know little about blood transfusions and a more proactive stance among the clinical staff involved would have been more helpful and reassuring. But, again, at least I was able to obtain information and to follow up.
Cell phones and other technology. Make sure the patient has a cell phone and determine how it will be kept charged and within reach (assuming the patient is well enough to use the phone, of course). If you or others would like to video chat with your loved one while they are an inpatient, make sure to download any needed apps to their phones prior to the admission and make sure they know how to use them. It is interesting that video monitoring of sleeping babies in their homes has become quite commonplace and yet we leave our loved ones in ICUs and other units without the ability to view them remotely. Some hospitals are already using remote video monitoring and there will likely be more apps and technologies available in the future. Patient confidentiality and HIPAA regulations may well be cited as impediments, but the trend seems inevitable and may actually be helpful in many situations. After all, FaceTime has been available for over a decade.
Planning for Discharge: Everything concerning an inpatient stay is more difficult to deal with when the situation is an emergency but, because the unexpected can happen, we all need to give some thought to dealing with what might arise with any family member at a certain age. Good health can decline abruptly. I cannot count the number of times a client has expressed distress at hearing a hospital or skilled nursing stay will not be covered at a certain point yet they don’t believe the loved one can return home. Hospital and skilled nursing stays are expensive and Medicare and other insurance will only pay for those who need that level of care. It is best to have a tentative plan before an emergency or urgent admission occurs.
Finally, a relative with clinical knowledge can often be a more effective advocate although a certain level of diplomacy is required in such situations. It’s not productive when any relative or friend alienates the staff caring for the patient.
Illness and infirmity of our loved ones is inevitable but we often aren’t prepared to deal with situations that are forced on us. I hope these few tips give our readers something to think about. If you have more to add, please share them with us for a future video.
