Senior Discounts
Old Age and the Fear of Dying

How To Fight For Yourself At The Hospital and Avoid Readmission by Judith Graham

[RONNI HERE: My friend Judith Graham recently became a regular columnist for Kaiser Health News which is one of the most useful and trustworthy websites on health in general and on elder health issues that you can find online.

Judith's experience makes her uniquely qualified. She was a national correspondent and senior health reporter at the
Chicago Tribune for many years and later blogged for The New York Times’ New Old Age blog.

Her new Kaiser Health column, which appears twice a month, concentrates on aging and health with a consumer focus.

Lucky for you and me, Kaiser Health News allows organizations to republish their stories free of charge and Judith's columns are an excellent fit for TGB.

Judith is always looking for older adults with aging and health stories to tell. If you’ve got one, send it to her at judithegraham@gmail.com.

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(Republished with permission from Kaiser Health News).

Everything initially went well with Barbara Charnes’ surgery to fix a troublesome ankle. But after leaving the hospital, the 83-year-old soon found herself in a bad way.

Dazed by a bad response to anesthesia, the Denver resident stopped eating and drinking. Within days, she was dangerously weak, almost entirely immobile and alarmingly apathetic.

“I didn’t see a way forward; I thought I was going to die, and I was OK with that,” Charnes remembered, thinking back to that awful time in the spring of 2015.

Her distraught husband didn’t know what to do until a long-time friend — a neurologist — insisted that Charnes return to the hospital.

That’s the kind of situation medical centers are trying hard to prevent. When hospitals readmit aging patients more often than average, they can face stiff government penalties.

But too often institutions don’t take the reality of seniors’ lives adequately into account, making it imperative that patients figure out how to advocate for themselves.

“People tell us over and over ‘I wasn’t at all prepared for what happened’ and ‘My needs weren’t anticipated,’” said Mary Naylor, director of the NewCourtland Center for Transitions and Health at the University of Pennsylvania.

It’s a mistake to rely on hospital staff to ensure that things go smoothly; medical centers’ interests (efficiency, opening up needed beds, maximizing payments, avoiding penalties) are not necessarily your interests (recovering as well as possible, remaining independent and easing the burden on caregivers).

Instead, you and a family member, friend or caregiver need to be prepared to ask plenty of questions and push for answers.

Here’s what doctors, health policy experts, geriatric care managers, older adults and caregivers recommend:

START PLANNING NOW
Planning for a transition home should begin as soon as you’re admitted to the hospital, advised Connie McKenzie, who runs Firstat RN Care Management Services in Fort Lauderdale, Fla. You may be too ill to do this, so have someone you trust ask your physician how long you’re likely to be hospitalized and whether you’ll be sent home or to rehabilitation afterward.

Ask if a physical therapist can evaluate you or your loved one at the hospital. Can you get out of bed by yourself? Walk across the room? Then discuss what difficulties might arise back home. Will you be able to handle your own bathroom needs? Get dressed? Climb stairs? What kind of assistance will you require?

Request a consultation with a nutritionist. What kinds of foods will and won’t you be able to eat? Does your diet need to change over the short term, or longer term?

Consider where you’ll go next. If you or your loved one is going to need rehabilitation, now is the time to start researching facilities. Ask a hospital social worker for advice or, if you can afford it, hire a geriatric care manager (now called aging life care professionals) to walk you through your options.

BEFORE BEING DISCHARGED
Don’t wait to learn about the kind of care that will be required at home. Will a wound need to be dressed? A catheter need tending to? What’s the best way to do this? Have a nurse show you, step by step, and then let you practice in front of her — several times, if that’s what it takes.

Ann Williams watched a nurse give her 77-year-old mother a shot of Warfarin two years ago after being hospitalized for a dangerous blood clot. But when it was Williams’ turn to give the injection on her own, she panicked.

“I’m not a medical professional: I’ve only given allergy shots to my cats,” she said. Fortunately, Williams found a good instructional video on the internet and watched it over and over.

Make sure you ask your doctor to sit down and walk you through what will happen next. How soon might you or your loved one recover? What should you expect if things are going well? What should you do if things are going poorly? How will you know if a trip back to the hospital is necessary?

If the doctor or a nurse rushes you, don’t be afraid to say, “Please slow down and repeat that” or “Can you be more specific?” or “Can you explain that using simple language?” said Dr. Suzanne Mitchell, an assistant professor of family medicine at Boston University’s School of Medicine.

GETTING READY TO LEAVE
Being discharged from a hospital can be overwhelming. Make sure you have someone with you to ask questions, take good notes and stand up for your interests — especially if you feel unprepared to leave the hospital in your current state, said Jullie Gray, a care manager with Aging Wisdom in Seattle.

This is the time to go over all the medications you’ll be taking at home, if you haven’t done so already. Bring in a complete list of all the prescriptions and over-the-counter medications you’ve been taking. You’ll want to have your physician or a pharmacist go over the entire list to make sure there aren’t duplicates or possibly dangerous interactions. Some hospitals are filling new prescriptions before patients go home; take advantage of this service if you can. Or get a list of nearby pharmacies that can fill medication orders.

Find out if equipment that’s been promised has been delivered. Will there be a hospital bed, a commode or a shower chair at home when you get there? How will you obtain other supplies that might be needed such as disposable gloves or adult diapers? A useful checklist can be found at Next Step in Care, a program of the United Hospital Fund.

Will home health care nurses be coming to offer a helping hand? If so, has that been scheduled — and when? How often will the nurses come, and for what period of time? What, exactly, will home health caregivers do and what other kinds of assistance will you need to arrange on your own? What will your insurance pay for?

Be sure to get contact information (phone numbers, cell phone numbers, email addresses) for the doctor who took care of you at the hospital, the person who arranged your discharge, a hospital social worker, the medical supply company and the home health agency. If something goes wrong, you’ll want to know who to contact.

Don’t leave without securing a copy of your medical records and asking the hospital to send those records to your primary care doctor.

BACK AT HOME
Seeing your primary care doctor within two weeks should be a priority. “Even if a patient seems to be doing really well, having their doctor lay eyes on them is really important,” said Dr. Kerry Hildreth, an assistant professor of geriatrics at the University of Colorado School of Medicine.

When you call for an appointment, make sure you explain that you’ve just been in the hospital.

Adjust your expectations. Up to one-third of people over 70 and half of those over 80 leave the hospital with more disabilities than when they arrived. Sometimes, seniors suffer from anxiety and depression after a traumatic illness; sometimes, they’ll experience problems with memory and attention. Returning to normal may take time or a new normal may need to be established. A physical or occupational therapist can help, but you may have to ask the hospital or a home health agency to help arrange these visits. Often, they won’t offer.

It took a year for Barbara Charnes to stand up and begin walking after her ankle operation, which was followed by two unexpected hospitalizations and stints in rehabilitation. For all the physical difficulties, the anguish of feeling like she’d never recover her sense of herself as an independent person was most difficult.

“I felt that my life, as I had known it, had ended,” she said, “but gradually I found my way forward.”

* * *

Kaiser Health News is eager to hear from readers about questions you’d like answered, problems you’ve been having with your care and advice you need in dealing with the health care system. Visit khn.org/columnists to submit your requests or tips.

KHN’s coverage of late life and geriatric care is supported by The John A. Hartford Foundation.

Comments

Hardly a week goes by here at the ALF that one of my fellow residents does not have to return to the hospital after only a couple of days (or even a couple of hours) upon returning home.
The concept of holding one over for "observation" after undergoing a procedure in a hospital seems to be a thing of the past.
I've seen people go back and forth two or three times for the same illness.

Thanks. This post is a keeper. I cannot even imagine what would need to be done afterwards if/when my husband or I are hospitalized. I can see where this could be overwhelming for a lot of us.

What a fabulous description of just what's wrong with our government and with healthcare today. While healthcare has shifted its goals toward profit our government has limited benefits and support for older adults and it continues to work toward eroding the few benefits left.

The media and AARP also work toward diminishing support for older adults by maintaining that people are living longer more PRODUCTIVE (read working) lives and backs up these claims with ads of those adults running to meetings in their high heels and off on trips around the world. And yes, there are a small percentage of people doing those things - but not the majority, by a long shot.

Sadly, many distracted, undereducated, those with compromised health and drastically reduced incomes see these ads and wonder "what's wrong with me" when it's the system that is wrong.

Ok, now I sound like a conspiracy theorist, but this is an area I study and there's some truth here in how, as a country, we fail our older adults.

There are many people being discharged from hospitals today without family, resources, or the ability to coordinate post hospital care and support - and there is no consideration for their needs. Imagine what happens to them...They need care coordinators that would address and arrange for everything mentioned in this article. And it should happen through Medicare.

How sad that in this speeded-up society that the responsibility has been shifted to the patient rather than the professionals who we are supposed to feel will look out for our well being. Seems hospitals are becoming more like restaurants- "get 'em in, get 'em out"...profit motivated. I totally agree with Susan-"They need care coordinators that would address and arrange for everything mentioned in this article. "

A check list is certainly a good idea, but good luck getting everyone concerned to sit down and go over it with you.

Allow me to join the chorus -- too many patients are discharged from the hospital too soon. Sending a post-op patient home to be cared for by a family member who knows nothing about medicine can border on criminal negligence. Lots of conditions can develop that only a nurse or other medical professional would recognize need immediate attention. For example, neither I nor my very attentive family recognized last summer that I'd become dangerously dehydrated (as determined by lab work, something that can't be done at home). When I went in for my next chemo infusion I was promptly admitted to the hospital overnight and pumped full of fluids. The list of things that can go wrong (and/or not be recognized) is frightening long. Thank the insurance companies that will only pay for x number of days of hospitalization for y condition.

Perhaps it's human nature to wait till an event happens, but I knew to have a plan in place when I became a widow for the scecond time. No family lives near by. I have a medical alert system, contact for home health,free rides to medical appts., neighbor who has a key,pharmacy that delivers,grocery store that delivers...a few simple things .I'm a bit anal, not liking surprises-:)I also have a great network of folks to call on.I take a tape recorder to appts. Being solo I want to be prepared as possible...So far I have enjoyed good health and knowing I have a few simple things in place takes the edge off of anxiety.

This is such good and important information! Thank you too for the link to Kaiser Health News. I have visited the site in the past an found it so helpful.

Thank you for this. I have send it along to my 'designated caregiver' in case it is needed.

Thanks for health related posts best articles ever keep it up

I totally agree with Susan and Lola. Where are the "professionals" whose job it is (or should be) to ensure that patients are actually ready to be discharged and that they can manage their condition/recovery at home? I've been lucky so far in that I haven't needed to be hospitalized in years, but it's certainly a frightening situation to contemplate. The place that's supposed to "heal" us (when that's possible) seems to be in the business of dispatching us to the Great Beyond at a rather high rate.

It is appalling to think that medical facilities do not follow your injunctions to start with. Fortunately, the only experience I have to go on (my brother's cardiac arrest) shows me that some hospitals do an excellent job for their patients and their families. Despite the best efforts of the medical community, there were a couple of things that bothered me, however: 1) his designated decider for healthcare decisions, although an RN, was unwilling to make necessary decisions. She did not seem to recognize, even with her experience, that my brother was in no condition to be making his own decisions. 2) We did not think to ask: Under what conditions do I call which medical professional? Because his primary care physician did not practice in the city in which my brother lived, it was impossible to get my brother to consult him. My suggestion, in one instance, that he call the home healthcare nurse to ask her advice was accepted - and she allayed his fears.

Excellent information as usual, ronni. Thanks so much.
Elle aka PlantCrone

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