The Care Company

empowered caregiving™

When your loved one has to go in to the hospital for a planned or unexpected stay, it is important for him/her to have, not only thedaily necessities, but familiar and comfortable items from home to make the stay more comfortable. If your loved one makes frequent or urgent trips to the hospital, it is helpful to have a bag with personal, medical and legal items prepared ahead of time and ready to go. In case of an emergency, personal items can be gathered at a later time. (A list is provided for you in the Empowered Caregiving Organizer available at The Care Company Store.)

Having the following items on hand can save a lot of time and improve the quality of care given because the doctors and staff have the most updated medical related information and care needs. Some of these things you will need in the emergency room and some you may not need until the elder moves into their room. It is helpful to have several copies of the documents below. Do not give original copies to the hospital personnel because they are rarely returned.

• 3 copies of the list of medical and surgical history
• 3 copies of the list of current medical doctors caring of the  elder
• 3 copies of the list of current medications and dosages
• Insurance cards – Medicare and Supplemental health insurance
• List of allergies
• Copy of advanced medical directive, living will and/or healthcare power of attorney documents.
• List of dietary preferences or restrictions
• List of special care needs, such as: walker, air mattress for bed, bipap mask to sleep at night (some people with sleep apnea wear this), etc.

It is helpful to have prepared ahead of time and made extra copies of the above information. If you give the original documents to hospital staff, keep a note of what you have given them and make sure the documents are returned to you before you leave the hospital department you are dealing with. If you give the documents to the emergency room staff and realize you did not get them back before your loved one was moved to their room, it will be virtually impossible to get them returned to you.

At the Hospital
When your loved one arrives in at the hospital, probably to the Emergency Room, things can happen quickly. A lot of medical people; doctors, nurses, lab technicians, x-ray technicians, etc. will be in and out of the room. There will be many questions asked about the patient’s current problem and medical history. Having the medical & legal information mentioned above on hand will expedite the process and help ensure the best possible care.  Many emergency rooms allow only one visitor in the patient’s room. This visitor should be the person that knows the most about the patient’s medical condition and wishes for medical care.

Here are some important tips on ways to ensure that your loved one gets the best possible care:

• Provide a copy of the following lists to the Emergency Room staff AND to the nurse in the patient’s room. You would think that the information is shared between both departments, but many times, it is not. Provide a list to both places. Always provide a copy because you do not want the original to get lost.
• Provide a list of medical & surgical history to the Emergency Room
• Provide a list of current medical doctors caring of the elder
• List of current medications and dosages
• List of allergies
• Copy of advanced medical directive, living will and/or healthcare power of attorney documents.
• List of dietary preferences or restrictions
• When your loved moves out of the emergency room and moves to the assigned room, you should follow them to the room. When you get to the new room, make sure you write down the room phone number and the nursing station phone number. It is good to have the nursing station number on hand in case you need to contact the staff during your loved one’s hospital stay.
• Upon arrival to the room, help your loved one get acquainted to their room. The nurse or nurses aid help with this too. Place personal items within reach in the room.  Assist to make the room as comfortable as possible.
• Make sure your loved one’s call bell is always within reach.  Encourage use of the call bell when assistance is needed. It is a good idea to use the call bell before the need is urgent. It often takes the nurses and staff up to 5 minutes to come to the room.
• Wash your hands before you enter and when you are leaving the room. Remind others, staff, doctors and visitors to do the same. This is the most important way to prevent the spread of infection.
• Remind your loved one to call the nurse or staff for assistance to get out of bed. Elderly people often get confused in the hospital because the usual routine is disturbed and the surroundings are unfamiliar.  Elderly people are at risk for falls, especially in the hospital. It is important to maintain a safe environment and call for help when needed.
• In a notebook, make a note of the names and specialty of the doctors that see your loved one. (It is not unusual for many physician specialists to see a patient, and it can be difficult to keep track of all of the names). It is also important to know why the doctor is seeing your loved one. Ask.
• In your notebook, make a note of the tests that your loved one has had had and write the results of the tests as you receive them. Many tests are done during the course of a hospitalization and sometimes the patient and or the family do not get the results.
• Ask questions. Do not be afraid to ask the doctors and nurses questions about what you don’t understand. It is important to have a clear understanding of the patient’s problem, plan of treatment, medications, necessary tests and necessary procedures.
• Make a list of questions and concerns that you want to discuss with the doctors and nurses. During stressful times it is very difficult to remember, so write things down. The doctors are very busy and have little time to have lengthy discussions on hospital rounds, so it is important to be clear and concise with your questions.
• It is ok to say no. If your loved one is not in a position to speak or make decisions about his/her own care, the designated medical power of attorney or next of kin (if a medical POA is not designated in writing) will make decisions. It is ok to say no, if you know that some treatment or procedure is not in accordance with your loved one’s wishes.
• If your loved one needs help at a certain time of day, like meal times or to take afternoon walks, plan your visits at the same time. Nurses and staff are supposed to assist with these activities, but the reality is that they are often too busy to spend enough time with their patients. Having a caregiver or family member help will ensure that the tasks are getting done.
• Many hospitals allow loved ones or caregivers to stay overnight in the hospital room with the patient. Ask what the department rules are and request a recliner, cot or portable bed if the department permits.

Planning for discharge
Planning for discharge begins soon after admission. It is important to plan for discharge early, because hospital stays are much shorter than they used to be due to insurance rules and coverage.  The hospital discharge planner or case worker (different hospitals use different titles for the individuals responsible for planning for discharge) will be involved with your loved ones care to assist in making any plans or arrangements for discharge. It is also very important for a family member or caregiver to be actively involved in the discharge planning.

When it is time for your loved one to be discharged from the hospital, it is important to be involved in the process. You know your loved one’s situation at home, their daily routine, how they get around, the physical layout of the residence, etc. It is important to anticipate discharge and what needs need to be addressed before the day of discharge.

• Does your loved one need someone to help them at home?  If so, will it require help for a few hours a day? Just overnight? 24 hours a day? Plan ahead for people to stay with them. It could be family members, friends, or hired caregivers.
• Are there any new medications ordered to start at home? If so, what is the medicine for, what are the side effects and expected results of the new medication?
• Is the home environment safe for your loved one’s return home?
• Do you need medical equipment at home? A hospital bed, walker, bedside commode, wheelchair, oxygen, etc.? The hospital discharge planner will make arrangements for delivery of these items.
• Discuss with the nurse the discharge plans. Were home nursing visits, physical therapy or hospice visits ordered. If so, get the company name, a contact person (if possible) and phone number for you records.
• When are follow-up appointments with physicians necessary?
• Is your loved one able to go home in a car? Is a transport van required to travel home? The hospital will make arrangements if travel home via car is not possible.
• When your loved one gets home will he/she be able to make it in to the house without assistance? Are there stairs and can the elder make it up without assistance?
• If the bedroom or bathroom is on a second floor and the elder is unable to make it up the stairs, a bed and portable commode will have to be arranged down stairs. This may be just a temporary measure until his/her condition improves or strengthens.

Keeping in mind the above tips and information can make the hospital visit less intimidating and will promote the highest level of care for your loved one.