Emergency hospitalization? What you need to know, and what you can do
We think of hospitals as places where we go to “get better”. Unfortunately, studies show this is not the case for 30% of older people who leave the hospital less able to care for themselves (walking, getting to the bathroom, etc) than they were going in. Even a year later, only 30% had recovered to their previous level of functioning.
- Who is most at risk for hospital-associated functional decline? People
- over age 80
- with limited mobility
- with cognitive impairment
Hospitalization includes risk of
- Hospital-acquired infections
- Surgical complications
- Adverse reactions to of new drugs, especially if the patient was already taking multiple medications
- Short and long-term cognitive/behavioral issues following general anesthesia
- Overall deconditioning due to bed rest
People with dementia are at especially high risk of injuring themselves if left unattended – for example breaking a hip trying to climb out of a hospital bed.
What you can do:
- Ask for a consultation from a palliative care specialist or geriatrician regarding the hospital stay protocol.
- Hospital staff will ask if an Advance Directive and POLST forms are in place. If not, these are important to complete (see additional resources).
- Have a family member stay overnight with a person with cognitive impairment. If no one is available, ask the hospital to provide a “sitter”.
- Start discharge planning the day of arrival. Consider extra care that may be needed if there is a new diagnosis or advancing level of illness. Review your options and make sure that help will be available within a day of returning home or to another location.
- Update the primary care physician. They may not be aware of everything that has happened, especially if the admission occurred at night or on the weekend.
You always have the right to choose your post-discharge providers. Medicare beneficiaries also have the right to a 48 hour independent review of a discharge date established by the hospital.
Home Care vs. Hospice
Both care types are often used together to supplement family caregiver time
|Care Type & Cost||Home Visits||Day/Night Medical Support||Meal Prep||Personal Care||House-Keeping & Company||Spiritual Support||Social Services||Arts||Transport|
|Non-Medical Home Care Cost: $25-$30/hr||Available||Not Available||Available||Available||Available||Not Available||Available by referral||Not Available||Available|
|Hospice Care Cost: Covered by Medicare, Medicaid & most private insurers||Multiple visits may be provided each day by team members||Nurses answer calls and make visits at any hour and a Medical Director is on call 24/7||Available by referral (Meals on Wheels)||Aides are Certified Nursing Assistants who are part of medical team||Volunteers come to home for 2-4 hrs/wk to help with light housework and provide companionship||Spiritual Care Counselor assigned to each household||Medical Social Worker assigned to each household||Certified Music and Art therapists support specific needs||Only medical transport is included|
Dementia Care Resources
Dementia Video Resources
The Gift of Caring: Saving Our Parents from the Perils of Modern Healthcare – Elizabeth Eckstrom and Marcy Cottrell Houle
Summary: Excellent resource that describes the experience of caring for one parent with dementia and another parent with multiple acute illnesses, interspersed with comments and advice from an OHSU Geriatrician.
A Beginner’s Guide to the End: Practical Advice for Living Life and Facing Death – BJ Miller and Shoshana Berger
Summary: Lots of good information on a wide range of topics, not just healthcare.
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