Picture your 80-year-old father in the intensive care unit needing dialysis or your 76-year-old mother with severe dementia facing emergency surgery. These scenarios are becoming increasingly common as 1 in 6 adults in the U.S. are now over 65, a number steadily rising with the aging baby boomer generation.
And as our population ages, the likelihood of an older family member becoming hospitalized grows. Many of us will inevitably confront the challenges of hospitalization — oftentimes due to a medical emergency when we least expect it.
The critical question is: Are you prepared?
Families often find themselves unprepared for the profound impact illness and injury can have on a loved one. While a patient may have been active and healthy before needing hospitalization, illness in a 75- or 80-year-old is not the same as illness in a 50-year-old. Older patients generally need extra support in the hospital, require longer recoveries after serious illness or injury and are less likely to return to their prior quality of life.
Understanding how to advocate for your loved one in the emergency department or inpatient hospital setting is crucial for ensuring they receive the best possible care.
[See: 8 Ways to Reduce Hospital Readmissions.]
6 Steps to Take If Your Older Family Member or Loved One Is Hospitalized
Following these steps will help ensure your aging parents and family members have a safe and successful hospital or emergency room experience.
1. Go to the Hospital With Your Loved One
Though seemingly obvious, the first crucial step is to actually go with your loved one to the hospital, particularly if they’re not being admitted immediately and will be spending time in the emergency department.
Kathleen Cameron, senior director of the National Council on Aging’s Center for Healthy Aging, says this is important for many reasons:
— To speak for your loved one if they can’t speak for themselves
— To help articulate what their needs are and how they’re feeling
— To share with health care providers what happened and what led to their hospital visit
— To answer any medical or personal questions, such as medication they are taking or their health history — about your loved one for medical personnel
In addition to advocating and communicating for your loved one, being with your loved one also provides emotional support and reassurance, especially in the emergency department where it can be loud, have bright lights, uncomfortable furniture and long wait times.
“Just being there to hold the person’s hand is really important,” Cameron says. “Having a friendly, familiar face for many older adults is vitally important.”
However, if your family member or loved one is able to coherently communicate, let them speak for themselves.
“Be there, listen to them and fill in the gaps,” says Dr. Saket Saxena, co-director of the geriatric emergency department at Cleveland Clinic in Ohio.
If they’re not providing accurate information, you can step outside and inform the provider of any additional concerns you may have.
“Play a supportive role for both your loved one and for your provider. We want to know more as well so we can make the right decision for your loved one,” Saxena says. “You are bridging that gap for your family members.”
[READ: How to Get Access to Your Hospital Records]
2. Bring Essential Information to the Hospital
Do you know what your family member wants?
Often in critical illness, older patients can’t speak for themselves, making it crucial for family members to serve as their advocates. Consider what your family member would tell their provider if they could. What kind of medical care would they prefer in this situation?
Understanding your loved one’s wants and needs requires having these conversations well before they get sick. Although seemingly difficult, planning ahead is imperative to ensuring your loved one receives their desired care.
Make sure you bring these items and health information to the hospital:
Essential documents
Bringing these documents to the ED helps health care providers deliver the best possible care:
— Form of identification
— Health insurance information
— Emergency contact information
— Advance directive, which is a legal document outlining someone’s personal preferences for care or treatment if they can’t communicate themselves
— Power of attorney for health care, also called a health care proxy, which designates a person to make medical decisions on their behalf
— Do-not-resuscitate (DNR) order, which is a medical order instructing medical professionals not to perform life-saving measures in the event that the patient stops breathing or their heart stops
Not all older adults have legal documents in place outlining their care preferences. However, advance care planning with your loved one before they’re sick or in a life-threatening situation is essential as an advocate for providing guidance about the type of care they wish to receive — or not receive.
Cameron suggests enlisting the help of a family lawyer who is locally based and understands the laws in the state to help provide personalized guidance and ensure documents comply with state laws. There are also many state-specific online resources, community organizations or geriatric care managers that can assist you in this process.
Medical history
Bring a complete medical history, including:
— Any major medical conditions
— List of allergies
— Previous illnesses
— Prior surgeries or hospitalizations
— Up-to-date list of prescription and over-the-counter medications, including dosages, medication schedule and any dietary supplements
— Information about alcohol or drug use
Assistive devices
If your family member or loved one uses any assistive devices — such as hearing aids, glasses or mobility aids — make sure to bring them with you to the hospital, especially because they may end up staying overnight for several days.
It helps to have a bag ready packed with items for an overnight hospital stay, which may include sleepwear, socks, an extra pair of glasses and a phone charger.
[READ: Where to Turn for a Safe and Efficient Hospital Transfer]
3. Ask Questions to the Care Team
Asking questions to your loved one’s care team ensures you’re informed about their treatment and fosters open communication among you, the patient and the providers.
Depending on your loved one’s condition, some key questions to ask may include:
— What treatments is my loved one currently receiving? With your loved one’s hospital room acting somewhat like a revolving door of providers, it can be hard to keep up. Don’t be afraid to ask the health provider entering the room what they’re administering and why.
— Are these treatments uncomfortable or painful for my loved one? It’s important to ask about expected benefits, potential side effects and risks that could have long-term consequences on your loved one’s quality of life.
— What other treatment options are available? As a family member making or helping make medical decisions, it’s important to know that there are options — even if that option may be to not pursue further interventions or to decline the current treatment plan.
— What is the expected prognosis for my loved one’s condition? Understanding the likely course and outcome of your loved one’s illness or injury can help you make informed decisions about care and set realistic expectations for recovery and long-term health. Don’t hesitate to seek further clarification if you don’t understand any medical terms or concepts.
— How will mobility be managed, and what can we do to support it? Mobility is a key factor in the recovery and overall well-being of older adults, especially for preventing falls. Whether this includes physical therapy plans, the use of mobility aids or safeguarding the hospital room, you may be able to support these efforts.
Key hospital personnel to familiarize yourself with include:
— Attending physician, who oversees the patient’s overall care
— Nurses, who often provides day-to-day care and can assist with personal needs
— Physical or occupational therapists, who may help your loved one with rehabilitation
— Medical specialists, who are doctors with expertise in specific areas based on your loved one’s condition and needs
There’s a growing movement to create geriatric emergency departments, which are specialized units or sections of a larger emergency department staffed with medical providers specially trained in geriatric care to address the unique needs of older adults.
“What’s important is that the geriatric specialists know how to identify what problems might be happening through a comprehensive screening and assessment process that’s tailored to the individual, whereas a general practitioner — someone who might not have that experience — might overlook certain things,” Cameron says.
Therefore, as an advocate, it’s important to understand what to look for in a doctor and what to ask for.
You can also find a list of accredited geriatric emergency departments in your area by using the American College of Emergency Physicians’ accreditation list. Use U.S. News’s Best Hospitals for Geriatrics to find a top-ranked geriatric hospital near you.
[READ: 5 Types of Primary Care Doctors]
4. Communicate Your Concerns
Providing background information about your parent or loved one and asking follow-up questions may not yield the expected outcome or clarity you’re seeking, so don’t hesitate to speak up. Express your concerns clearly to your loved one’s health provider and/or care team.
Effectively communicating your concerns may include:
— Be clear and specific about your concerns, citing specific examples or observations where you can.
— Ask direct questions to get more information about their condition, treatment plan or prognosis.
— Listen actively to the provider’s response and ask follow-up questions accordingly.
— Write down information while you talk with your loved one’s providers, as this can help you recall details later on and provide clarity to the situation, as well as prevent medical errors.
— Try to stay calm and avoid being confrontational — even though this may be a challenging or emotional time.
If you feel the response is still unclear or inadequate, ask for further explanation or seek a second opinion.
Additionally, make sure that any end-of-life care decisions are clearly articulated to those in the hospital. Even if they have documents like an advance directive in place, it’s important to make sure hospital staff know what the last wishes are for individuals.
5. Seek Out Hospital Resources
Another question to ask the care team: Are there any support services available for my loved one and our family?
Available support services to help meet the medical or emotional demand for patients and their families may include:
— Patient advocates. Patient advocates support patients and families in understanding and navigating hospital services and policies.
— Social workers or case managers. Both coordinate various aspects of patient care and can help connect families with community or hospital resources and services. Social workers, including geriatric care managers, often focus on emotional and social support, whereas case managers typically focus on logistical and administrative aspects of care.
— Chaplains. Chaplains can offer spiritual or emotional support, regardless of religious affiliation. These are often associated with serious illness or the end of life, but chaplains can provide comfort and guidance during stressful or emotional times as needed.
— Emotional support animals. Some hospitals offer pet visits to provide companionship and ease the stress of being in the hospital.
6. Plan for Discharge and Post-Hospitalization Care
What kind of help might your loved one need after they leave the hospital, and where will they receive this care?
Recovery doesn’t end after a patient is discharged. On the contrary: It’s only the beginning. Even if a patient has been living independently at home, your loved one may not be able to return home or live independently after a significant illness or injury.
“Being an advocate means having access to those discharge papers, having time with someone from the hospital team to go through all the discharge instructions and answering any questions they may have,” Cameron says.
Recovery can mean different things to different people, so it’s important to understand what life will potentially look like after your loved one leaves the hospital. Understanding what type of help or living situation would likely be needed, such as a nursing home or rehabilitation facility, and for how long, will guide discussions about treatments during the hospital stay.
Asking questions during the discharge process may help you have a better understanding of what to expect for your loved one, such as:
— What kind of quality of life can my loved one expect after hospitalization?
— Will they be able to participate in his or her favorite activities?
— What medications or follow-up care will my loved one need, and are there any potential side effects or risks I should be aware of?
— Are they at an increased risk of further complications or hospitalizations?
— What signs or symptoms might indicate a need to be readmitted to the hospital?
— Who should we contact if we have any questions or concerns about their recovery?
What to Do as a Long-Distance Caregiver
Ideally, the primary caregiver would go to the hospital with their family member or loved one, particularly if 911 was called and they are transported by ambulance. However, not everyone has a support system who lives locally and can drop everything to run to the emergency department.
If you can’t enlist the help of a trusted local friend, acquaintance or community member in an emergency, you may need to seek outside support to “be the eyes and ears” for that long-distance caregiver, Cameron says.
Some local support options may include:
— Geriatric care managers, who can make home visits, help you identify in-home needs, coordinate medical services or connect you with services in the community
— Area agencies on aging (AAA), which are state-designated and can help support independent living for older adults
— Local community resources or organizations with senior companion or support services
— Home health care, which provides in-home care services and support to promote recovery after an illness or disability
— Village, a growing volunteer movement across the country that’s made up of neighbors helping older neighbors age in place
Often, a local agency can connect the older adult to resources beyond just an emergency care setting too. For example, they can connect someone with food and meal delivery services via Meals on Wheels America to ensure they’re eating nutritious meals or with a local senior center if they’re socially isolated and want to engage in programs.
If a resource isn’t immediately available or you didn’t have time to plan in advance before landing in the emergency department, Saxena advises patients to inform their health care provider that their daughter or son wants to talk to them, that their point of contact may be able to provide additional insight and to then pass along their phone number.
“That sort of openness has helped immensely in (a) fast-moving acute care environment,” he says. “It could help a group of patients who come to the emergency room (and) want their family members to be engaged in the process and disseminate the real-time information.”
Those who live far away should learn as much as they can about what services are available locally for their loved one and make sure they’re connected.
“Sometimes, it may take some persuading too because not all older people want to be connected,” Cameron adds.
The Bottom Line
In an aging population where hospitalizations of older adults are increasingly common, families must be prepared to advocate effectively for their loved one.
Planning ahead, understanding the unique challenges of hospital care and asking the right questions are essential for ensuring your loved one receives appropriate and compassionate treatment and post-discharge care.
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How to Advocate for an Older Loved One in the ER or Hospital originally appeared on usnews.com
