You or a loved one is taken to the hospital, now what?
There are so many people in and out of your room and there is a doctor for every part of your system, welcome to healthcare today. It can be frightening and frustrating to be a patient in the hospital especially if you are older and become very ill. Studies show that most older adults and people hospitalized in general show mild cognitive decline and become susceptible and vulnerable when they are sick. You have to ask yourself how the person is functioning relative to themselves and how they normally function day to day. You can not expect to make or have them make sound decisions under this type of stress.
What can you do to make the best of the situation and ensure the best care possible?
The following are my recommendations based on years working in hospitals and particularly ICU.
Before you or your loved one is ever hospitalized; buy a notebook or binder and place a list of emergency information and contacts, including primary care physicians name and phone number, list all medications, schedule taken, and who prescribed and why, any advance directives and medical power of attorney. If you have a copy of the History and Physical from the doctor as well as the business cards of all specialists. You can add background on yourself or loved one if they can not or will not speak up for themselves; eg: my mom enjoys listing to or watching The Price is Right or Please no ice in her water.
First and foremost, try to have a person scheduled to stay with you or your loved one during the entire hospitalization. I know this sounds difficult however there is a two fold reason for this recommendation; patient care levels are at an all time low so you will want to be there to help your loved one with small tasks and stay comfortable. Secondly, doctors and therapists come on their schedule, not yours, so you need to be there if you want information and to speak directly with them. It is very difficult to remember, hear and understand everything that the professionals are saying. I often hear families tell me that the first doctor came in and said one thing then the next specialist came in and contradicted the primary physician and so forth. If you are very sick and have no one to advocate for you, to listen and understand what is being said you should write everything down, because when you are ill, you are often impaired.
This recommendation is also for the primary family member or anyone with the patient in the room. I recommend purchasing a notebook to write down every doctor and specialist entering the room name and contact or office information in the event you need to follow up. Write down the date and location of hospitalization, original reason for the admission, the attending physicians name or the admitting doctor. Write down everything they say regarding their assessment and any questions asked and the answer. Make daily notes regarding what tests were done and any therapies completed. Most Important NO QUESTION IS A DUMB QUESTION, if you don’t understand ask, doctors and specialist speak a different language than we do and sometimes they say things we don’t understand.
I often ask my family member, when you go home and tell your siblings what the doctor said is wrong with your mother, what will you say? The answer is always different than what the doctor said, even though the person didn’t ask any questions or said they understood. Sometimes we become very upset and scared about what is happening around us either to ourselves or our loved one. If you are admitted to the hospital it is because you are very sick; yelling and being angry with all the staff will not help change the outcome. Your nurse is overwhelmed most days due to the requirements so please go easy on him or her. Be patient and kind and hopefully you will receive the same treatment in return.
If you do have a problem you should go to the charge nurse first, if you are not satisfied you can ask for the floor manager or the hospital advocate if they have one. Remember the nurse is not allowed to discuss test results with you until the doctor does so first, but the nurse can be a good resource for other matters and to explain after the doctor leaves. She can page the doctor for you but can’t help if the physician doesn’t respond.
If your loved one has a mental illness diagnosis and is on psychotropic medications make sure these are ordered and administered. If the person has their medications immediately discontinued and the patient goes into withdrawal often the side effects of headaches, decreased memory and increased depression and anxiety will occur. These are just a few, sometimes more severe problems occur. If your loved one has a diagnosis of dementia of any kind remember they will experience increased confusion, agitation and sometimes aggression. This is normal for a person with dementia and if you do not have a loved one in the room to provide care and comfort the nurses will request the doctor place the patient on some type of medication to calm them down.
Sometimes these medications can cause an increase in behavioral problems and have long lasting, unwanted effects. To avoid some of this I recommend the patient be permitted to get up to a chair daily, use the bathroom if possible and be comforted by familiar home bedroom objects such as a familiar blanket, picture or robe. The sicker the patient is and the longer the patient stays in the hospital the more possible it is to develop what is termed “hospital psychosis”. This is a form of a mental breakdown due to illness and lack of orientation. The above recommendations hold true for this problem as well. I recommend that the patient be up to chair and walking if possible to keep them oriented.
I also recommend they not be permitted to sleep all day as this confuses the sleep/wake cycle. I believe a good afternoon nap is all that is needed to help the person recover. These are just a few ways to make your situation better, no hospital stay is a good stay. If you or your loved one can remain admission free this is ideal. Staying on top of your health and managing your chronic illnesses are key.
An Aging Life Care Manager can help with all these situation including prevention, and care during hospitalization as well as discharge planning and after care. If you are overwhelmed by your situation and need advocacy and professional care please consider hiring an Aging Life Care Manager.
