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Hospitalization & Discharge

Eventually, elders are likely to have a health crisis and need to enter a hospital or an "acute care facility." You may think that a caregiver's job starts only when the patient is discharged, but any caregiver who has lived through this will tell you otherwise. Caregivers play a critical role in all phases of hospitalization.

Hospitalizations are emotionally stressful not only for the elder but for caregivers too. One challenge that is often unanticipated is the absence of the elder's regular physician. An elder may be cared for by a "hospitalist" (sometimes called an "inpatient specialist"), a doctor who is unfamiliar to you or the elder. Hospitalists, trained and board certified in internal medicine, specialize in the care of hospitalized patients. They serve as the "physicians of record" for inpatients during the hospital stay. The hospitalist coordinates care with specialists, such as an orthopedic surgeon. After being discharged from the hospital, patients return to their primary care physician (PCP).

There are advantages and disadvantages to this system. On the positive side, hospitalists can rapidly coordinate inpatient care and react in real time throughout the day to changes in a patient's medical status. However, some elders and their families do not like having a new and unfamiliar doctor during an acutely stressful time. There may also be gaps in communication between inpatient physicians and the elder's primary care physician during hospital admission and discharge. This can lead to additional stress for caregivers.

You can discuss beforehand with the elder's PCP what would happen in a crisis in order to be better prepared for an elder's hospital stay.

Discharge to Rehabilitation Facilities

Many acute care hospital stays are shorter these days, and patients are often discharged to a rehabilitation facility (also called a skilled nursing care facility) for short-term follow-up care before returning home. The rehab environment provides medical monitoring, nursing, and personal care, as well as occupational, speech, and physical therapy treatments as needed. Patients are encouraged to regain strength and mobility in this supervised environment so that they can transition back to their normal life. Meals are served in dining rooms rather than in bed when patients are able, and patients are encouraged to dress in their own clothes.

Medicare covers these short-term rehabilitation stays, and hospital discharge staff will refer the elder to a certified nursing facility. (You may also choose another facility if you wish, but hospital staff will usually have a good sense of where the nearest certified facility with an available bed is when you need it.) See Medicare for more information.

Physicians and caseworkers will assess an elder's progress during rehabilitation and help families understand an elder's capacity to return home, including what home modifications might be needed, or if a more supervised environment might be required.

Like hospitalization, rehab stays can also be stressful for families. A stay in rehab is often the turning point in an elder's ability to live independently, especially after a stroke or surgery. It may be the first time you see the elder as frail or permanently impaired. Recovery can be slow, and there may be dramatic changes in an elder's abilities and emotions during rehabilitation.

Sometimes elder patients will need to transition back to the hospital because of a complication, only to return to the rehab facility, or a different rehab altogether, based on available beds. During these transitions, talk with the staff about issues that concern you. They are well trained to assess an elder's health conditions, but you are the one who knows the elder best, and your own assessment of his or her condition is very important. Don't be afraid to speak up to get the elder's needs met. Together, you and the rehab staff make a team that can help produce the best possible outcome for the elder in your care.

Discharge to Home

For a caregiver, the discharge to home may be even more stressful—and sometimes more distressing—than the discharge to a rehab facility, because the transfer of responsibility for the elder then comes to rest solely on the caregiver. Keep in mind the following:

  • Timing: Make sure that you and the elder in your care agree with the doctor's assessment that the elder is ready to go home. Caregivers may need to advocate for more time in rehab, and this may involve complex insurance issues about coverage that exceeds certain predetermined time limits.
  • Transportation: Make sure that you have adequate support for getting the elder home safely. A car ride may be fine, but sometimes you may need a wheelchair van or another type of handicap-accessible vehicle. You should receive help from the hospital in making these arrangements.
  • Services: Make sure that you have the skilled nursing care, physical therapy, or other personal care services that the elder needs in place before you go home. Sometimes discharge planners will simply hand a caregiver a folder of brochures and provide little guidance about which one is best or how to get things started in a timely way. Insist on more help. It is important that you are not put in a situation where you are expected to provide a kind of care you are not trained to do.
  • Follow-up/contact person: Before you leave the hospital, make sure you understand what kind of follow-up will be needed. Are there doctor's appointments that have been made, or do you need to make them? Are there prescriptions that need to be filled by the hospital or home pharmacy? Who should you call if you are concerned about your elder's condition once you are home? It is important to know who you can call and reliably reach in case of an emergency or other concerns.

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