4 Must-Know Tips for Your Parent’s Hospital Stay
It always comes as a shock to me that being likeable doesn’t solve all my problems. In my mind, being accommodating is the key to being likable. Of course, the problem with this thinking is that occasionally all that pent up accommodation and desire to be likeable comes boiling to the surface and I become enraged and irrational.
I’ve found that I can sometimes avoid this cycle by being less accommodating and clearer right up front about what I need and what I expect. But, it’s not easy.
There is no better place to avoid the likeability trap than when your parent is hospitalized. You have to be firm and relatively non-accommodating so you can head off the white-hot fury that ends up making you look like a looney and reduces your effectiveness.
The truth is that, when you are dealing with a hospital and all its attendant issues, you have to be vigilant and firm — right from the very beginning. Or, truth is, sometimes you kinda have to rock the boat and be a professional bad ass. You have to stand up to authority because, as crazy as it sounds, you cannot assume that the hospital knows what it is doing or has your parent’s best interests at heart.
Unfortunately, the quality of hospitals in this country is really mixed. And even the hospitals that are great aren’t necessarily all that good at handling care for very frail, old people.
Frankly, it’s entirely possible that, after reading this blog, you will know much more than the hospital staff about the unique issues frail, older adults face when they are hospitalized.
Ideally, during your parent’s hospitalization, advice and help would come from a geriatrician or primary care doctor who would guide you through the hospitalization. Their staff in turn would coordinate with the hospital team to make sure everyone’s on the same page. Unfortunately, that rarely happens in our healthcare system. So, it falls on you, the daughter, to do some pretty complex things that are far outside your expertise and comfort zone….all at the same time your life is on hold.
So, with this in mind, as I said in the previous blog, you want to avoid the hospital if at all possible. But, if your parent does end up there, here are the 4 things you can do to mitigate problems.
Know Your Parent’s “Status”
Even though we’ve been talking about avoiding the hospital, sometimes big medical events happen: a stroke, a massive heart attack, a broken bone. In this case, your mom or dad is whisked to the Emergency Room and then admitted as a hospital “inpatient” and that’s what is supposed to happen.
On the other hand, many frail older adults get shuttled off to the hospital Emergency Room for less clear cut reasons. Something seems “off” and the assisted living facility, nursing home, or physician on call default to the hospital.
When this happens, it may not be clear right away whether your parent’s issue warrants a hospitalization. And recently Medicare — your parent’s health insurance program — has been clamping down on hospitals for admitting people in this situation too frequently, profiting off of it and wasting taxpayer money.
So, more and more hospitals have been playing it safe and “observing” patients as “outpatients” before admitting them as “inpatients.” The good news is that the payment is lower for Medicare and usually the care is the same. And, in some cases, this option may be less expensive and overall better for the patient.
The bad news is that, often this whole process can end up being invisible to you and your parent with very serious consequences for the type of rehabilitation care he or she can receive.
This is because from Medicare’s perspective, your parent wasn’t actually admitted to the hospital (!)…and…Medicare requires at least three consecutive inpatient days for coverage of rehabilitation care in a skilled nursing facility.
Worst case scenario: No one tells you or your mom that she isn’t actually, technically “in the hospital,” she gets sent to a nursing facility for rehabilitation anyway, and then gets stuck with an unexpected bill from the nursing facility in the range of $12,000. Believe it or not, this can and does happen.
This is one of those times when it’s good to insist on knowing what’s what. You don’t want to get caught off guard by these rules because many people do. If, in your judgment (which is probably right), you think your mom will need rehabilitation care, you’ll want to talk to your doctor about the trade-offs of getting her admitted as an “inpatient” for three consecutive days.
Be Prepared to Combat Disorientation
There are a lot of scary medical things that can go wrong in a hospital. It’s always a dangerous place but especially so for very frail, old people.
In particular, the hospital setting actually seems to traumatize the brain of a frail, older person, leading to confusion that can decline into dementia that lasts long past the hospital stay. It’s worth taking just a little bit of time to prepare yourself for this.
Experts who run the Hospital Elder Life Program emphasize that patients benefit from having family members around to orient them and explain what’s going on, to bring hearing aids and glasses and other things from home that remind them of who they are.
They also tell us that it’s important to keep an eye out for even slight changes in your parent’s behavior, for when your parent isn’t making sense or seems unusually distressed. Chances are excellent that you’ll be the first person to notice and to alert the medical team. And you want to always question any attempts to sedate your parents because it’s rarely the solution and often causes more problems.
This program’s website also includes guidelines for hospital staff, which I urge you to read as well. For that matter, it’s a good idea to print things out and hand them to staff (they’ll love that – ha!). There’s a lot of research now that shows that, in the ICU where patients really suffer from disorientation — also called “delirium,” best practices include reducing use of medications that cause drowsiness, and providing consistent breaks from sedation and the ventilator.
According to these experts and others, it’s really important to get your parent up and walking, even around the room or down the hall a little bit. Just lying immobile in a hospital bed can be really harmful. They lose a lot of muscle strength even if they haven’t had a complicated surgery. Also, when they get up and walk around, they are better oriented and less likely to get confused. There are a lot of benefits from walking in the hospital and Paula Span has a great article on it here.
Anticipate Medication Screw-Ups
I had the opportunity this week to attend the national conference of geriatric care managers — now rebranded as Aging Life Care professionals. I asked several of them —
What is the number one thing they do or monitor when their clients are in the hospital?
And, they all said, “medications.” Again, wouldn’t be nice if you had some help from the medical teams involved in your parent’s care? Well, they do try, but there is a wide variety in the types and numbers of medications prescribed to older adults. When your parent is on a lot of medications — and many older adults are on 10 or more — imagine how easily and quickly things can get screwed up, even by the most well-meaning hospital staff.
This is one of those areas where you can only do what you can do…if possible, bring the medications with you to the hospital in a big bag and ask someone — a doctor or nurse — to review every medication in the patient chart and question how it relates to what mom or dad was taking at home. You want to be especially forceful about this if your mom or dad are on a lot of medications.
And, you want to repeat the process of checking and “reconciling” the medications every time your parent moves from one part of the hospital to another (e.g., upon discharge from the ICU to the regular part of the hospital). Ask questions, call the doctor, just be a general pain in the butt about this.
You are RIGHT TO BE CONCERNED. Don’t let anyone tell you otherwise.
Push Back When You Think You Are Being Pushed Out
Everyone wants to get out of the hospital as soon as possible, right?. And, there are good reasons for that as I mentioned above. But, sometimes you might need to delay the discharge, especially if the hospital seems to be pushing your parent out too soon.
Hospitals make more money the less time your mom is there so they are usually in a Big Hurry. It seems backwards, I know, but the shorter your stay, the more money hospitals make. The problem is that, what’s optimal for the hospital’s bottom line might not be optimal for your mom’s care or for smoothly transitioning home or to a rehabilitation facility.
And yet, all of a sudden, you hear: it’s time to go. Holy moly — go where? Next thing you know, you are trying to pick among dozens of skilled rehabilitation facilities or home health agencies with no real time to make the right choice.
The good news is that you can slow this train down a little by appealing to a third party called a quality improvement organization (Q.I.O.). Theoretically, the hospital is supposed to give you “An Important Message from Medicare” with the information you need to do this. But if it doesn’t, you can call [number here] and request a fast or “expedited” review, which ensures that the hospital care, including any out of pocket cost, is covered until the Q.I.O. makes a decision.
This will buy you time but you’ve got to be sure to call as soon as the hospital notifies you that you’re being discharged — you can’t delay calling past noon of the day you get notified of the discharge by the hospital. If the Q.I.O. agrees with you, Medicare will continue to cover the hospital stay for as long as medically necessary. If not, your care is covered through noon of the day after you get the decision.
What to do when the hospital won’t listen
Your recourse for a non-responsive hospital staff is limited. However, I would urge you to be on the lookout for a patient satisfaction survey that your parent will receive after the stay. Please fill that out. It affects the “value” rating of the hospital and ultimately how it is paid. We want hospitals to care more about the patient experience.
In the meantime, you can request help from the hospital ombudsman who can act on your behalf. Most hospitals have one and you should not hesitate to ask for help. You should also seek help from your primary care doctor. Hospitals want to have good relationships with doctors because the hospital depends on the doctor to refer the business.
Finally, trust your instincts and stay calm. It’s particularly hard ‘cause it’s your mom or your dad. But you handle complicated situations all the time in your life so draw on all your considerable talents and skills.
You’ve got this.
Thank you for your blog – I am a nurse and fairly familiar with hospitals and the ‘healthcare provider’ goals. My elderly mother is scheduled for a repeat orthopedic repair very soon. All of what you detail is sadly true. I’ve been thru it before with her – and will likely experience it (the hospital chaos and asynchronous clinical ‘care’) again. I spend nearly 18+ hours beside when she is hospitalized – just to protect her, and insist my professional colleagues do their jobs correctly for her benefit. Nursing and patient care, aren’t what they used to be.
Being prepared for all the things that can happen in a hospital, good or bad, can make your experience a lot better. Being able to be in the hospital with your loved one is a great privilege and you should want to take advantage of that. Thanks for these tips, they will help me through a hard time with a parent in the hospital.
I came across your site today and so glad I did! I just got home from transferring my elderly mother into a rehab facility for a couple of weeks after she spent five days in the hospital. This has been our life numerous times over the last nine years, and once again I had to do the “bad ass” routine at the hospital because they didn’t give her any of her prescribed meds for fifteen hours after she was admitted, and she was in distress as a result. I have learned everything I can about her medical conditions and I am her strongest advocate, because she deserves it! But, it does take its toll on even the most dedicated daughter-caregiver, and yes, sometimes I want to run away or scream, but that’s ok, I just step back and clear my head, then start over again. Thanks for the encouragement!
Hi Donna,
I can def relate to your post.
My mother had a whipple surgery done on monday…since then, I have been with her every moment, right next to her. The nurse staff is actually very wonderful but I think that’ s because, they saw how much I have been advocating for her. I know everything abt my mother’s health..and I mean everything. Sometimes, I can tell the doctors mind when they see me but to be honest with you, I don really care lol. My mother has been misreated and misdiagnosed by other doctors, and during those appt’s, I lived in a different state so I wasn’t around always. However, it’s a diff story now. I have been with her every minute after the surgery. Yes, I do sleep over as well. My mom comes first, I can care less if hospital staff or whatever minds.
Also, her endocrinologist got mad at me the other day..he was like oh your daughter isn’t a doctor, nurse, pa..so why does she know everything abt your health? every dr my mother has gone to before has always misdiagnosed her…so I had to take initiative and start doing my own research.
Finally, it was only after I took initiative that doctors got serious and started giving her the appropriate medications etc.
I also have to add, if it wasn’t for me, we would have never known that my mother has a tumor on her pancreas. None of her previous dr’s ever allowed her to get a CT SCAN until I forced her endo to allow her to get 1
hope your mother is doing well and please keep my mother in your prayers. Thank you
My brother’s mother in law is in an assisted living facility and has dementia. She was recently taken to the E.R. of the local hospital for an infected, draining arm wound. They were told she needed to be admitted for intravenous antibiotic therapy. Then, they proceeded to tell them they had to stay with her round the clock or they would not admit her. It wasn’t a request. It was an ultimatum. I was a nurse from 1975 until the end of 2008, and this was not the case. We could ask them and stress the importance, but they could not be forced to stay. My brother and his wife are in their late 60’s and not in the best of health. This was disturbing to me.
Really needed to read this today. Caring for my 85 yr mother and being her spokes person has been very trying to say the least. I can so relate to your article. She has been in and out of hospital since April 2016 with pneumonia and every floor/ care change has been a major challenge. Medications have been omitted, old medication chart was pulled from 5 yrs ago and family wasn’t consulted. After walking in Saturday and finding her in a low sugar episode I lost it with medical staff and this has set her rehab back days but they are still planning her discharge ! she was given way too much insulin and actually had 2 low sugars ( 49 and 37 same day) due to this error. I will try to find an ombudsman at her facility and see if I can get help with all my questions. Glad my sister found your site and shared it with me.
I’m so thankful for this article as my elderly dad has been hospitalized several times over the past 10 years including what we called “episodes” for what they couldn’t figure out, a stroke, seizures, heart issues, subdural hematoma, etc.
While trying to figure out what was causing his episodes of what we thought were mini seizures; seeing many doctors, etc.; his primary care physician finally referred him to an electrocardiologist who diagnosed him and put in a pacemaker. I wasn’t going to accept any other diagnosis until I found one that made sense. With a medical background, I worked my way up the food chain until I felt a diagnosis finally made sense.
For every one of my dad’s hospitalizations, I wasn’t afraid to speak my mind to staff when they didn’t treat my dad as he should be treated. I’m extremely proactive and I’m not afraid to ask questions. Along with that, I also work with staff, telling them how my dad interacts, help to calm my dad down when they need to draw blood or insert an IV line. Sometimes he can get fairly combative and I’m there to calm him down.
Every time Dad’s been in the hospital, I’ve stayed there pretty much 24/7, going home to shower and coming right back. I truly believe that this has helped him immensely, not only to heal, but to give him a purpose to live.
The last time he was hospitalized, it was for aspirational pneumonia, sepsis, and dehydration. The doctors told me how very sick he was, but I stayed by his side again 24/7, sleeping on a cot and leaving for as little time as possible going home to shower. I truly believe that having someone that loves you near..it does help a person to fight and heal.
They wanted to do a colonoscopy on him due to some of his blood work, and before I even signed paperwork to ok the procedure, they came in with this big bottle of fluid that my dad was supposed to drink the night before the procedure to clean him out. My dad is 88 years old with dementia..has some (yet little) ability to swallow..so they figured they’d stick a tube down his nose and into his stomach; while administering it gradually.
You have GOT to be kidding me. WHO was going to sit with my dad all night while he’d certainly want to pull that tube out; who would be in the room constantly changing his Depends, etc.??!
The doctor that was going to do the procedure the next morning came in Dad’s room to meet with me, telling me how easy the procedure was going to be. Maybe on some, but an 88 year old man?? I don’t think so.
I made a call to Dad’s primary care provider for advice and being the best PCP ever, he actually came up to my dad’s room to discuss him not having it done with me. The pros and cons, etc. His final thoughts were that his blood levels were off due to Dad fighting off sepsis, etc., and would see what the numbers looked like in the morning.
Next morning, they were great.
So I guess my advice to all of you regarding the health care the people you love and care about receive is:
Don’t be afraid to ask questions as health care providers don’t always have all the information. Any questions you might ask may help them ask questions of you regarding the best care.
Don’t be afraid to speak up if you don’t believe your loved one, etc., isn’t getting the care you believe they deserve.
Follow your instincts. You know the patient more than anyone and if you see that somethings not right..speak up.
Most importantly, be very proactive regarding what you know about their past health history. Don’t be afraid to tell their story over and over again as most health professionals don’t have the time to read the entire health record. Every time my dad had been taken to the ER, they need to hear his health history story. Every time there was a shift change of nurses, I had to tell his health history again.
Much is in the health record, but some things aren’t. I find them constantly updating things as I fill them in and they ask questions of me regarding my dad.
Thanks for reading and I hope I’ve helped.
I just found this and appreciate knowing k am not alone being the only daughter advocate for my 89 year old mother, 93 old father and 92 year old father inlaw. It has been a journey and an eye opener. I am exhausted trying to advocate for all 3 of them. I am now up against the wall with my mother needing to go away to rehab after z fall and fractured shoulder as to taking care of my dementia father when retirement was not to happen with me and my husband for 2 years. I just do not know what to do.
I am a retired registered nurse currently trying to help my friend with her 99 year old mother who is currently hospitalized. My friend has been her caregiver for ten years with the last five years totally in her home. The mother was admitted with a diagnosis of pneumonia, dehydration , shortness of breath, high sodium level. She was started on IV’s , oxygen, antibiotics, prednisone and a catheter was placed. Blood was drawn for culture and sensitivity. The ER doctor immediately began the ” end of life” routine because of her assumed non quality of life. My friend would have no part of that and explained that she wanted all aggressive treatment possible short of ventilator/ CPR. Her mother was conscious upon arrival, but unable to take adequate oral intake without choking. Ultimately she had to be placed on a CPAP machine to assist her ventilation perfusion for a little over 24 hours. The Dr decided that it was much too uncomfortable and had it removed and started her on oxygen by nasal canola , switched to a venti mask and then back again to nasal cannula increased to 15l/min. She is a mouth breather and no doubt is not receiving 15l/min of 02. As some of her stats and labs improved, the pneumonia increased from both lower lobes to both middle lobes as well. Her IV rate was changed often from 50 cc/hour to 150 cc/ hour and then down again. In spite of this vacillation, her BP remained stable and her urine output increased. Home medications had been stopped as well as food and drink . After three days and in spite of becoming septic with staph, the doctor talked of nutrition via placement of NG tube. However, after two attempts, they stopped , saying she could not follow directions to swallow. Would do no further attempts even under imaging. Nurses and doctors alike continue to not want to do what family asked and that was to be aggressive in her treatment. Have openly stated that she is dying, that there is no need to attempt to give nutrition , that you ” are in a pickle” when daughter asked about alternative nutrition. Doctors continue to agree that making her comfortable , leaving her alone because they feel that family is being selfish and harming her. They also told the family they were glad she had not asked for ventilator and CPR.! Now six days later, my friends mother remains a ” hostage” to the doctors and nurses Remarkably, she is still fighting, is a febrile, electrolytes are normal, glucose level has come down, still on nasal cannula instead of mask, no nutrition to speak of for over a week, continues on antibiotics, is conscious but not alert even though many mannerisms are much the same as when home. Today she was referred to Hospice which my friend does not want. This was second attempt to get her to agree to Hospice. She was to have gone to ICU after the second day, but that did not take place either. My dear friend is not as assertive as I would be even though I have been present with her and directed her via phone. So, the mother is losing some ground, but could possibly be turned around with enteral or even par enteral nutrition. Right now, nothing is being done. One doctor even threatened to find another doctor if he had to do what he didn’t think was right. So, there is currently a power struggle between the daughter, my friend and one of the doctors. I am afraid my friend is gonna have to do a little butt kicking to get anything done! Please pray for her if you are inclined to do so. needless to sat, this experience has been an absolute nightmare and one that shouldn’t be!! Although I am one of them, my chosen profession scares me now!
Ms Sandra Mason, what has become of this 99 year old lady? Hopefully she is still hanging in there….my 75 year old mom is at a rehab facility after two seizures and a week at ICU. It’s disturbing how they want to sedate and want next of kin to agree to a DNR. My mom is a fighter and wants to live as long as she can! God Bless:)
Monica , EVERYONE should be fighting for the elderly. I’m same as you & i refuse to agree to a DNR. My uncle was supposedly end of life, was resuscitated & went on to live another 4 happy filled years. Why are we throwing ppl away like they don’t matter? We’re all going to be in the same boat someday. Keep advocating for your mum. Become a pest if need be & ur mum will live longer. God bless you and everyone else here for your passion & heart.
My grandmother passed away in May. I strongly believe the hospital killed her. One day during her hospital stay they said her kidneys begun to fail and they stopped treating her and began the morphine. After no food or drink for a week, and higher doses of morphine…they basically starved her to death. I wanted to do everything to save her, but my idiot uncle with Power of Attorney went along with the hospital’s plan to let her go…because she is old and frail. I will never forgive my uncle and will always feel that certain hospitals are inclined to murder the elderly.
The Hospital won’t let my mother go! Now they’re talking to her about moving to a nursing facility. 4 days ago she was ready to leave, because someone wrote on her info board “1-2 days” so she assumed she was leaving soon and she was ready to leave, but now she’s suddenly too poorly to even live at home? It’s the hospital! I need to get her out of there. She suffered a suspicious heart arrest at the hospital her day there 8 days ago and I believe all of this is an attempt to convince her that it wasn’t their fault, something they gave her. They want her to believe that she’s very ill.
Can a hospital threaten you to call sercurity to make you leave if all you want to do is go walk around? He doesn’t have any iv attached. They are being really “bitchy ” they won’t let my father walk around. He doesn’t eat regular food. No noodles rice. He has bad teeth. They have threatened him with being thrown out. If he goes outside. They have searched his belongings.
Thank you for you all and the info you have shared. How is it, once you are older and health issues arise , you are no longer fit to make decisions and have your life validated by being given the best care you so rightly deserve. At times I have wondered if ” some” nurses and drs, would want their parents and loved ones treated with same disregard they give to their patients ,especially the elderly in our medical system . Perhaps this is our medical system?. I ask my dads nurses and dr to please treat my dad with the same respect and caring they would want their parents treated with. It is not the quantity of our lives but the quality. As for my dad I am being his voice so he gets the best as only he deserves , the same he gave me as I grew up, and it is a honor to give back with the same unconditional love. I also want to a be a example for my kids too , as one day I will be older. Be their Voice…
I had a different problem. My 87 year old mother, who lives alone in her 70 year old home place, recently needed her 2nd knee replacement. She had her first one at 83 and at that time, the surgeon sent her to a rehab/nursing facility for 4-5 weeks. She came home with more inhome PT and eventually was back to driving and living independently as she desires. In the interim, not only had the 2nd knee deteriorated to the point that walking was very painful, but she also suffered a heart attack and was sent to the same rehab facility for cardiac rehab. When we consulted with her same, original ortho doctor for the 2nd knee surgery last summer, he scheduled her for the surgery in “late” fall. Then, just before the late fall preop appointment, the office contacted us and said that the doctor would not be working that week and we would have to push the date back 2 more weeks! When we arrived for “that ” preop appointment, a PA came in the room and said that something called BPCI was causing the surgeon “and social worker” were going to have to relook at mama’s postoperative care, surgery was “postponed ” again and we were to.d to come back 2 weeks later! During those two weeks we did a great deal of research on BPCI and learned that it is a Medicare initiative that in my opinion, “speaks with forked tongue”! This time the surgeon did meet with us but his spill was all about how much better off mama would be going home directly after surgery! “Research shows it is better for the patient to go home and have in home PT.” he said. What! Are you kidding me! I ttold him that just 4 years before then, in that same room, he had to,d us that inhome PT was crap and was not any better than what the PT could cram in the trunk of his/her car! Now, my mother is 4 years older, has congestive heart failure, high blood pressure, lives alone, 50 miles out in the county and you are now changing you’re tune as to what is best for her? He then said that “he” could not afford to send her to a rehab facility because he would have to pay for it out of his payment from Medicare and that he would then only make $1,100 on her surgery. (I don’t know what turnip truck he thought we had fallen off of he if really expected us to believe that lie!) Long story short, we found another ortho surgeon who said that not only would he do the replacement surgery, but he had no problem sending her to a rehab facility. He did the surgery, sent her to the same facility in Wilmington, NC where she had gone after her first knee replacement. She had a difficult time, but made progress. At the end of the 3rd week in rehab, they said she was ready to go home. She was going to her own home, where she has to go up and down 2 steps to get to the front door to turn her alarm off and on and to access her laundry room. I argued for 72 hours that she needed more time. She was walking with a walker but still on Tramadol and in lots of pain. I sent in two requests to Medicare for more rehab time. I have 3 siblings, but none who would help me when she came home. I have a family, a part time job and live 80 miles away and at that time had already been out of work for over a month. I kept insisting that they not release her until she could handle those 2 steps in her home. But somewhere off there in that black unknown, some doctor who had never laid eyes on my mother, said nope, she’s going home. I was to,d by other people who had been in the same situation, to say, “Well dismiss her if you will, but I will not be here to pick her up. Then see what you will do.” But I couldn’t do that to my mother. To top it off, during her last 5 days in the facility, she ran a fever, had a scan for possible blood clots in her leg because the pain was so bad and they transported her to a GI doctor for swallowing difficulties. But yet, they said she was ready to go home. “She has accomplished all our goals.” was their mantra. She is now at her home, I spent another week away from my family to be with her and she still cannot walk up and down those 2 steps without help. Yet she was ready to go home. My mother has paid into Medicare all her adult life and she pays for a great AARP supplemental policy, yet some “death panel” somewhere who has never laid eyes on her decides her care plan. What,is going on with our medical community? The patient’s best needs were not taken into consideration from the beginning of this fiasco, till the end,
Iris, thanks for sharing this. I’m so sorry! It sounds like you’ve really been through it with your mom.
Wow Anne, thank you for the depth of this post – loved it reading it <3
I don’t understand Medicare……my 90 year old father fell the end of January and dislocated and fractured his shoulder. A trip to the ER, resulted in a hospital stay to wait for the ortho surgeon to decide if best to due surgery or just let it heal and do therapy. Well, six weeks of therapy, the arm is still dislocated and dad has less use of his arm than before. A visit to another ortho surgeon, and now decided that he will benefit from a reverse shoulder replacement……now, here’s my problem. This doc says Medicare only pays for an overnight hospital stay….yet Medicare says must have 3 night stay to qualify for rehab placement in LTC…..are you kidding me? I need some answers quickly!
Jeannie, Thanks for your question. I don’t blame you for being confused. It’s not true that Medicare only pays for one night in the hospital. That’s not how hospital payment works. Hospitals are paid a flat rate for patients and then they have the discretion to keep a patient as long as they feel is clinically necessary. And you are right that your Dad would need three overnights in the hospital in order to qualify for Medicare coverage of the rehab care through a skilled nursing facility stay.
It’s possible that the hospital has said it would only keep your Dad for one night — or for shoulder replacements generally — because the hospital believes that’s the only way it will make money under the flat rate it receives for that particular procedure.
What concerns me more is that reverse shoulder replacement is a very serious and challenging surgery — even for young people. I’m not a doctor or clinician but it concerns me when orthopedists prescribe such challenging surgeries for very old adults. If it’s possible to get another opinion (I know you’re on your second!) or to talk to a primary care doctor, I’d highly recommend it.
I also sent this response to your email so please feel free to respond back to me via email.
Thanks!
Anne
One of my biggest fears is my parents being in a hospital, and not knowing what to do to help them or make sure that they are alright. It’s good to know that if I feel if the hospital is pushing them out to soon, that I need to push back and insist that they need to stay. This is something that I will need to remember, and actual try to be more assertive with if things ever get down to this.
Can a RN who is not an employee in the hospital where her father is admitted restart an iv line to her father .
What is your liability?
I’m having a problem with the case manager and social worker my mother had a really bad spinal cord entry accident I’m trying to send her to rehab of my choice which is spinal cord associated with it’s in one of the model systems in the social worker and a case manager is trying to send my mother 2 something opposite where it’s not spinal cord associated it’s a very dirty places legally I’m going to get a lawyer I’m fighting very hard because this is so wrong my mother’s been in the hospital for 30 days I need to know what my rights are as far as dealing with the social worker and a case manager I know I have the right to place my mother where I want her to be it is not their choice and patient advocacy is not doing me any good as well
Thank you for this site. My 81 yr old mom fell last night. I call 911 this morning because she couldn’t maneuver from her bed to the bathroom without extreme help from me. She libes with me and has never had any issues with vertigo. She is also very independent and has no dementia. After her fall she seemed confused and made at least one trip to the bathroom every hour. I finally figured out that she could be having a stroke. So far after 15 hours I’m the hospital (she was admitted) I still have no definitive diagnosis. Her care seems to be ‘ok’ but after reading the experiences of others, I will start asking and demanding more information. Again, thank you.
My soon to be 91 year old dad who was “with it” fell in the bathroom and started trembling, becoming aggressive, and confused. He was admitted to hospital and released 4 days later when the doctor thought his confusion was over. I was rather anxious with his homecoming and spent a very hectic day with him at home. Late that night he had more hallucinations, and was very agitated. Back to hospital. I never know what he will be like when I visit twice daily to assist him with his meals. He even had a seizure/mini stroke??? when I was alone with him. He wants to get out and has figured out how to escape from the restraining belt on his chair. His back which has always been sore is worse now that he is confined to this chair. Nursing homes in our town have a 2 year waiting list and there are people who have been waiting over 6 months in the hospital for a nursing home bed. The nearby towns/cities aslo have long waiting lists. Day by day is my motto. Thank you for letting me vent.
My 74 year old mom lives alone in NJ and I live in Canada. Recently her health has declined and when i was last there to visit to her to her doctors where they ordered home nursing/PT/OT to try to help her out even though it’s short term from Medicare. She doesn’t take her medications or insulin regularly even though I call and remind her every day. Recently the PT on his first day found her on the floor from a fall and she was taken to the hospital. I can’t rush down there as i have a job and had recently taken off to be with her. She had a brain bleed but has stabilized, her legs are swollen and she’s weak. One night she called me and kept telling me she was at someone’s house and wanted me to pick her up. She argued with me no matter how much i told her she was in the hospital. I don’t understand how they think they can discharge her to her home!! I know she doesn’t want to go to rehab. However she is not safe to be alone. I can not take her because there are immigration laws. She can be rude & angry and I’m not sure how to go about taking care of someone like this when they don’t listen to medical advice or their daughters advice. I think she needs a nursing home but I can’t force her and i can’t afford it. Such a difficult situation and trying to deal with it so far away. The stress & anxiety levels are so high, and i worry about my mom, I just want her to be safe.
My husband’s father had to go to the hospital the other weekend and we were unable to go visit him while he was there (they live in another state). I had no idea that there were so many reasons to be at the hospital and making sure that they take care of our dad! I didn’t know that hospitals make more money the shorter your stay is, but that makes sense! Thanks for the advice!
Another fabulous article by Ms. Tumlinson. I can relate to every aspect of what she discusses in this article as I went through it all with my Mom. Each time my mother was hospitalized by insistence of her assisted living facility she came out sicker than when she went in and was not even being treated for the original condition that put her in the ER. Pain me, ds and steroids were discontinued leaving her in horrible distress. The doctor was uncommunicative and I had to chase him down. They never conferred with me about anything and just made decisions without explaining. In fact. my sister and I diagnosed one of my mom’s conditions which was a rare and severe allergic reaction to an antibiotic. She almost died then. The hospital said her deteriorating condition was due to her fall she had. They never did admit it was the antibiotic. Anyway, appreciate this article. One of the first things the overseeing doctor should do is confer with the primary doctor and then reconfirm meds with family. I also offered them my moms advanced directive and dnr which they said they didn’t need and was called later that night as they needed it.
Thank goodness my Mom seems to have found some pretty good doctors, but she has Tricare for Life insurance in addition to Medicare, but when she needed IV iron treatments (at a facility) for anemia, Tricare won’t pick up their portion and so Mom is being billed *$750.! At least Medicare did pay their part. She has also had to get IV antibiotics, and the same thing has happened. We managed to get it taken care of the first time and the second time, her doctor’s office was going to charge her, but the doctor overrode it since we had already told her about the problem. She didn’t use home health; she did it herself and the doctor’s office had nurses who checked on it weekly, changed the PIc line and drew blood and gave her the meds for each week (she had them at the same time she was going to receive the iron IV’s) for 4 weeks.
But what I don’t get is that Tricare for Life insurance won’t cover the IV meds unless she is in the hospital! This is crazy, the last place she needs to be is a hospital! She lives in a very nice Independent Retirement place where they have regular activities, plus she still drives and is active with her church.
Thank goodness my Mom seems to have found some pretty good doctors, but it looks like (according to a bill she received) that Medicare will not cover anything for IV treatments (she gets iron by IV and IV Antibiotics for UTI’s-the charges were overridden by her doctor), why won’t Medicare pay their part-her co-insurance (Tricare for Life) seems to be paying even though it says Disallow on the bill?
This is some really good information about home care. It is good to know that it would be smart to find a place that has an alert medical team. That is good for me to know that because I am starting to look for a home care place for my parents.
RN Case Manager here! I can empathize with the difficulty of navigating the hospital, post acute care, and long-term care with your family members. It’s very stressful to be the advocate, and feel that you cannot necessarily trust the healthcare team. One suggestion I would make to everyone is to have an advance directive. This can describe the care you want and don’t want in the event you become incapacitated and are unable to make your wishes known. Accidents can happen to anyone! It’s so helpful to have this in place before you need one, and it can take a lot of pressure of you as an advocate if the wishes are clear.