May 2011 – A Trip to the Hospital

A Trip to the Hospital



What should you take?

Make sure the patient has the following with them when they go to the hospital:

  1. Insurance cards
  2. Picture ID or driver’s license
  3. Personal health summary
  4. Numbers of all doctors patient has seen
  5. List of medications/amounts
  6. A copy of the Healthcare Power of Attorney document outlining who the doctors are allowed to talk to concerning the patient’s care.
  7. Suitcase with underwear, slippers, bed jacket or shirt that closes down the front and is easy to manipulate. Do not bring medications and leave all jewelry and valuables at home.

If caregivers have been coming into the home and have kept a daily log of symptoms, blood sugar levels and blood pressure checks, bring it along.

When a loved one experiences a health event, it is usually not planned. A state of confusion ensues for everyone involved. If the person helping is not familiar with the senior services arena, they often do not know where to turn and may not make informed decisions.

Choose the hospital ahead of time. Make sure it is on your insurance company’s list of approved providers. Post all emergency numbers for doctors, hospitals, dentists, and pharmacy on the refrigerator or some obvious place.

Check with the insurance company when hospital stay is warranted

Check with your insurance company for pre-authorization. Normally, your doctors will be in your insurance network of providers but the hospital staff may not. Be sure to
let them know if it was a hospitalist that saw you. Monitor your claims.

Make contact with the doctor and nurses who will see your loved one. There will be many nurses on different shifts coming in. They may not be familiar with your case so advocate for your patient. If you see something you question, ask about it. Healthcare POAs may have access to the nurses notes.

Begin planning for returning home?

Begin Discharge Planning with the social worker. Who will care for your loved one when they return home? Will they need in-home assistance with bathing, dressing, transferring, toileting, etc.? What condition will they be in when they are discharged? How long is recovery expected to take? Will they need rehabilitation services such as physical therapy, occupational therapy, music therapy or physical therapy? Ask what you can do to help speed their recovery and help them become self-sufficient once again. Check with nurses and the hospital social worker.

One of the most common diagnosis in hospitals among seniors is dehydration. Aging adults lose their ability to sense when they thirst. Keep water bedside and encourage them to take sips often.

When dealing with the insurance company, be sure to monitor the bills. They will come in from doctors, specialists, Xray technicians, CT or MRI scans, blood work, etc. for up to a year. Validate each charge and check for duplications or items the patient did not use. If a charge is denied by insurance, go through the appeal process. Most times it will be paid once more info is collected. The Denial Process has strict timelines so be sure to follow up soon.

Discharge Planning Alternatives:

What are some of the alternatives available to patients when they are discharged?

  1. In-home health aide. Most services provide a companion service which is for patients who need 24/7 monitoring. Ask if the aide is a CNA, certified Nursing assistant, who has been specially trained and can take blood pressure and sugar level tests. Some patients may need a private duty nurse to administer medications. Many home health companies offer a variety of options regarding care. Some will send in an aide for 1 hour to do bathing or prepare meals but it is more expensive that way. Ask how they screen their personnel.
  2. Rehabilitation facility – This is usually suggested if there is extensive rehabilitation needed that cannot be done in the home. It is more expensive but usually lasts for 2-6 weeks. All of the various professionals are available for services.
  3. Assisted Living: These facilities provide some nursing services and offer respite services as an option for patients who cannot be by themselves at home and may need meals and medication provided for them. It is a temporary situation.
  4. Skilled Nursing: This type of facility has nursing staff on call 24/7 and provides most medical services. Some times hospice services will come into the facility and administer to the patient. This happens especially if the facility is not associated with a particular hospice company.
  5. Group home: Group homes provide a safe environment for patients with mental illness diagnosis. It is usually an intimate setting and feels more like a family setting. It would not be acceptable for someone needing a lot of medical care.
  6. Geriatric Care Manager (GCM): These professionals come from different fields, i.e. social work, nursing, etc. Choose one that suits your situation. They will take your loved one to doctor’s appointments; advocate in the hospital and manage the services needed in the home. Go to find a GCM.

Medicare is requiring many hospitals to be more proactive with discharge planning because too many patients were going home alone too early. They ended up being re-admitted. Medicare will be not paying for diagnosis for re-admission within a certain period of time. Hospitals will be docked payments for patients who catch something in the hospital or didn’t have adequate aftercare.