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There is no doubt that a hospital is like a foreign country for most folks outside the healthcare system. They speak a different language with all sorts of initials in it that they don't bother to explain to you. They rush around and may seem to ignore the family members with a loved one in that hospital bed. Yet the family members are the ones who must ensure that their elder gets what they're supposed to get. It's overwhelming and confusing. It may seem like a strange idea, but if you are a family member, you need to stand up for your loved one there. If you don't, bad outcomes can readily happen.
Here's a real life example:
Kendra's dad, Norm, age 78, was sent to a local hospital in the semi-rural area where several family members had gathered in their vacation home. He had an acute episode and was in serious condition. He ended up in ICU. After a couple of weeks, he had improved but was still very weak. The doctor assigned to him had never met him before, as Norm didn't live in that town. Kendra got the feeling that the doctor had no particular interest in her Dad, other than to discharge him as fast as possible.
As Norm improved, the physical therapist finally was able to get him out of bed and take a few steps with him, using a walker and her assistance. What happened next illustrates the broken healthcare system in hospitals well. The doctor told Kendra that Norm was ready to be discharged the next day, after only being able to walk a few steps less than 24 hours before! He was nowhere strong enough for Kendra's Mom, Justine, age 77, to manage him at home. But that was where Kendra and Justine were told he was going.
Improper Discharge Planning
When Kendra and Justine consulted with us at AgingParents.com, we gave them advice about how to handle the situation. First they had to refuse to take him home, given that it would be an #unsafe discharge, which the hospital is legally forbidden to do. They requested that he go to rehab for #physicaltherapy and they wanted it to be in a place close to where they lived, not hours away near that hospital, where it would be hard to visit every day. The discharge coordinator was in conflict with what they asked for. She was not truthful about arranging for Norm's transfer to a local rehab facility. We counseled Kendra to insist on what Norm needed.
Dishonesty
Kendra had picked out a place for Norm to go to which had a bed available and was a rehab place with a decent reputation. They needed Norm's #medical records from the hospital where he was. The discharge person told Kendra that she had called the place and they never called back. She never sent Norm's records as requested. Kendra explored this herself and heard that the home had never gotten a call nor any contact from the coordinator! This snarled all the plans and it took days to straighten that out. Meanwhile the hospital tried to pressure Kendra and Justine to take Norm home. I counseled them to refuse.
Can Be Resolved With Advocacy
Kendra stood up for Norm as well as Justine. With guidance, she was able to get to the truth of the hospital's failure to protect its patient from being released home to an unsafe situation where an elderly spouse could not properly take care of him. She called them out. They ultimately backed down. She got the records sent as was Norm's right to have done. Without Kendra, Justine and Norm might well have lived another nightmare of re-hospitalization due to the poor judgment of the hospital far from home. She was an effective advocate with guidance from AgingParents.com.
The Takeaways
The broken healthcare system we live with is not broken everywhere and Norm's story may not be average. However, it is unfortunately common. The hospital directors in some places can be more concerned about whether Medicare will pay for each day of the patient's stay than they are about what is best for the patient. No one thinks through what discharge means to the family. Nor do they necessarily ask what the family wants or needs. If you ever have a loved one who must go to a hospital for any care, remember these three tips:
- Every hospitalized patient has legal rights to stay there for however long it takes to be released from care safely. Pressuring a family to take on full time care when that is not a safe option is wrong. The hospital has a duty to fully disclose all care options rather than dumping this responsibility on family. In this case rehab was definitely a reasonable option.
- No one should be forced to take a bad option for hospital discharge because of being pressured by hospital staff. You, the family can request a care conference with hospital staff, specifically the discharge coordinator, to explore and discuss discharge options that are safe and will meet the patient's needs.
- Never accept what looks to you like a dangerous choice for any loved one being released from a hospital. Speak up. Tell them that this would be an unsafe discharge and that they are obligated to find a safer option. Maintain calm. Do your own research as to what choices would work for you and your loved one. Not everyone can instantly be managed at home after leaving a hospital. #Medicare does indeed cover rehab (aka "nursing home") after a few days in a hospital for skilled nursing, physical, occupational and speech therapy.
Even if you are uncomfortable confronting hospital personnel, doctors and discharge coordinators, you must get past that to assert your loved one's rights in our difficult healthcare system.
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