A bigger crowd than usual attended the March 3 Woman of Wellness (WOW) event to hear the presentation on “Things You Don’t Know That You Need to Know About Hospital Discharge and Homecare”. Speaker Colleen Van Horn, RN, BSN, PHN, CCM, and owner of Innovative Healthcare Consultants, spoke from her experience as a nurse (coming to Fallbrook in the mid-70s to work at Fallbrook Hospital) and, subsequently, a geriatric care manager.
Geriatric care takes a client-centered approach, focusing on what the patient needs and guiding them to the best care for the best quality of life, Van Horn said. She also said a senior’s goal should be to “stay healthy so as to not go to the hospital in the first place.”
She explained that there are three ways for a senior to be admitted to a hospital: sent by a doctor, taken by ambulance or driven to the emergency room. Once there, the patient will have to tell his or her story many times to many different people. Van Horn recommended that seniors take two or three copies of their medicine list with them, as once they give it to someone, they won’t get it back.
She explained that admission to the hospital depends on the results of all the tests that will be done first. A patient can be admitted with in-patient or observation status. The important thing to remember she warned is that insurance companies only allow a two-night stay under observation and Medicare requires a three-night stay for coverage at a rehabilitation facility. So it is important for the patient to ask, ‘Am I an inpatient or on observation status,’ she said.
Van Horn detailed the common causes for hospital stays for people over 75 years old. CHF (congestive heart failure) is one of the main reasons as people who have it “get sick fast and also get
well fast,” she said. Pneumonia, another cause, develops when seniors stop moving around. A UTI (urinary tract infection) is also a common problem for men as well as women; if they don’t feel good and seem confused, they should be checked for a UTI.
Septicemia develops from an infection that spreads to the blood stream if untreated, requiring a hospital stay for treatment. More than 95 percent of hip fractures are caused by a fall which not only sends seniors to the hospital but also takes away their independence. This is why Van Horn advises seniors to “stay active and healthy; eat well and don’t fall!”
When it appears a senior has had a stroke, it is important to get him or her to a hospital right away as there are treatments that can lessen the damage it given within a few hours.
Medication errors are also a reason seniors are admitted to a hospital. Mismanagement of medication includes taking the wrong one, taking one at the wrong time or the wrong dose or not taking it at all; these happen with 40 percent of patients over age 65.
When a patient is ready for discharge, there are important issues to remember Van Horn said. During a hospital stay, seniors tend to get sicker, acquiring new infections; catheters can lead to a UTI, lab results being off track, causing confusion.
The new environment of a hospital also leads to lack of sleep and delirium from bright lights, constant activity, nurses coming in and out, different food, numerous new medications (including narcotics) which can cause drug interaction, and little or no exercise. Inactivity causes seniors to lose one to three percent of mobility each day so they need more assistance.
Van Horn recommended that patients “turn from side to side; do as much as you can with movement to not develop blood clots, or pneumonia.” They should try to stand up and walk away from the bed, with help, if they can.
Most likely, they will “be dependent on someone else at discharge” she said, although they “want to get home, be normal, get back to their old routine, it takes awhile to get back to normal, especially with Alzheimer’s or dementia – those patients never come back to the point they were at.” Because of the effects of being in a hospital, it is “better to get them out and home; often times, the delirium goes away at home” she added.
At discharge, it is very important that the patient has someone there to listen to the instructions and take notes as seniors are not likely to remember them. That someone can be a family member, friend, or paid caregiver. They should compare the patient’s medicines from home with the prescriptions given at the hospital, reviewing them with a nurse, as brand names differ from generic ones.
Patients are always told to see their own doctor a week after discharge. “Ask the discharge nurse to make the appointment and write it down; make sure the doctor knows why you were admitted,” Van Horn said. She advised asking for a copy of the history and physical form that was filled out on admission to the hospital as well as a copy of the discharge summary and the most recent lab reports, “tells your story of what happened in the hospital.”
She also said, “In case you need to see a specialist, get copies of CT scans or other tests, that gives them clues to what is going on.”
There are options for where a patient is discharged to depending on their condition. An acute rehab facility is required when the patient has suffered a multi-trauma event or had a stroke. The patient needs to be able to tolerate a total of three hours of therapy a day – a combination of speech, occupational, and physical therapy. This is the best course to get back on one’s feet she said.
Another option is a skilled nursing facility. There are many in San Diego County and they provide skilled needs in physical therapy, IV therapy, wound care, oxygen therapy, and nursing care, all of which qualify for Medicare coverage. Some families choose a board and care residence (usually six to 15 bed homes) for their parent.
Home health requires a medical order from a doctor, she explained. A home health worker comes to the patient at home to assist her with care, evaluate if it was a good discharge, if the caregiver is helping, and what kind of care is needed.
A fourth option is hospice which is provided by Medicare. Patients are put on hospice when they have a diagnosis of living no longer than six months. The discharge manager guides the patient through the forms and paperwork needed, providing a list of qualified companies to chose from. Hospice workers and volunteers do not stay all day, but only an hour or two a day.
Yet another option is hiring non-medical home care which is not paid by insurance. This kind of worker helps the patient with daily activities like housekeeping, bathing, food preparation, etc.
A lot of home care can be done by family or friends, but caregiving (done by a relative) is not realistic for everyone as it is a 24/7 job and can by physically demanding.
Caregivers and seniors can find more information on care services at www.caregivercoalitionsd.org and at www.innovativehc.com.