Hospitalization Happens: Now What?
Being admitted to the hospital, whether it is for an elective procedure or an acute illness, can be a stressful and confusing experience for both the patient and their family.
This article provides you with key information to use during and after a hospital stay. We hope you don’t need to use it often, but once you do you will be more prepared.
What to Bring – and What Not to Bring - to the Hospital
What to Bring
Personal Medical Records: Keep a current copy of all pertinent medical records on a thumb drive, in the cloud, or in a 3-ring binder so you can easily locate them, add and remove papers, and easily share. Include the following information:
A list of your current medications – anything you take on a regular basis. Include prescription and over-the-counter drugs. While it is very important to have a list of your medications, leave your pills at home, because except in rare situations the hospital will provide any medication you need while you are there.
A list of any allergies you suffer from
Past medical records – include important tests and previous hospital stays
Advance Directives – Living Will and Durable Power of Attorney
A list of the names and telephone numbers (home and business) of family members to contact in an emergency
Names of physicians and preferred pharmacy, home healthcare company, or other health care providers
A list of daily household tasks and daily activities that you might need to have taken care of for you. For example, taking care of a pet or plants, mail and newspaper pick-up, paying bills, volunteer activities, and storm preparation (during hurricane season). Create a list ahead of time and keep it in your binder.
Add a few blank sheets of paper for notes
Health Insurance Card(s)
$20 or less for newspapers, magazines, or other items you may wish to buy in the hospital gift shop.
Personal Belongings: It’s best to pack as little as you can. However, be sure to bring the following items and label everything:
Nightclothes, bathrobe, and slippers (only if they have non-skid soles)
Comfortable clothes to wear on the trip home
A toothbrush, toothpaste, shampoo, comb and brush, deodorant, and a disposable razor.
Glasses, hearing aids, and dentures. Bring cases for storing items when you are not using them. Bring cleaning supplies for the dentures.
What NOT to Bring – or What to Send Home
Leave large sums of cash, jewelry (including wedding rings, earrings, and watches), credit cards, and checkbooks at home or have a family member or friend keep them for you. If you must bring valuables, ask that they be kept in the hospital safe during your stay. Leave electric razors, hair dryers, and curling irons at home.
Your Hospital Stay
Step 1: Admissions/Insurance/Advance Directives
Your first stop in the hospital will be the admitting office. You will be asked to sign a number of forms. In some cases the Admissions team will come to your room to complete this process.
The key parts of the process are to:
Register as a patient in the facility, give permission for care and be informed of the privacy policy of the facility. One focus of this process will be on patient confidentiality. When you first register you will receive a “HIPAA Notice of Privacy Practices” and sign a statement indicating that you’ve received it. The Health Insurance Portability and Accountability Act (HIPAA) governs how hospitals and other healthcare providers or businesses use a patient’s private health information.
Identify and verify your insurance status, and your willingness for the hospital to tell the insurance company your medical information. Most people 65 and older have Medicare health insurance, which has two parts: Part A (hospital insurance) and Part B (medical insurance for out-patient care and diagnostic testing). Medicare Part A helps pay for care in hospitals, skilled nursing facilities, and hospices, as well as some home health care. It covers a semi-private room, meals, general nursing, and other hospital services and supplies. It does not pay for private duty nursing, a television or telephone in your room, or a private room (unless medically necessary). For more information about Medicare coverage, call the toll free helpline at 1-800-MEDICARE (1-800-633-4227).
Per your insurance plan, any identified patient financial responsibility such as a co-pay, deductible, or co-insurance will be asked to be paid at the time of service. Should you need help or have any questions about your portion of the bill there will be financial counselors available at the hospital to assist you in making payment arrangements so that you are able to afford your healthcare.
If you don’t have health insurance, an admissions counselor can advise you about other payment methods and sources of financial aid available to you.
Confirm your willingness to receive care by signing a form.
Identify how you would like to be cared for in the event you become seriously ill and cannot communicate on your own behalf. This is where Advance Directives, such as Living Wills and Durable Power of Attorney for Healthcare, become important.
Advance Directives and Living Wills
You can decide in advance what medical treatments you want or don’t want in the hospital in case you lose your ability to speak for yourself. You can do this by preparing something called an advance directive. In an advance directive, you tell people how to make medical decisions for you when you can’t make them for yourself. You also can name someone else to make medical decisions for you. Two common advance directives are a living will and a durable power of attorney for health care.
In a living will, you write down the kind of medical care you want (or don’t want) in case you become unable to make your own decisions. It’s called a living will because it takes effect while you are still alive, but only takes effect if you are too ill to make decisions for yourself.
In a durable power of attorney for health care, you name someone else (a family member or friend, for example) to make medical decisions for you if you are unable to make them for yourself. You also can include instructions about any treatment you want to have or want to avoid.
If you have an advance directive, tell your family and make sure they know where it’s located. Also, tell your doctor and make sure that the advance directive is part of your medical records. If you have a durable power of attorney for health care, give a copy to the person you’ve chosen to act on your behalf. If you have not created these forms, you can complete them during your stay. Most hospitals will have forms they can give you on request.
Step 2: Where in the World Am I?
Once you’ve filled out all the forms, you’ll be taken to your room. Hospitals have many patient-care areas. Typically, most patients are admitted to a bed on a certain floor — the 7th floor on a general medical unit, for example. Patients may be in a private (one-bed) or semi-private (two-bed) room.
For patients that are very ill the intensive care unit (also called the ICU) has the special equipment and staff necessary. Coronary care units (CCUs) give intensive medical care to patients with severe heart disease. In both the ICU and CCU, visiting hours are strictly limited and usually only family members are allowed to see patients. Surgery is done in the operating room (OR). After an operation, patients spend time in the recovery room before going back to their own room.
Step 3: Meet Your Care Team
In the hospital setting there are numerous health professionals who will care for you:
Doctors, Nurse Practitioners, and Physician Assistants typically direct your overall care. You’ll have an attending or admitting physician, who is ultimately in charge of your care. The admitting physician may be your primary care physician or another doctor on the hospital staff to whom you’ve been referred called a Hospitalist, or Hospital Specialist.
Hospitalists are physicians specially trained to care for patients admitted to a hospital.
Specialists are physicians who are experts in a particular disease or part of the body. For example, a cardiologist is a specialist who might be called to treat you for a heart attack. These physicians should communicate with your primary care provider about the course of your care.
Nurses – There are a number of nurses who will help you during your stay. These include: registered nurses, nurse practitioners, licensed practical nurses, nurse’s aides, and nursing students. Nurses are responsible for many of the basic patient-care services. Such as giving medicines, checking vital signs (blood pressure, temperature, and pulse), providing treatments, and teaching patients to care for themselves.
Head Nurse – The head nurse coordinates nursing care for each patient on the unit (the floor or section of the hospital where your room is located). Each floor has a head nurse who is responsible for all the care provided by the other nurses.
Nurse’s Aid - There are many names for this position but in general these individuals are dedicated to assisting with your personal care needs, comfort, and safety.
Therapists – There are a number of different therapists who may be called in to help you. Physical therapists teach patients how to build muscles, increase flexibility, and improve coordination. They may use exercise, heat, cold, or water therapy to help patients whose ability to move is limited. Occupational therapists work with patients to restore, maintain, or increase their ability to perform daily tasks such as cooking, eating, bathing, and dressing. Respiratory therapists prevent and treat breathing problems. For example, they teach patients exercises to help prevent lung infections after surgery.
Social workers offer support to patients and their families. They can help patients and families learn about home care, social services, and support groups available to them after discharge.
Discharge planners are usually nurses or social workers who help patients arrange for health and home care needs after they go home from the hospital.
Technicians perform a variety of tests such as x-rays and procedures such as taking blood.
Dietitians help plan specialized menus for patients and teach them how to plan a well-balanced diet.
Pharmacists know the chemical makeup and correct use of drugs. They prepare the medicines used in the hospital.
Safety First
The staff of the hospital work very hard to ensure your safety during your stay. Here is what you can do to keep yourself safe:
Communicate clearly with the staff about changes in your condition or questions you have about your care.
Follow recommendations of the care team with regards to getting assistance for getting out of bed, eating, showering, etc.
Keep a binder of personal medical information with you and update it regularly.
If at all possible, have a family member or friend stay with you as many hours as possible. In some settings there will not be accommodations for family/friends to stay overnight. Check with your nurse if you need to make arrangements.
All hospital staff will have a name badge on and should introduce themselves to you and ask your name and date of birth before they perform any tests or provide other care for you.
When nurses bring you medications, ask for the names of medications. If it is a new medication ask about it and begin to learn about it since it may be a new part of your regimen at home.
Here are some more tips to keep in mind during your stay: A hospital room is a complicated one with lots of equipment around you probably aren’t familiar with. Because you may feel weak or tired, please take a few extra safety steps while in the hospital:
Use the call bell or button when you need help.
Do not get out of bed unless your nurse gives the okay.
Use the controls to lower your bed before getting in or out.
Be careful not to trip over the wires and tubes that may be around the bed.
Try to keep the things you need within easy reach.
Take only prescribed medicines. If you bring your own medicines with you, tell your nurse or doctor. Don’t take other drugs without your doctor’s permission.
Hold on to grab bars for support when getting in and out of the bathtub or shower.
Use handrails on stairways and in hallways.
Pay attention to what you are allowed to eat and drink. Before certain tests you may be asked to fast (not eat or drink for a certain period of time).
Speak the Language
Here are some common words and phrases, and their meaning, that you may hear while at the hospital:
Testing Abnormal – not the usual result expected.
Within normal limits – the result is within a range that is usually considered normal.
Medications:
As needed – A medication that is taken only when symptoms are present. Typically the patient must request these types of medications from the nurse. They are not put on a regular schedule of administration. Keep in mind there can be a time lag after asking for a medication so don’t wait too long if it is a medication for pain, for example.
PO – by mouth
PR – by rectum – a suppository
IM – intramuscular – a “shot”
Diet:
NPO – nothing by mouth
Nothing after midnight – often for tests or blood tests in the morning your doctor will order that you have nothing to eat or drink after midnight and until the test is done. The doctor will specify if you are to take certain medications with a sip of water or not.
Clear Liquids – Liquids that one can see through
Soft – Foods that require little chewing
Full – A “regular” or typical diet of foods and drink
ADA – American Diabetic Association diets are specially formulated for patients with Diabetes and typically will identify the number of calories. For example, an “1800 calorie ADA diet” is one that will provide 1800 calories over the course of the day and in keeping with the needs and restrictions of diabetic diets.
Hospitals Care for You – Policies to Protect Your Care
As a family caregiver, it can be difficult to be involved in a patient’s care and fully recognized. Some hospitals manage this better than others. Here are some typical policies that have special application for patients with Alzheimer’s disease or related disorders. You may need to be aware of these.
Patient Rights
As a patient you have the right to expect high quality, respectful care where your personal preferences and values are understood. Most hospitals provide that. They consider the patient a partner in the process of caring for you and want to keep you well informed, allow you to participate in treatment decisions, and promote open communication with your doctor and other healthcare professionals, to ultimately make your care as effective as possible.
If you find yourself not being recognized in your role as patient advocate, start with the bedside nurse and see if you can explain your observations, and come to a new plan for including you in the patient’s care decisions. Of course, if your loved one cannot express it, they will need to see the documentation of a Living Will or Durable Power of Attorney for HealthCare.
When an individual has early stage Alzheimer’s disease or a related disorder it can be difficult for hospital staff to recognize the need for caregiver support. Typically a calm, respectful conversation will resolve the situation. If it does not have conversations with higher and higher positioned nurses and then facility administrators.
The typical leadership structure in a hospital includes a Bedside nurse, a Head nurse for the floor, and a Director of Nursing for the Hospital. After hours or on weekends there is typically an “Administrator on Call” or “Patient Ombudsman” who can be contacted. You may also want to reach out to the Primary care Provider who can explain the specifics of your loved ones needs to the hospital team.
Restraint use policy
Most hospitals will commit to creating a physical, social, and cultural environment that limits the use of restraints to situations in which they’re adequately justified and clinically appropriate. Some will say “Use of restraints will be eliminated whenever possible.”
As a caregiver you have the right to ask them to NOT use restraints. You also have the right to request other help for your loved one. In some cases if a staff member is assigned to be a companion (sometimes unfortunately they are called a “sitter”) an individual can be kept safe without physical restraints.
However, the reality is there are some situations where physically restraining someone keeps them safe and allows for life saving care. For example: a patient who needs life-saving medication may pull out the intravenous line that is delivering the medication unless their arms are tied down.
For individuals with Alzheimer’s disease there is a risk of a hospital syndrome called delirium which is an abrupt onset of increased confusion due to the illness precipitating the hospitalization. At times physical restraints or medications are needed to keep an individual from harming themselves during this time. With proper medical attention delirium should not last more than a few days.
Organ and tissue donations
On admission to the hospital, patients or their representative will be asked if they have a donor card or would be interested in becoming a donor. This information will become part of the patient’s medical record. If your loved one is involved in a program for donating the brain or their body and the hospitalization is of a serious nature it is best to notify the care team as early as possible so this knowledge can be communicated to the care team in a timely fashion.
Pain Management
Pain management is an important part of care, extending beyond pain relief and encompassing quality of life and ability to function optimally. Most hospitals have an interdisciplinary team approach to pain management and three are strict rules to ensure patients have access to timely pain relief.
In some cases patients with Alzheimer’s disease or related dementias are not able to remember they have to ask for pain medication. They may need medication on a schedule. As the caregiver, be sure the care team understands if your loved one cannot advocate for themselves in this regard. There are other more objective ways to identify and monitor pain that can be used.
Step 4: Staying Informed: Test and Treatments
In some cases your treatment will be very straightforward, such as the removal of an appendix when it is inflamed. In other cases it’s not as clear how your illness should be managed. As the doctor(s) are deciding how to treat your illness, you may have questions about that as well.
What treatment is needed, and how long will it last?
What are the benefits and risks of treatment?
Often during a hospital stay tests are indicated to determine the exact nature of a problem. As tests are discussed, you may want to ask your doctor or nurse some or all of the following questions:
What will this test tell us?
When will you know the results? How will I learn about the results?
What are the risks of this test?
If it is a high risk test, are there options to this test that can give similar information?
Step 5: Prepare for Discharge (Discharge Planning)
As your loved one’s condition improves you will have questions about what needs to happen when you leave to ensure you stay on the road to recovery. In some cases you will need assistance at home that you did not require before coming to the hospital. In other cases you will need certain tests and follow-up appointments. Your nurses will help you learn what you/your family need to know. In some cases a discharge planner or social worker will also assist you. Be sure to get clarification on these matters before you leave.
When will I be discharged?
Will I be able to go home? If not what are the options for me care once I can leave the hospital?
When I go home, will I have to change my regular activities or my diet?
How often will I need checkups?
Will anyone be coming to see me at home?
Is any other follow-up needed?
When do I need to see my primary care provider?
Do I need to take new medications? If at all possible, compare the medication list from the discharge orders to the medication list your loved one was using before admission. If you don’t understand the changes ask BEFORE YOU LEAVE to get any differences explained.
Once there is a clear plan:
Ask for a written copy of the discharge orders or plan
Ask for the name of the floor and the direct phone number to the floor so if you need to call back you have the direct line
If you have any concerns, ask BEFORE DISCHARGE! Don’t let the discharge happen if you don’t feel arrangements are adequate.
In some cases you may feel more comfortable with the discharge if you get some help. If your physician orders it, the discharge planner can help arrange for a visiting nurse who will come to your home for a short time after discharge. Typically this type of short term care is covered by Medicare. If you are still in need of help after Medicare coverage is over, there are “private duty” hire caregivers that you can hire. In addition, the discharge planners can help you obtain hospital equipment, meals-on-wheels, or other services to make your transition back home successful. The discharge planner also knows about senior centers, rehabilitation centers, nursing homes, and other long-term care services.
If you disagree your loved one is ready for discharge, remember you have rights. In this case, you have the right to ask for additional understanding of your loved one’s status and discharge plan. Start with the discharge planner and floor nurse and follow the escalation to Head nurse for the floor, and the Director of Nursing for the Hospital; After hours or on weekends there is typically an “Administrator on Call” or “Patient Ombudsman” who can be contacted. Again keep the primary care provider in mind as they can often communicate with the hospitalist team on your behalf.
Step 6: After the Hospital
Wherever your loved one goes after they leave the hospital, there are some key steps you need to take:
If you weren’t able to do this before discharge, compare the medication list from the discharge orders to the list your loved one was using before admission. If you don’t understand the changes, you can call the hospital back and/or write down the differences and plan to include that in a message to your loved one’s primary care provider.
Make a copy of the discharge orders and send it to the primary care provider’s office.
Make an appointment with the primary care provider.
Make all appointments listed on the discharge orders.
Take note of any upcoming home care or services and follow through immediately if they do not show up as expected.
Please talk with your own/loved one’s healthcare provider before using any of this information.
