Consider this scenario: You’ve gotten a frantic phone call from your elderly parent who, returning from a 10-day cruise, broke her hip and is in a distant hospital room recovering from surgery. Her nurse just warned her that her health care insurance coverage expires tomorrow, and wants to know where mom wants to be transferred. You’re completely unprepared for this and panic sets in. What do you do?
This is hypothetical, of course, but the fact is that more than 80 percent of us will be in a similar situation at some point. A parent, spouse, sibling or child will experience a fall, stroke, heart attack or some other traumatic episode and after a short hospital stay to stabilize their condition, hospital personnel (and/or the insurance provider) tell you to “make other arrangements.” Returning home is often not an option because the physician has concluded that the patient needs some level of care to perform basic life functions. Consequently, a rehabilitative, transitional or perhaps permanent care facility must be found. The placement depends on availability, cost, needed therapies and geographic location.
“Help!” Assistance is available from both paid and unpaid advisers but you need to prepare and implement an action plan almost immediately—despite the fact that you know little or nothing about the health care system. Adding to the crisis may be the resistance or confusion of the patient who wants desperately to go home.
Here’s help. I’ve prepared a short checklist of items to help you make an informed decision. Take a deep breath and do some research. Most hospitals offer lists of qualified facilities and employ nurses or social workers to advise you. These individuals often do not impose their preferences but they may know current availability and their list will give you a starting point.
Search our housing directory for alternatives using the criteria suggested by the hospital staff. Most of the care that is necessary immediately after a hospital stay involves specific therapies (e.g., speech, physical, cognitive) and time to heal, and their availability is essential to a positive outcome.
· Actively involve the patient in the decision. Their greatest fear is likely a loss of control. They may also view a long-term health facility as a death sentence even if the facility has “rehabilitative” or “transitional” in its name. Involvement will result in less resistance and a more positive result.
· Ask lots of questions of the physician, the nursing and other hospital staff. Don’t forget to ask the patient questions, too. You need to get objective answers about what is needed to achieve the most positive outcome. Change is difficult both physically and emotionally. Moving a person from one facility to another can be devastating. But frequent moves may be the result of poor selections made with little or incorrect information.
· Transitional and rehabilitative facilities require that the patient has certain physical and cognitive ability levels upon admission; improvement in those areas is charted at frequent intervals. One of our dear friends has undergone two moves since being stricken with a massive stroke, because she failed to make the necessary progress in her recovery.
· Search with your senses. Nothing takes the place of physically visiting a facility in advance of placement. What do you see when you visit? Is it clean and bright? It need not be new. Frequently—unfortunately--décor is substituted for care. Are members the staff visibly engaged in caring for the residents? What do you hear? Silence for me is a red flag in some facilities. It certainly depends on the type of facility but it sometimes signals the overuse of antipsychotic drugs to quiet the population. What do you smell? Is it urine? Stale food? It should smell like home.
· Ask about food choices and taste something from that day’s menu. One of the serious problems that patients encounter is a loss of strength because they fail (or refuse) to eat. The problem may be that the quality of the food doesn’t satisfy a patient who is a good cook or has a particular love for good food.
· Be visible. Visit often for the sake of the patient. Your visits are important for the companionship and love that they provide, but they have another purpose. Most facilities are understaffed. Staff ratios of seven or eight patients to one care provider make it difficult for that care provider to give sufficient attention to any one patient. But humans tend to perform better when they know they are being observed. I have no proof to support this statement, but I have observed that staff communicates with those patients whose family and friends are frequently present. One of our friends found that bringing a box of candy or a bouquet of flowers as a thank you gift to the staff a good idea. We don’t say “thank you” enough and most of us respond positively when we are told we’ve done a good job.
· Be positive and encouraging. Illness often results in depression. Prolonged rehabilitation can be very discouraging when positive results are in short supply.
· Review our Toolkit chapter for additional tips and specific questions you might use when searching for facilities by phone or in person.
Now that you have experienced how difficult a task this is perhaps you could take a moment to make a list of what you have learned and what your wishes would be should you find yourself in the same situation.