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The Senior Hub Podcast is a resource hub for planning and caring well for your aging parents and loved ones. This podcast tackles everything from data, to key terms, to personal stories, to sacred moments, to tricky family dynamics.
Join hosts Daniel Alexander and Rebecca Hill as they engage their guests, and each other, on this most important topic. We are all learning about this topic as we get older. Let's do it together.
Find us at www.theseniorhub.com
Hello, and welcome to the Senior Hub Podcast. I am Daniel Alexander, founding director of the Senior Hub, and I'll be your host for today's conversation. Our hope is that each time we do this, by the time we're done, you'll feel a little more equipped and maybe even a little more hopeful for whatever's ahead. So without further ado, let's dive in. As usual, we have Rebecca Hill, our resident expert of The Senior Hub, our chief care strategist with us today.
Daniel Alexander:Hello, Rebecca.
Rebecca Hill:Hey there, Daniel.
Daniel Alexander:Glad to have you here. We are picking up the story that we left off after the last episode. For those of you that have not listened to this just five minutes ago, if it's been a little while, as a recap, we are talking through Margaret's journey. Margaret is our fictitional character. She is 78.
Daniel Alexander:She fell at home. She called EMS and one of her children. As a result, she EMS arrived. She has been, taken to the hospital. Her other two children live out of town, so one of her children is also on the way to the hospital.
Daniel Alexander:So that's where we left off, and that's what we're gonna pick up today. So, let's start with you, Rebecca, on this question. They are all arriving at the hospital, but as the child who was alerted and is going to the hospital was preparing to leave, what should that child be taking with him or her? Yeah. What do they need to grab on their way out the door?
Rebecca Hill:Yeah. This is where a quick list would be really helpful of things to gather. You can have this stored, electronically in a digital file, or you can actually bring a copy with you, a hard copy. Both are ideal, But if you're just looking for the quick basics, you certainly need a medication list. Name, dosage, how often Margaret takes this med.
Rebecca Hill:I promise you somebody is gonna ask this. And these are actually critical pieces of information, because it determines how you get treated, dependent on what type of medication you're on.
Daniel Alexander:So, I'm assuming, what you're saying is not only does Margaret need to know this, but the person who's going to help process all of this and help walk through this journey is going to need to have this on hand.
Rebecca Hill:And you can't assume that Margaret in crisis is going to be able to tell someone, Oh, I'm on a blood thinner, or I am on thyroid medicine, or I have recently changed my dosage of blood pressure medicine. These are things that need to be declared accurately so that she can get treated accurately and not be overdosed or, some blend of medicines that act well together.
Daniel Alexander:Okay. Okay. So medication list is one. What else do they need to grab?
Rebecca Hill:Primary physician's name and phone number, hospitals that she's recently been to. So if she's had recent falls and she's been treated elsewhere, they need to know that. And insurance cards, Medicare cards, supplement plan, any secondary coverage if she has that. Doesn't need to be an exhaustive list of insurances, but certainly Medicare supplement, and certainly her ID card, so that, you know, that's quickly part of the bundle, the ID bundle.
Daniel Alexander:Okay. How much of all that you're explaining to us right here needs to be in hard copy? Do we need anything in hard copy or can this all be digital?
Rebecca Hill:You really don't. Digital copies are prevalent. Hospitals are working with them, it's nice to be able to transfer those. A hard copy is sometimes easier to access technology, glitches, password inaccuracies, things like that do happen, but everything is accepted digitally these days.
Daniel Alexander:Gotcha. Okay, great. So medication lists, you mentioned the primary care or the hospital names, insurance cards, anything else?
Rebecca Hill:So, somebody needs to be named health care power of attorney. Mhmm. Ideally, that is the child that's responding, in the ER. So, yeah, healthcare power of attorney is really important. That's the person who is legally going to be authorized to receive information about Margaret's diagnosis and her impending care.
Daniel Alexander:Okay, okay, great. So this is even before they arrive at the hospital, ideally, this information is on hand.
Rebecca Hill:Having access to it, for sure. If you have hard copies, great. But, certainly having access to any or all of that information helps.
Daniel Alexander:In our scenario here, Margaret has fallen and broken a hip. So more than likely she can speak for herself, but there are plenty of scenarios where someone has a heart attack.
Rebecca Hill:For
Daniel Alexander:sure. And the information is not coming from the patient themselves, but from someone else. So, I assume all that means is that information is even in the timeline of getting that information to the right hands is even more
Rebecca Hill:suppressed. Absolutely. Yeah. Acting quickly is the key in any emergency scenario and having accurate information is the key. So, knowing when documents and medication lists have been updated is really quite important.
Daniel Alexander:Okay. So in the information that sells, it needs to say last updated and the date.
Rebecca Hill:Yeah, absolutely. Gotcha.
Daniel Alexander:Okay. So let's move into the arrival. Margaret's been checked in and is being looked at from medical facility. The point person arrives immediately. What should the point person be thinking and then asking as they start getting up to speed with what's going on?
Rebecca Hill:Very basic questions. What are you treating Margaret for? What is broken? Do we know? Sometimes you can ask the question, is mom in triage or is she in observation?
Rebecca Hill:If Margaret is in observation, it's likely that they don't have a full picture of what they're treating yet. But somebody will likely be able to tell you what's being treated now and kind of what they're looking for. So, if there's impending scans that need to be done, more x rays, the point person in the ER will be able to tell you that. And that could be a triage nurse, it could be an observation nurse. Anyone who has recently touched Margaret upon her arrival should be able to give you those basic Okay.
Rebecca Hill:Understandings.
Daniel Alexander:So, yeah, the word observation's relatively common. Give me a little bit more on the word triage. What do you mean when you say that?
Rebecca Hill:Triage means there is a definable, treatable, need. So, a wound, a, you know, bloodletting of any kind. Triage means quick action.
Daniel Alexander:Okay. So observation comes first, generally, and then triage comes second as necessary or is it?
Rebecca Hill:Actually, it's the reverse. Okay. Triage then observation.
Daniel Alexander:Triage if necessary.
Rebecca Hill:If necessary.
Daniel Alexander:Quick action, solve something, and then we get into observation.
Rebecca Hill:Solve and then observe for what else is happening.
Daniel Alexander:So in Margaret's case, use those two words.
Rebecca Hill:So she would be triaged for any kind of wound. Okay. She would be observed for any subsequent, new symptoms. So, she may have hit her head as she, fell and broke the hip. They're gonna watch that for a little bit and they're going to actually do scans.
Rebecca Hill:They're going to take blood pressures, they're going to do CT scans, they're going to make sure that they have as much information as possible before determining what to treat.
Daniel Alexander:Okay. So you're asking a lot of the what questions. What comes next once you get the basic facts of what the status is?
Rebecca Hill:Yeah, I think it's necessary to say, Talk to me in plain terms. Let me know what you're seeing and what you're looking for, and if so, what comes next? There is something called patient education that every step of the hospital system should be educating both the patient and their healthcare power of attorney, or anyone who has HIPAA authorization to receive information about the patient. So, ask very simply, what's the follow-up? What do you predict the plan will be from here?
Rebecca Hill:And you should be able to get simple, direct answers.
Daniel Alexander:Okay. Okay. So what I'm hearing you say is part of their job is to educate you, the family member
Rebecca Hill:on
Daniel Alexander:what's going on and what's coming up next. And if you don't have enough clarity in your mind, or you're just getting confused, or it's 03:00 in the morning and you're tired and you need to ask again, it's okay to keep asking.
Rebecca Hill:That is the nature of an emergency room, or an emergency department. It's crisis, it's triage, quick solve, and then it's, observation and discerning what other things are going on. So, it's never, a fault to ask a question. And if you're not clear about what a word means, don't pause, Google it later. You need to know now from the person who is delivering that diagnosis to you.
Rebecca Hill:No one should speak to you in code or acronyms. You should say, what does that mean in plain terms?
Daniel Alexander:Got it. I got it. Okay, that can come across defensive or demanding. Is that okay? Or what is your advice to the care provider, the family member at this point in time?
Rebecca Hill:The family member needs understanding. Ask questions until you have understanding.
Daniel Alexander:Okay.
Rebecca Hill:It's all about education. It's all about giving quick understanding and a determination about what comes next.
Daniel Alexander:Gotcha. All right, there's a lot that's going to be coming at the family member this moment, in addition to the crisis and the fears and all the different emotions. What should they do with all that information?
Rebecca Hill:Yeah, begin to collect it.
Daniel Alexander:Okay.
Rebecca Hill:Take a note. I really love a digital note that is shareable because you may not be the person who's tending to Margaret, for the entirety of her stay, and you will want that information to pass on to, the next person who's seeing Margaret. So, the nature of hospitals is that they are busy. They are, full of staff members and those staff members do change. Hospitalists, nurses, certified nurses aides, people who are tending to you in the process as you move through the hospital system.
Rebecca Hill:You need to be able to accurately recall what was said to you by the previous provider. And a note is a great way to do that.
Daniel Alexander:And are you writing down like the time and the names of the people that are saying it, all those kinds of things?
Rebecca Hill:Absolutely. Gain as much information as you can about who's treating Margaret, what they're treating her for, and note it so that you can then advocate for Margaret when she sees a new provider.
Daniel Alexander:Are you saying that there's a chance that doctors and hospitals could get things wrong?
Rebecca Hill:For sure.
Daniel Alexander:Okay.
Rebecca Hill:We don't, I mean, we trust doctors that they are the most knowledgeable and skilled in what they're treating, but there's always human error. There's always information share errors. And so, even if it's just for your own timeline and clarity, you want to capture those dates, those diagnoses, those, next treatment plans, so that, yes, you can hold people accountable, but you also have a good record of your own to keep moving forward because you'll need these notes.
Daniel Alexander:Gotcha. Especially as you, I assume, communicate with your siblings or other folks that are, asking and needing to be updated.
Rebecca Hill:Correct. A lot of families choose to operate in shifts of their own. I do recommend this. Create a chain of observation of your own and your own family and send in family members to relieve each other, especially in a hospital when information is shared quickly, and there's a lot of it to capture.
Daniel Alexander:Okay. So, lot of information is going to be coming out. Let's get back to Margaret's Story. The family care point person has gotten the basic information. They have decided that surgery is required.
Daniel Alexander:So, what's that person's next questions alongside the surgery and all that?
Rebecca Hill:What are the risks associated with the surgery? Is Margaret experiencing other diagnoses that might impact her recovery from this surgery? And then what is the typical pathway to recovery for this surgery?
Daniel Alexander:Gotcha. Why why is all that necessary on the front end?
Rebecca Hill:Yeah. While you're gathering all of this information, you're you're gaining knowledge about really pockets and windows of time for you to plan how Margaret's going to be supported next. So, you want to understand what therapy she's going to receive while at the hospital, but then you also want to know how much time do I have before Margaret either discharges or goes to the next therapy facility. Gotcha. A rehab.
Daniel Alexander:Yeah, because there's a decent scenario where it's not the best for Margaret to go home, right? Brings up a whole list of other questions.
Rebecca Hill:Right, right. So we'll get to that.
Daniel Alexander:Okay.
Rebecca Hill:But, the idea is that you would be able to advocate.
Daniel Alexander:Great, great. All right, so she comes through surgery. And you're still in the hospital or your sibling has now relieved you and they're present in the room. What's the immediate? What are the next questions and next steps that we need to be thinking about and even asking in this next phase?
Rebecca Hill:Yeah. So, once she's settled, on likely an Ortho Floor, she's going to be given a care team. Part of that care team is not only a rounding physician, but it's a nurse, it's a certified nurse's aid, and it is, therapists. So, people don't know this, but there's a whiteboard in every hospital room. It should be updated daily with a list of providers.
Rebecca Hill:And it should follow day, date, time that they're going to be seen by that person. If you don't know, there's always a nurses station on every floor where you can go and get questions answered from a general practicing nurse. Not be assigned to you or Margaret specifically, but you can go to the nurse's station desk and ask any question you have.
Daniel Alexander:So, you just rattled off like five or six different roles on a given floor.
Rebecca Hill:That's right.
Daniel Alexander:Do you have any advice or resources for us on how to get organized with that? Who to ask what questions? All those kinds of things.
Rebecca Hill:Yeah, you can ask when does Margaret see a physician? When does the nurse come in? What time of day are her therapies happening? What are the therapies that she's receiving? I think the message here is that ask questions so that you understand who is in charge of what delivery.
Rebecca Hill:And then you wanna know when is that person accessible. I think it's also worth noting that hospitals do provide case managers to educate you about what's happening over a hospital stay. That case manager will likely inform you of discharge at some point, either to home or to rehab. So, you're going to want to know who is that person and does that person change during your hospital stay.
Daniel Alexander:Gotcha. Yeah, lots of different people. Okay. So, as an advocate for my mother, if my mother is Margaret, what else do I need to be looking for during her three, five, hospital that I can help make sure she's getting better or things are progressing.
Rebecca Hill:Yeah. So you want to ask of nurses and therapists, what are the goals while she's here? What are the benchmarks that say that she is now able to, look toward discharging? Some of those might be as simple as being able to stand and walk to the bathroom on her own. Is she able to, eliminate both bowel and urine?
Rebecca Hill:Is she able to walk a 100 steps with the aid of a durable medical equipment piece, a walker? Some of those very simple things, you need to know exactly what's expected of her so that when she discharges, she's actually met that goal. If you have any, you know, question or concern that maybe she isn't quite ready to do the next thing that's required, I. E. Go home, you can say out loud, I think that that's an unsafe next step.
Daniel Alexander:Okay.
Rebecca Hill:And again, the message here is that you know your loved one better than anyone else. So you are an advocate, you know what their baseline is, you know how their home is structured. And if it's safe, given the mobility range of motion and cognition, alertness orientation, that they're currently experiencing.
Daniel Alexander:Okay. So that's a lot of questions. You just gave us a lot of, content there and things to think about, and we'll wrap it up for this episode. What is your advice for people that are in the middle of all of this as far as asking you follow-up questions, engaging with the Senior Hub?
Rebecca Hill:You are an advocate, and sometimes you need to find your advocates. And what that could look like is hiring someone like myself through the Senior Hub to actually help guide you through the if then scenarios related to a hospital stay. And more than that, we offer boots on the ground coordination in the hospital. I think that in itself is a game changer. Having advocates present at the hospital in the room asking the right questions can save readmission, you know, falls, being able to stay in place in their homes where they prefer to be long term.
Rebecca Hill:You know, a lot of critical thinking is happening in these hospital stays, and you need the tools to make the right decisions.
Daniel Alexander:Great. Well, we encourage anyone to call you and it can save time, money, and ultimately, it sounds like it could save lives. Mean, if you really know what questions to ask and how to be an advocate, that's super, super helpful. Okay, so to summarize, Margaret has now come through surgery. Her family is equipped with the right questions and has been asking along the way.
Daniel Alexander:She is being prepared for discharge, and we will pause there and pick up on episode three with where Margaret goes next. So, Rebecca, thank you for sharing your wisdom with us. As always, our hope is that you are all walking away a little more equipped, maybe a little more hopeful than we started. Wherever you are on this journey, call us at any point. We're here to help.
Daniel Alexander:So thank you for joining us, Rebecca, and all of you that are listening, and we'll see you next time on the Senior Hub Podcast.