4 Must-Know Tips for Your Parent's Hospital Stay

Many women are pleasers and accommodators. But, there's no more important time to avoid being accommodating than when your parent is hospitalized.

The truth is that, when you're dealing with a hospital, you have to be vigilant and firm -- right from the very beginning. As crazy as it sounds, you cannot assume that the hospital knows what it's doing or has your parent's best interests at heart.

Unfortunately, the quality of hospitals in this country is really mixed. And even the ones that are great aren't necessarily all that good at handling care for frail, old people.

Ideally, advice and help would come from a doctor who would guide you through your parent's hospitalization. But, since that rarely happens, it falls on the family to do some pretty complex things that are far outside their expertise and comfort zone.

It's best if you can avoid the hospital all together. But, if your parent does end up there, here are 4 things you can do to take control of the situation.

Know Your Parent's "Status"

Ask the hospital whether your parent is being admitted as an "inpatient" or observed as an "outpatient." These two things look the same to you 'cause in both cases your parent is in a bed in a hospital but they have very different implications for post-hospital care and costs.

Many frail older adults get shuttled off to the hospital Emergency Room for almost any reason. Something just seems "off" and the assisted living facility, nursing home, or physician on call default to the hospital.

If the hospital admits someone who doesn't really need to be there, it gets in big trouble with Medicare. So, more and more hospitals have been playing it safe and "observing" older adults as "outpatients" before admitting them as "inpatients."

The good news is that this doesn't usually affect the care.

The bad news is that, being observed as an "outpatient" -- which is often invisible to you and your parent --- has very serious consequences for the type of rehabilitation care that Medicare covers, and for your parent's total out of pocket costs.

That's because Medicare requires a three day inpatient stay for coverage of rehabilitation care in a skilled nursing facility. If your mom isn't officially admitted to the hospital and gets referred for this type of care, she could end up being responsible for the full nursing facility bill -- which can be in the range of $8,000 to $12,000.

Be Prepared to Combat Disorientation

The hospital setting seems to traumatize the brains of frail, older adults, leading to confusion that can decline into long-lasting dementia.

Experts who run the Hospital Elder Life Program emphasize that you can help your parents avoid hospital delirium by hanging around to orient them and explain what's going on. You can also help by bringing familiar items from home and by making sure they have their glasses and hearing aids.

They also tell us that it's important to keep an eye out for even slight changes in your parent's behavior, for when your parent isn't making sense or seems unusually distressed. Chances are excellent that you'll be the first person to notice and to alert the medical team.

And you want to always question any attempts to sedate your parents because it's rarely the solution and often causes more problems.

Anticipate Medication Screw-Ups

When your parent is on a lot of medications -- and many older adults are often on 10 or more -- imagine how easily and quickly things can get screwed up, even by the most well-meaning hospital staff.

To help avoid problems, bring medications with you to the hospital in a big bag and ask a doctor or nurse to review every medication in the patient chart and question how it relates to what mom or dad was taking at home.

Repeat the process of checking and "reconciling" the medications every time your parent moves from one part of the hospital to another (e.g., upon discharge from the ICU to the regular part of the hospital). Ask questions, call the doctor, just be a general pain in the butt about this. You are right to be concerned -- and don't let anyone tell you otherwise.

Push Back When You Think You're Being Pushed Out

Sometimes it may feel as if the hospital is pushing your parent out too soon.

Hospitals make more money the less time your parent is there so they're usually in a Big Hurry. It seems backwards but the shorter your stay, the more money hospitals make.

The problem is that, what's optimal for the hospital's bottom line might not be optimal for your mom's care or for smoothly transitioning home or to a rehabilitation facility. Often, a family member is asked to quickly choose among dozens of options for post-hospital care, with no time to check them out and very little guidance on which one is best.

The good news is that you can slow this process down a little by appealing to a third party called a quality improvement organization (Q.I.O.). You can get the Q.I.O. number from this website. Make sure you request a fast or "expedited" review, which ensures that the hospital care, including any out of pocket cost, is covered until the Q.I.O. makes a decision.

This will buy you time but be sure to call as soon as the hospital notifies you that you're being discharged -- you can't delay calling past noon of the day you get notified of the discharge by the hospital. If the Q.I.O. agrees with you, Medicare will continue to cover the hospital stay for as long as medically necessary. If not, your care is covered through noon of the day after you get the decision.

What to do when the hospital won't listen

You can request help from a hospital ombudsman who can act on your behalf. Don't hesitate to ask for help.

Also, be on the lookout for a patient satisfaction survey your parent will receive after the stay. Your response affects the "value" rating of the hospital and ultimately how it's paid.

No matter what happens, trust your instincts and stay calm.

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