The Weakest Part Of America's Healthcare System

So, you've navigated your frail parent's hospital stay and now it's time to go home. You probably can't wait to leave but ... what's coming next is extremely uncertain. Leaving a hospital with a frail older adult in tow is like stepping off a cliff blindfolded.

The hospital discharge process is arguably the weakest part of our entire healthcare system. I know this sounds backwards, but the less time your parent is in the hospital, the more Medicare money the hospital gets to keep. Your mom's safe transition home is not the hospital discharge planner's priority. It's her job to get you out as quickly as possible.

Here are five concrete things you can do that will fill this gap so that leaving the hospital will not feel like such a free fall.

Get a Good Plan BEFORE You Leave

The very first thing is to have the hospital to make you a "discharge care plan" that clearly lays out what you need to do, how to do it and when.

For example, say your mom fractured her hip and will now need physical therapy. How much physical therapy will she need, for how long and from whom? All of these questions need to be answered by professionals before she leaves the hospital.

Of course this seems like good common sense but hospitals vary in how much attention they pay to this. So, you may need to force them to give you a good plan -- and more importantly -- TO MAKE SURE YOU UNDERSTAND IT. Just because a nurse says, "this is easy" (as she quickly instructs you in administering an injection (!)) doesn't mean it is.

This checklist is a good guide. Print this out and sit down with the discharge planner, and/or the doctor on staff to help with these things. Be pesky. As my friend says: ask, ask, and ask again.

Be Pro-Active on Rehabilitative Care

Now, there's a decent chance that the hospital or your doc will tell you that your parent needs to go to another facility for "rehabilitative" care. There are two main types of places where that usually occurs: a special rehabilitation hospital or a skilled nursing facility (i.e., nursing home). Of those two, the vast majority of patients, getting rehab care in a facility, get it in a nursing home.

But DON'T worry. This does not mean that's where your parent will end up permanently. Most rehab patients go into the skilled facility for an average of about 25 days and then go home. Medicare covers full cost for the first 20 days and then there's a copayment.

These places are not.created.equal. Go to Medicare's Nursing Home Compare and look for the "four- or five-star" facilities. Generally speaking, one- and two-star facilities should be avoided.

And, if the discharge planner is forcing you to leave before the good facilities have availability, refer back to my advice for slowing the process down until there's a bed ready.

Prepare to Get Help at Home

You're certainly going to need some help when you get home. Managing a frail elderly parent at home directly after a hospitalization is really challenging. Please try and arrange for some help in the home at least for a short period of time.

Medicare will pay for some home health care in certain circumstances and you can find a Medicare home health agency on Medicare's Home Health Compare.

If your mom doesn't qualify for home health, you can pay a home care agency privately for "personal care aides." These are often lovely people who are trained to do some very challenging and personal things -- like getting a recuperating person out of a bed and into a chair. Unfortunately, the average pay for this is only about $10 -- $15 an hour.

Be the Medication CZAR

Keeping yourself and everyone else straight about your mom's medications will be a moving target. You'll need to track medications carefully. I recommend using this form and bringing it to every new stop in the health care assembly line.

Also, when you get home, ask the pharmacist to guide you through the medication transition, to make sure you know how to help your parents follow the directions and take everything as it's prescribed and to discard old prescriptions. Here's some great advice from the United Hospital Fund's Next Step in Care on how to approach all of this.

Make a Doctor's Appointment

Sounds simple but it's so, so important. The research shows that going for a follow-up doctor's appointment prevents landing back in the hospital. So, make the appointment!

It's also important that you're ready to engage in a meaningful way with that doctor. She's really relying on you to report on your mom's situation. One of the geriatric care managers I talked to a few weeks ago told me that she types up a one page list of all her observations and concerns, in addition to the medication list, and brings it all in with her.

That's good advice but you can also use this post-discharge appointment guide. Arrive at the doctor's office with this and the medication form and you will be in better shape than most people.

Lastly, Don't be Hard on Yourself

I really want to give you a little perspective here .... this whole hospital to post-hospital process sucks for you and your mom AND ALSO for every other frail elderly hospital patient in the entire freakin' country. Seriously. The federal government, as I write this, is spending tens of millions of dollars trying to straighten it out and make it better.

So do not feel bad that you can't make this smooth sailing. This is one of the roughest patches of water you'll encounter in your entire daughterhood journey.

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