Having a loved one rushed to the emergency room or even go in to the hospital for an expected surgery is anxiety-producing any time, but it is made much worse if your loved one has dementia.  As a dementia/Alzheimer’s caregiver, you know how important routine is and how the unexpected that might occur at the hospital (along with the medical situation, medications, etc.) will be challenging for your loved one.  Consider these areas when your loved one is/will be hospitalized:

Weigh the pros and cons of planned surgeries or interventions carefully.  Emergencies cannot be helped, but when it comes to planned interventions, caregivers should consider the person’s overall wishes and desires for healthcare, expected outcomes (will this surgery improve my loved one’s quality of life significantly?, will the side effects and effect of hospitalization possibly be worse than the benefits?), and the possible detriments to the patient.  There have been a number of studies indicating that dementia patients tend to worsen after a hospitalization.

• Talk with care providers (the doctor handling the hospitalization, the nursing staff) about your loved one’s usual functioning and routine, as well as concerns (for example, things that you know may cause your loved one to become agitated).  Provide written information as well that can be passed along to different providers (this article for medical providers has a handy informational sheet).

• Consider staying with your loved one and/or hiring sitters/home care support.  Often, it is best to have someone familiar there at all times so consider setting up a rotation schedule (you and other family, friends or hired caregivers).  As an example, the person who is one-on-one can notice immediately if your loved one is uncomfortable or crying out for something and resolve the issue before it leads to further agitation and concerns.  Doctors and other staff may come in to ask questions without understanding your loved one’s confusion.  Having someone there can prevent a lot of misunderstandings.

• Stay involved and ask questions (or consider hiring a patient advocate/geriatric care manager to assist you in this) especially regarding medication changes, procedures and tests.

Patients with cognitive impairment are amongst those most likely to be readmitted to the hospital within a short time, so discharge planning is another important consideration for caregivers.  It is important that a family member or patient advocate be involved in this process, as it may be difficult for the patient to grasp the discharge instructions or give an accurate picture of his/her needs and abilities after discharge.  Here are some additional tips for caregiver about discharge:

• Advocate for your loved one to ensure they will get sufficient after-care.  Understand he/she will likely be weakened and perhaps more confused than before, so additional care may be needed.  If you are the primary caregiver, are you going to need some additional help immediately following the hospitalization?

• What type of home health or inpatient care is available and might be needed?  A person who has had a three day qualifying hospital stay typically qualifies for some inpatient nursing care.  Explore and discuss the pros and cons of this versus returning home with support.  Get an idea of how much additional family or private duty care may be needed to ensure safety.

• Plan for the details of the immediate discharge period.  For example, think about the return drive home and getting in and out of the house—do you need physical help or equipment?  Will your loved one need you with him round-the-clock and if so, how will you handle needs such as running out for medications or groceries?  Enlist additional help and don’t underestimate these needs.  Remember, Medicare home health will typically not be there immediately and is not intended to provide custodial care (similarly, if the doctor is ordering equipment that you need, find out when it will be delivered).

• Sometimes a hospitalization may indicate or instigate the need for a further transition.  Will your loved one be able to return home, or may an alternative living situation (or increased care at home) be needed moving forward (or at least until reassessment if you see improvement)?  Consider a geriatric care assessment at this point.

• Get discharge instructions in writing and make sure you understand any follow up that needs to occur as well as details about any after-care.

To find out more information about Hospital Readmissions, read Shannon Martin’s article, The Revolving Door: Avoiding Hospital Readmission of Elders, here.

Shannon Martin, M.S.W., CMC, is Director of Communications at Aging Wisely, LLC (http://www.agingwisely.com), a professional care management and patient advocacy organization and EasyLiving, Inc. (www.easylivingfl.com), a licensed home care agency, in Clearwater, FL.  Shannon served as adjunct professor at Eckerd College in St. Petersburg, FL, where she created a course on “Eldercare”.  Prior in her career, Shannon served as social services director and admissions coordinator in an assisted living/skilled nursing facility and worked as a social worker and volunteer coordinator for a large hospice. 

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