You support your parent, others support you
As you learn about the hospitalization, focus on emotional support of your parent. You may be upset, but you are not the main character of this scene. You are auditioning for a part in future scenes, and you are showing them how you will react to bad news. If you do a good job, you may win their trust and be informed of other upsetting things earlier. Listen to what your parent wants and
This doesn't mean you have to keep it bottled up. Find others who are less affected by the situation, and turn to them for support. This can be your spouse, your friend, your neighbor, or your therapist. It should not be your siblings, your children, or your other parent. This may be the first of multiple, escalating stresses, so "put your own oxygen mask on first." Tell your employer what's happening if your work will be affected. Think carefully about whether your parent will do better with you in person versus supporting from afar.
Keep one clear picture of the stay
The first major hospital stay I was involved with was before cell phones, so I had a paper notebook and a shoebox to gather notes from the stay. Going back in recent years, I've found those same materials are still useful. A gift bag works better than a shoebox, so long as it's not mistaken for trash, and a notebook with removable pages is better than a composition book. Even if you're far away, you can choose a single place to capture every name and bit of information you hear. You might ask for pictures of documents and screens within the room. Keep a running list of questions, and try to be present during rounds to ask the questions directly. Prepare for a follow-up meeting with the primary care doctor after discharge as a time for both questions and for you to pass along concerns.
Electronic health records are a great way to see status from afar, but I've experienced a particular frustration with hospital stays: cut and paste. It may appear that a problem has continued across multiple days, or a medicine may still be given, despite the condition resolving itself. Keep in mind this risk and double check any information you are receiving only from the chart if it conflicts with what you believe for other reasons.
Status and timing matter for Medicare benefits
Your parents probably have Medicare, which covers hospital stays. Medicare Part A, in particular, cover inpatient stays only. All other stays are covered by Medicare Part B or Part C, and it gets very complicated.
An overnight hospital stay does not necessarily mean the person has been admitted as an inpatient. Someone receiving emergency or observation services can still be classified as an outpatient until a clinician writes an inpatient admission order and the hospital formally admits them. This could mean that their bill is much higher than if they were admitted as an inpatient from the start.
Being inpatient during the hospital stay, and staying for at least three days (past two midnights) as an inpatient also matters because it is necessary to qualify your parent for reimbursement from Original Medicare of a skilled nursing facility stay after their hospital discharge. (If they have Medicare Advantage, this 3-night rule doesn’t apply, but there may be other rules that do apply.) Ask the doctor, hospital social worker, case manager, or patient advocate to confirm the status each day. Medicare patients who receive observation services for more than 24 hours generally receive a Medicare Outpatient Observation Notice explaining the status and potential costs. The hospitals know all of this and will understand why you're asking.
On the topic of Medicare, readmissions close together are not subject to the same coinsurance as readmissions many months apart. Kind of like a warranty, your parent with Original Medicare may save money by readmitting at the first sign of problems rather than toughing it out at home for a few more days if it pushes their time at home beyond 60 days. Check out our Medicare page for more information on how to learn these kinds of details.
Discharge can happen quickly
Before discharge, your loved one should know:
- what symptoms or changes require a call or urgent help;
- when to discontinue new medications, restart old medications, or make any other changes, and how to get the new medications filled;
- follow-up appointments, tests, or lab work, including who will schedule them;
- activity, diet, wound care, equipment, or therapy instructions;
- the name and number to call with questions after discharge; and
- any home health, rehabilitation, skilled nursing, transportation, or caregiver arrangements.
Your parent is likely to be focused on their own body and getting it home. You will be helping them out by gathering this information, even if they don't yet know they want it. The most important thing you can gather is the contact information for whom to call when your parent has more questions later.
If the discharge does not feel safe
The medical providers are seeing your parent in a special situation and do not know what awaits them at home. Your parent may not have mentioned the stairs they have to climb, the lack of air conditioning, or their inability to get transportation to physical therapy sessions. Your parent likely wants to go home, even if it is not the best thing for them. If you don't think it is safe for them to go home, explain your specific concern to the doctor, nurse, case manager, or patient advocate. Ask what support or alternative setting is available.
Medicare hospital inpatients receive an “Important Message from Medicare” explaining discharge appeal rights. Appeal deadlines can be short but do give your parent extra insurance-paid time in the hospital, so follow the notice immediately if you or your parent believe discharge is happening too soon. A Medicare Advantage plan will have its own process and contact information to push back against premature medical discharge.
Free at last!
As you help your parents settle in after a hospitalization, it is likely they will go home and put their head in the sand. They may want to sleep, or snuggle with their cat, or do the dishes you let pile up. You can help by following through on their discharge actions. Fill prescriptions, confirm follow-up appointments, and compare the medicines at home with the discharge list before the next dose is due. If instructions conflict or the person's condition changes, contact the named clinician or care team promptly.
Also, figure out how to prevent another hospitalization. Is there a tripping hazard, a missed medication, or anything else that went wrong and could happen again? Is there a cognitive factor? Is there any new injury or disability that could exacerbate things further (see: hip fracture morbidity)? I like to think about the root cause of the problem and say it out loud, not as a question or accusation and not with a solution. E.g., "It seems like you lost your balance in the shower." This is planting a seed for a later discussion.
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Next step
Identify changes that can help prevent future hospitalizations.