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I have been asked by a few clients whose parents have unexpectedly gone to the hospital about how the transition from Hospital to Rehab Facility to Nursing Home works.
How does a Power of Attorney or close family member navigate through this process for their parent? There is no one within the Healthcare System that will tell you how this whole process works.
In this RLO Blog Series, we have a fact pattern where “Jane Smith” unexpectedly goes to the hospital because she fell and broke her hip. She first goes to the Emergency Room and then from there is admitted to the Hospital. She is eventually discharged from the Hospital to a Rehab Facility and then from the Rehab facility goes to a Nursing Home for long-term care.
This is a long story that will be broken up into three or four blog articles.
The goal of this Blog Article Series is to give the people with Power of Attorney or close family members of elderly parents a general overview of what to expect if their parent unexpectedly has to go to the hospital and they find themselves immersed in today’s “health care system”.
What do Jane Smith and her son Tom Smith (her Power of Attorney for Healthcare) go through at each stage of this process?
Blog 1, titled – The Emergency Room -- gives general background information about our fact pattern and describes what Jane and Tom go through in a typical Emergency Room visit.
Jane Smith Goes to the Hospital
The Emergency Room
Jane Smith is 81 years old. Her husband John Smith died 5 years ago. Jane still lives at home on her own, but her children and friends check on her regularly. Jane is having meals delivered on weekdays and does not drive anymore.
Jane’s mobility is limited but she has still managed to stay at home on her own up to this point. Jane has diabetes and takes insulin daily. Jane also takes various other medications.
Jane falls and breaks her hip at home. She has Life Alert so the ambulance is called and she is taken to the hospital’s Emergency Room. Jane Smith’s son – Tom Smith – is her Power of Attorney for Healthcare and Power of Attorney for Property.
The Call:
Tom is called by someone from the ER that his mother has fallen and has been taken to the emergency room. He leaves work to see his mom in the emergency room. Tom needs to take a copy of his Healthcare Power of Attorney with him to the Hospital so they will let Tom see his Mom in the Emergency Room. For safety reasons the Emergency Room has a “one visitor” policy – meaning only one person can be with Jane while she is in the emergency room.
The ER Stay:
Tom thought he needed to rush to see his Mom right away in the emergency room. On one hand yes – to be there for his Mom – but on the other hand – Jane will be in the Emergency Room for at least 8 hours if not overnight. Once admitted to the ER, blood tests are taken, and an X-ray is ordered. A nurse asks for a list of all medications that Jane is on. Jane can’t remember all of the names of the medication and she is overwhelmed by the whole ordeal. Tom does not know her medication list. Jane is able to remember her primary care doctor’s name and so the ER works on getting her medication list. It takes an hour and a half for Jane to receive an X-Ray.
The Hospitalist:
It takes 3 hours for the ER Doctor to actually see Jane. The ER Doctor is called a “hospitalist” which means he is a doctor who works only in the hospital. They work 12-hour shifts for a couple of days and then you may never see them again. A lot of hospitalists are contract doctors that are not employees of the hospital.
During their 12-hour shift, they will go from room to room seeing patients and checking on them.
Hospitalists are often too busy to actually read Jane’s hospital file – so he asks Jane and Tom to give them Jane’s medical history.
Also, because they don’t know Jane’s medications – they can’t give Jane any real pain medication for her broken hip.
They are giving her Tylenol for the broken hip until they can get things figured out. Tom and Jane see the hospitalist for about 3 minutes.
The hospitalist leaves and they thought he would be right back - they would never see him again.
It is usually 45 minutes before Tom and Jane see anyone.
Tom goes outside of Janes's room in the ER to try to flag someone down for a status update – but he doesn’t want to seem pushy.
The End:
10 hours later the x-rays are done, the medication list is found and Jane is sleeping in the ER bed with Tom by her side. It is 1:00 am. Jane will be staying in the ER room as the Hospital is full and there are no regular hospital rooms to admit her to. The nursing staff tells Tom that Jane will be transferred to a regular hospital room around noon that day. Tom has to decide if he is going to sleep in a chair in the Emergency Room or go home to sleep and see his Mom in the morning.
Tips and Advice:
As Jane’s Power of Attorney for Property and Healthcare Tom should make sure that he has copies of his mother’s power of attorney documents available to him at a moment’s notice in case there is an emergency. Tom should have hard copies of his Mom’s POA documents at home and in the glove compartment of his car. He should have pdf copies available to e-mail or text to hospital administrators if necessary.
Tom should ideally have a copy of Jane’s medication list and a list of Jane’s primary care physician and any specialists that she sees.
Anyone going into the ER should have a relative, friend, and POA with them at all times to advocate for their behalf.
Communication in hospitals is absolutely horrible.
The Hospitalist doctors do not read the file and will only see a patient for a shift or two.
They get up to speed on the patient’s medical history and needs and then they leave and you never see them again – only to have a new hospitalist starting from scratch (and not reading the patient’s file). There is no continuity of care. The Advocate has to make sure new doctors, nurses, and techs receive any critical patient information.
The ER process takes a long time. Hospitals are understaffed. Communication between doctors, nurses, and techs is poor. Patients are not kept informed. Hospitals are full – meaning administrators are scrambling to find rooms and beds for new patients.
Ideally, someone named as a Power of Attorney for Healthcare should have the ability and time to be an advocate for their family member who is a patient in the ER; Hospital; Rehab Center, or Nursing Home.
Next Blog Article in This Series: Jane is admitted to the Hospital and has to stay there for three weeks. What are the challenges that Tom and Jane face once admitted to the Hospital from the Emergency Room?
This article is a service of Attorney Chad A. Ritchie and the Ritchie Law Office, Ltd.
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