Earlier I discussed how important medical advocacy is when a loved one or friend is hospitalized. As someone’s medical advocate, you want to ensure the hospital staff is serving her as well as possible. Especially at discharge. No one should ever be discharged from a hospital without an advocate, or at least a friend or caregiver, present to hear a discharge nurse’s instructions and review the paperwork that most discharged patients rarely have the capacity to absorb.

Following her hospital discharge your loved one (who has Medicare) may require skilled nursing care (SNC). She qualifies for SNC if: 

(1) she was ADMITTED to the hospital (not entered for observation); 

(2) her doctor certified she needs daily skilled care, such as physical and occupational therapy, because it’s necessary to improve or maintain her current condition; and

(3) she spent a minimum of three days in the hospital.  

After researching several skilled nursing facilities, you’ve found one that meets her needs. Think your work is done? No way.

You and she need to review with the skilled nursing staff your loved one’s prescription regimen and the doctor’s recommendations for therapy. 

Whatever you’re loved one’s condition was BEFORE she entered the hospital, you know she hopes to return to her prior condition with as few new challenges as possible. She may have to use a walker for several months. Or continue therapy after discharge from SNC. 

Among her priorities is making sure she can perform her ADLs (Activities of Daily Living)* to the same extent as before admission to the hospital.

Will the rehab’s physical and occupational therapist prepare her to perform basic ADLs to the best of her ability? Namely: 

• Dress and undress herself?
• Walk independently?
• Feed herself?
• Toilet herself?
• Wash and bathe herself?
• Take her medications correctly and on time?

Observe whether the therapists are in sync with the aides (and vice versa) who assist your loved one. As my wife and I learned recently with a loved one, while the therapists were training our loved one to walk with a walker, the aides were still wheeling him in a wheelchair. While they were preparing him to clothe himself, the aides continued to dress and undress him. And so on. We had to intervene (somewhat audibly) to break down the silos between the therapists and the aides.  

At some SNC facilities, communication among the staff may be seamless, but don’t count on it. Unless the aides are in sync with the therapists and vice versa, your loved one may not be fully ready to return to her prior condition by discharge day.

A friend recently arranged to have his will prepared.  He told me he planned to bequeath his one piece of real property in three equal measures to his brother and his two sons.  In other words, three persons would become co-owners of one property. 

I asked whether he planned to discuss with them the terms (not the value) of his bequest.  He replied that they refused to discuss the matter. He said their unwillingness to discuss the bequest almost guaranteed a dispute over the distribution of the property after his death.  He acknowledged that from past experience he was powerless to avert this outcome. Discussions about death or money were out of the question. 

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Trust

Parents need to know their adult children will, to the best of their ability, ensure they receive appropriate care in a hospital, assisted living, or skilled nursing residence. They hope their kids will look out for their safety without diminishing their autonomy and independence, but enough to keep them safe.

Transparency

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A friend recently had spine surgery that took 5+ hours. After regaining consciousness, she found herself in the recovery unit…for the next 26 hours! Groggy from the anesthetic and not knowing whom to talk to, she languished there until a friend arrived and raised hell. She subsequently learned that private rooms were available throughout the 26 hours, but somehow the Recovery Unit staff wasn’t aware of any. When they finally wheeled her to a private room, she waited another hour for the room to be cleaned.

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Like many of you, I have an Advanced Care Directive comprising a Living Will and Health Care Proxy (or Power of Attorney) to make decisions for me if I lose my capacity to do so. I live in a jurisdiction (the District of Columbia) that permits physician-assisted death. My family and I have discussed my health care values and preferences. If I ever have a mind crippling illness and had earlier told my family and physician my preference not to continue living in that situation, my family and doctor know what to do. Right? Wrong!

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My last blog listed types of listeners. From the ‘pouncer’ to the ‘monopolizer.’ Now, on a more positive note, this post suggests ways to enhance conversation. The first (and for me) most challenging step calls on us to become empathic listeners. I came across this term in an article by Dr. Tammy Lenski* who attributed it to author Steven Covey. For Covey “empathic listening is listening from the other person’s frame of reference. Only empathic listening comes from a desire and commitment to listen without an agenda (emphasis added).”

Developing the “mental muscle” to listen empathically takes practice. Give it a shot the next time you’re engaged in dialogue. In addition, consider these techniques to enrich your exchanges:

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One of the topics Carolyn and I discuss in our presentations about our new book Love’s Way involves Listening.  Most of us don’t listen well. And even when we think we are listening, we sometimes fall into one of the following categories:

The Pouncer: This non-listener is waiting for the other speaker to pause just long enough to inject his point into the conversation.   The speaker may be in the middle of conveying a thought, but hesitated to take a breath or sip some water. That’s the moment the pouncer has been waiting for: to take charge of the conversation.

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Talking with your doctor (provider) is not just about what ails you. It’s more.  Lot’s more. Let us count the ways:

First, a patient should know his or her health goals, or seek help in defining them, especially as she or he advances in years.  For example, if you became severely ill, even mortally ill, how much ‘heroic effort’ would you want your doctor to provide?  You should understand your medical options in case a health crisis occurs.  Bottom line: What quality of life would you want were you severely ill with questionable chances of recovery?  

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