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.
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