Submitted by: Taylor Miller and Malinda Rutledge Carlisle; Senior Matters/One Matters 

As we know, family members can become caregivers when a loved one has unexpected health care changes. The following information is a combination of experience and a checklist of focus that will benefit some of the day –to- day challenges that might be faced.

Preparing for a Medical Appointment

• Make a written list of your concerns and put them in priority order. Be honest and straightforward.
• Gather all the medications that your loved one takes and either put them in a bag to bring to the appointment, or prepare a list, including dosages. (Vitamins and herbals as well)
• Bring Insurance plan information, and names of other healthcare practitioners your loved one has recently seen.
• Bring a notebook and pen so you can keep notes on the information provided by the doctor for your personal review or to share with family member.
• Ask what permissions the patient needs documented in their medical record to allow a healthcare professional to share information with you. (i.e. Advanced Directive, Living Will)

Questions to ask at the Medical Appointment

• What is the diagnosis? Is this a permanent or reversible condition? Is it progressive? What causes this disorder?
• What treatments are available? What are the benefits or risks? Why is this the preferred approach, and what is the likelihood of benefit (success)?
• What are the side effects of the medicines being prescribed? Does the patient’s insurance cover the medication? If not, is there an equally good drug on the panel to use instead? Does it conflict with other medications my loved one is taking?
• Do we need to see a specialist? What are our options for a second opinion?

In the Hospital or Emergency Room

• If your loved one is admitted to the hospital, you probably will be seeing the “hospitalist” (physician on duty for hospital) for the admission. They will not be familiar with your loved one’s medical history, other than what is in their chart at the hospital. It will fall on you to fill in their medical history, allergic reactions, chronic conditions, symptoms and medications.
• Ask for an estimate of how long your loved one will be in the hospital, and begin discussing discharge planning as soon as possible during the stay. Is this an admission or observation stay?
• Designate only one person to be the liaison in communicating with the doctor and rest of the family.
• If primary physician accepts e-mail, you may want to contact him or her to inform them.
• If you are caring for someone with a memory disorder, be sure that the hospital staff knows that, and they do not rely on your loved one to communicate important medical details or medication history.
• Make sure you understand all instructions when it’s time to leave the hospital. Ask to receive all instructions and medical records.
• As your loved one’s advocate, you have a right to appeal a decision if you think it is too early. Your first step is to talk with the physician or discharge planner and express reservations. The next step is to contact Medicare, Medicaid or your insurance company. You may also contact the hospital’s guest services department. Lastly, you can hire or consult with an independent case manager.

Transitions to home or Facility: Communications at Discharge Time

• You should have written, legible discharge documents and the discharge planner and nurse should review them with you.
• If your loved one is coming home, who will be there to help? If you have physical limitations, a job, childcare obligations or other factors that will impact your ability to give care, communicate this to the discharge staff. Home health nurses, PT, and in home aides may be needed.
• Is there equipment you need to be trained to use? Are there techniques such as blood pressure testing, feeding tube, catheter or wound care, a ventilator, injections or transferring someone from bed to chair that you need to be taught? Request a thorough training, so you can provide the best of care at home.
• Are you clear on any new medications your loved one may need and how to administer them? (Medication errors are a primary reason for hospital readmissions)
• Are there any special dietary needs to be accommodated?
• Do you have phone numbers for contacting healthcare staff if you have questions after discharge?
• Has a follow-up appointment been made with your loved one’s primary physician?Transitions to a Facility: Communications at Discharge Time
• How will the facility be selected? Does it provide high quality care? Ask for a list of most current Medicare ratings.
• How and when will information about the patient be communicated to the facility?
• What communication will there be between the hospital, the facility and primary doctor?
• Is there an estimate as to how long your loved one might be in the facility? ( Medicare generally covers 20 days of care after discharge directly from the hospital.)

This is a lot of information but this will allow you to know that you have made the right decisions regarding the care of your loved one.