As our previous blog post points out, the hospital discharge process is a key transition time. Without proper support and resources as well as good understanding of follow up instructions, many individuals will return to the hospital for reasons that could have been avoided. No one wants this, and it can be especially dangerous for elders and persons with chronic conditions.

If you are a family caregiver and an elderly loved one is hospitalized what can you do to ensure a safe transition after the hospital stay?

• Consider the discharge process as beginning at the start of the hospital stay. Find out who is responsible for discharge planning and introduce yourself, explaining that you will be involved and giving relevant information about the patient’s living situation, supports and concerns. Discharge may not seem like a top concern at the beginning of a hospital stay, but with shorter hospital stay lengths, good groundwork starts as soon as possible.

• Keep good records. An online personal medical record system is an ideal way to manage your loved one’s health history, medications, and store key contacts so this information can be readily available. You can also use a notebook or file to store the information, as long as you have it available and provide good information to new providers. Make sure you communicate information that is vital to your loved one’s health, such as medications that really should not be changed or typical complications or concerns that arise during hospitalization or procedures.

• Get to know the medical staff and check in about what is going on throughout the stay. Ask questions (and keep records as per above) about procedures, tests, expected outcomes, medications.

• Understand that you or a designated patient advocate will need to take charge in being the centralized hub of information. This includes ensuring you understand instructions, what will happen after discharge, and the functional status of the person (and therefore what support might be needed). Ask questions and anticipate concerns that might arise and do not hesitate to voice them.

• Consider using a professional patient advocate for consulting or assessment during this process. Aging Wisely’s Care Managers know the discharge process, use a systematic approach and can help families anticipate needs and find resources to help. If you are caregiving from a distance, this support is vital as it is very difficult to manage the discharge process from afar.

• Plan for the immediate transition time. The first day or two after discharge can be particularly problematic. Think about practical issues such as getting new medications, food and personal items while needing to attend to a person in a weakened state. Will you be able to help the patient from bed to bathroom? Services such as Medicare home health care and medical equipment rarely arrive immediately and are not meant to fulfill “custodial” needs, so you may need additional home caregiver support.

• Find out about the options for services and rehabilitation after the hospital stay. There are essentially three rehabilitation options: inpatient (i.e. at a skilled nursing facility/rehabilitation center), home health care (for someone who is considered homebound) and outpatient rehabilitation (going to a clinic or center to receive therapy). We will cover these in more depth in a future post, including the insurance ins and outs & we invite you to contact us if you have immediate questions.

• Ask for thorough discharge instructions in laymen’s terms and explain that you would like to be there when they are reviewed with the patient. Make a list of questions and help ensure you and your loved one are clear on instructions and who to contact if there is a problem later. Here is one example of a simple discharge form that you can provide if the hospital does not have one.

• Know your patient’s rights, including the option to appeal a discharge if additional planning needs to be done to ensure a safe discharge.

Our next blog post will contain a checklist of items to consider and ask about when preparing for your elderly family member’s discharge, as well as more on resources to help during the transition of care.

Contact us if you have immediate questions. Our Florida geriatric care managers serve as your professional patient advocate, providing caregiver support and consultation, as well as geriatric assessments and resources.

Helping Florida Serve the Geriatric Care Needs of its Senior Citizens

Florida has many great resources for senior care and aging assistance. Over the last century elderly people have been migrating to Florida for its warm weather and healthy senior environment. Many times they are geographically separated from loved ones but wish to stay in Florida, but need some eldercare support to do so. Here at Aging Wisely we hope to continue in this long tradition of serving our nation’s elderly parents, relatives and loved ones.

Below you’ll find a list of links and senior care resources we believe important to not only helping Florida seniors care for themselves but also nationwide and international citizens looking to make Florida their home and families at a distance concerned about elderly loved ones living in Florida.

Below you can find resources dealing with Alzheimer’s, Florida Caregivers, Geriatric Care Management, Florida Prescription Drug Information, along with Housing and Legal Issues. If you’re trying to make the best healthcare choices, we offer specialized Medicaid and Medicare advocacy and analysis.

The following links are great resources as you navigate your senior care journey, but we know it can be confusing to figure this all out alone! We encourage you to contact us at 727-447-5845 for a personal needs analysis or reach out online for further information on Florida eldercare, healthcare or geriatric care management.

ALZHEIMER’S

http://www.alz.org – Alzheimer’s Association

Alzheimer’s Specialty Home Care in Florida

CAREGIVERS

http://www.caregiving.com – Solutions to caregiving situations, managing stress and making decisions

http://www.caregiver.org – Family Caregiver Alliance, a non-profit organization for family caregivers and the professionals with whom they work (provides research, education, awareness, advocacy)

http://www.easylivingfl.com/blog/-EasyLiving Florida home caregivers’ blog offers a wide array of information for family and professional senior caregivers.

http://www.parentgiving.com – Information & Resources for Caregivers

http://www.ec-online.net – Online community for elder caregivers

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CARE MANAGEMENT

http://www.caremanager.org – National Association of Professional Geriatric Care Managers, information on the field of care management and links to geriatric care managers throughout the U.S. and in other areas of Florida.

Signs You Might Need a Geriatric Care Manager

Benefits of a Geriatric Care Management Assessment

DRUG INFORMATION

http://www.needymeds.com -This website offers comprehensive information on patient assistance programs and prescription drug information.

www.medicare.gov – Medicare’s official site

http://www.mypillbox.org – Allows you to make weekly medicine schedules, including pictures of medicines

http://www.ismp.org/ – Institute for Safe Medication Practices, a nonprofit organization educating professionals and consumers on safe medication practices

http://www.fda.gov/medwatch – FDA safety information and adverse event reporting program

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ELDER CARE/SENIOR ISSUES

http://www.easylivingfl.com – EasyLiving, Inc. provides home health care and senior home care services in Pinellas County, Florida.

http://www.eldercare.gov – The Eldercare Locator has a listing of government and local eldercare services (good place to find contact information, but will not offer recommendations).

http://www.benefitscheckup.org – Searchable listings of various benefits programs that help seniors pay for costs of food, utilities, prescription drugs, etc.

http://www.aoa.gov – Administration on Aging, created by the Older Americans Act

http://www.agingcare.com – AgingCare.com is an online community that connects people caring for elderly parents to other caregivers, personalized information and local resources.

https://www.agingwisely.com/category/blog/– Aging Wisely’s weekly blog posts cover the most current topics in aging, caregiver questions and insights from our eldercare experts. Leave us a comment or question you’d like answered!

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HEALTH ISSUES

http://www.nih.gov – National Institute of Health

http://www.caringinfo.org – Caring Connections from the National Hospice Foundation, information on end of life care and downloadable state-specific advance directives.

http://www.familydoctor.org – American Academy of Family Physicians’ patient information site, search for useful articles/topics related to seniors and family health

http://www.fdhc.state.fl.us – Florida Health & Human Services: Agency for Health Care Administration (state surveys of nursing homes, home health and other eldercare and healthcare organizations, healthcare regulation information and state updates)

http://www.apdaparkinson.org – American Parkinson’s Disease Association. The Information and Referral Center-West Coast of Florida can be contacted at 727-328-6246.

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HOUSING

http://www.leadingage.org – Previously called the American Association of Homes & Services for the Aging

Guide to Choosing the Best Assisted Living– Tips for choosing a care facility for seniors from our eldercare experts who know the inside scoop on care facilities

Florida Health Finder-Facility Locator – A listing of all regulated Florida health entities such as nursing homes, assisted living facilities and home health agencies, managed by Florida’s Agency for Healthcare Administration.

Senior Citizen Housing Information– U.S. Department of Housing and Urban Development’s information for seniors on housing assistance and various programs

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LEGAL ISSUES

http://www.naela.org – National Academy of Elder Law Attorneys – assists lawyers, bar organizations and others who work with older clients and their families – resource of information, education, networking and assistance

http://www.nsclc.org – National Senior Citizens Law Center – advocates nationwide to promote independence and well being of low-income elderly individuals and persons wit disabilities, with particular emphasis on women and racial and ethic minorities

Ask us for a referral to a local Florida elder law or estate planning attorney!

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MEDICARE AND MEDICAID

http://www.medicare.gov – The official U.S. government site for Medicare information. Includes search tools for helpful contacts, Medicare personal plan finders, nursing home information and frequently asked questions.

http://www.medicareadvocacy.org/ – Center for Medicare Advocacy

http://www.cms.hhs.gov – Centers for Medicare and Medicaid Services – information for consumers and professional regarding Medicare and Medicaid

Florida Health Finder’s Medicaid information – Florida Agency for Healthcare Administration’s portal for Florida Medicaid information and key contacts.

Medicaid Fact Sheet– The latest Medicare numbers and an overview of the various parts of Medicare, presented in a clear, concise manner.

Medicare Under 65 – Overview of information and resources for people under age 65 who may qualify for Medicare coverage, such as those with disabilities.

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ADDITIONAL INFORMATION & RESOURCES

http://www.aarp.com

http://www.va.gov – Department of Veteran’s Affairs

http://www.ssa.gov – Social Security Administration and Social Security Online

http://www.elderabusecenter.org – National Center on Elder Abuse

http://www.myflorida.com – The state of Florida’s official web portal, with a wide variety of information and links on government services. Contains specific sections on elders ans retirement in Florida with links to various senior services and information for older adults in Florida.

For more information about how you and your family can prepare for eldercare, contact us at 727-447-5845 and get your copy of our Essential Eldercare Checklist.