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Hospitalizations: Before you go
One advantage of a planned hospitalization is the ability to prepare ahead of time: choose the best hospital, arrange for help afterward, select a health care proxy (decision maker) and have those important conversations you may have been putting off.
Choosing a hospital? Look to the stars
One to five stars. Medicare gathers hospital data regularly. It posts the information on its Hospital Compare webpage (medicare.gov). To make comparisons simple, Medicare created a star rating system. Hospital Compare combines information for as many as 64 quality measures. Five stars is truly top notch. In 2018, out of 4,805 hospitals, only 7% received a five star rating. Most received three stars (25%) or four (24%).
The star rating looks at statistics that reflect a variety of issues:
- Quality. Check out the section on “Unplanned Hospital Visits.” How many patients are readmitted within a month of being discharged is a sign of quality care. Readmission could indicate that patients are being sent home before they are fully healed; patients may not have received the most up-to-date treatments; or patients may have been released to a home situation unable to handle their needs.
- Timeliness. How quickly is a recommended treatment offered? For instance, how long was someone in the ER for a heart attack before they received an aspirin?
- Safety. The “Complications and Death” section measures things such as infection rates after a surgery or the rate of general infections, such as MRSA. A high or low infection rate can indicate how carefully a hospital works to reduce the spread of disease.
- Patient experience. This is based on comments from patients after their stay.
The Hospital Safety Grade
Consumers can view the safety grade (A–F) of more than 2,600 hospitals across the country. The Hospital Safety Grade (hospitalsafetygrade.org) is assembled by the Leap Frog Group, a national consortium of large employers. It looks at issues such as
- infection rates after surgery;
- enforcement of safety procedures for staff;
- use of technology to reduce errors.
Bottom line. If your loved one’s health coverage allows for a choice, research the options. Not all hospitals are alike!
Return to topPreparing for a hospital stay
If your loved one is slated for a hospital stay, don’t underestimate the impact. Expect that he or she will have reduced energy and greater needs. In addition, medications may cause side effects that result in dizziness and require another person’s presence, especially if pain is involved. You can prepare ahead for a smooth recovery:
Find out what to expect
- Talk with the doctor about the care plan at home. What should be expected in the first few days or weeks in terms of pain? Stamina? Medications? Side effects? Ability to get around? Should arrangements be made for someone to stay overnight?
- Can medical specialists come by the house to monitor progress? This service is called “home health care.” It provides for periodic visits from a nurse and other therapists as needed. It is paid for by Medicare.
Make practical arrangements
- Prepare an up-to-date medication list and a list of your loved one’s doctors.
- Pack a personal care bag with toothbrush, comb, etc. Bring a cell phone and charger.
- Plan to have a trusted friend or family member at the hospital as much as possible. Besides a reassuring presence, this person can inform staff and help if there are mood or memory problems.
- Decide who in the family is going to be the point person for the discharge planner —the hospital professional who will help you coordinate care needs to ease the transition home.
Rearrange the house
- Create a center of operations, ideally on the first floor. Ensure that phone, TV remote, computer, books, meds, and water are all within easy reach.
- Consider a bedside commode for the first week or so. It makes life MUCH easier, especially if a medication’s side effects include dizziness.
- Remove throw rugs. They are a serious trip hazard.
If you are the "health care proxy"
A planned hospital stay usually requires that your loved one turn in an advance directive. This is a document outlining a patient’s treatment preferences if they are unable to speak for themselves. It also includes selection of a decision maker: the health care proxy.
Being chosen to act as someone’s proxy is an honor and a responsibility. You may need to make sensitive decisions about life support measures.
Prepare for the role
- Talk with your relative about quality of life. What makes life worth living from his or her point of view? What, if anything, would be worse than death? Clarify spiritual or religious beliefs. Talk about hopes and fears for life’s last chapter.
- Discuss crisis issues. Learn your loved one’s priorities. Talk specifics. What life-support measures are desired, or not? CPR? A ventilator (breathing machine)? Tube feeding? If death was inevitable, would your loved one prefer to die at home or in the hospital?
- Keep the advance directive. Make sure you have copies of the signed advance directive on hand.
Be ready at the hospital
- Introduce yourself to the medical team. Explain that you are the health care proxy.
- Get involved. As the decision maker, learn the facts about the situation. Also observe your relative’s condition yourself. Ask yourself what he or she would want right now. Take notes. Assemble questions ahead of time so you are prepared when the doctor comes by.
- Focus on the patient’s wishes. You may want to get input from other family members. But in the end, you must do as your loved one would have wanted, even if others disagree. A social worker, chaplain, or care manager can help facilitate a family meeting and provide support.
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