This care manager spent last Sunday at a Raleigh, NC hospital Emergency Department. I went with a client who had an early morning health crisis (and has dementia). During our visit I was reminded of the many benefits of having a knowledgeable “plus one” by the patient’s side. If you are sick enough to be sent to the emergency department, you need a buddy to answer questions, listen, take notes, and to advocate for you. A good choice to be your buddy is an adult child, other relative or a professional care manager.
Even better than having one person by your side is to have a second person ready to relieve your “buddy” and to help you after you are discharged or admitted to the hospital from the emergency department.
1. Food: my client, like so many aging adults, has a special diet. However, because of dementia, he cannot tell you what he can and cannot eat. He was given a box lunch that included pretzels, whole raw baby carrots and a turkey sandwich. He has problems chewing and swallowing and is on a soft food, thickened liquid diet. Because I was with him, I removed the choking hazards (pretzels and carrots) before he saw or ate them. He needed help opening his drink, holding his drink and someone to cut up his sandwich into small bites.
2. Pain: my client cannot self-report his level of pain. However, someone that knows him well can read his body language and facial expressions to help his nurses and doctor understand how he feels.
3. Comfort: My client was cold, then hot, kept sliding to the end of the bed, losing his pillow, etc. He needed a hand to squeeze while nurses started an IV line. My client is incontinent. He cannot communicate when he needs to be cleaned and changed. The ED nurses were fantastic and responded quickly but I had to remind them every 2-3 hours to provide this care.
4. Information: my client had a medical history he was unable to communicate to emergency department staff. Without someone to answer the nurses and doctors’ questions, he very likely would have had additional lab work and medical tests and procedures. Speaking with surgical residents and a surgeon, I took notes to share with family, his regular physician and his memory care caregivers.
5. Post-discharge: receive doctor’s orders, arrange transportation, fill prescriptions, schedule follow-up appointments. My client required skilled transport services to return to his facility. Heads up, everyone! Medicare pays for the least restrictive mode of transportation. What does that mean? If the patient can be transferred by wheelchair then Medicare will not cover costs of transfer by stretcher. Wheelchair transport was not available Sunday evening. It took 4 telephone calls and 2 hours to find safe transportation for my client.
Email, smart phone apps and old school handwritten lists help patients and caregivers stay prepared. Everyone should have a “grab and go” folder that is updated regularly.
- Up to date medical information about surgeries, allergies, recent hospitalization
- Medications list including dosage and dispensing instructions
- Health insurance information including copies of cards (it is January, folks. That means insurance coverage and network status may have changed!)
- Power of Attorney, if applicable
- Telephone contact list
- Mobile phone charger (your battery will die!)