How to Care for Aging Parents in the Hospital [Video]

by Financial Design Studio, Inc. / November 11, 2024

Out of the blue, your parent has fallen and the hospital tells you they can’t go back home. What next? In this video, an ICU nurse shares how to care for aging parents while in the hospital and transitioning to the next care facility. Read the transcript below!

What professionals can help you?

Michelle Smalenberger, CFP®
One of the situations that we’re going to talk about over the course of this episode here is, it might sound something like this. Mom or dad has fallen and they can’t come home. So we can’t afford maybe a long -term care facility that has private care. But we also can’t care for them at home ourselves either. So we’re limited, whether physically or geographically, whatever those look like. And so this is kind of the situation where we’re in the hospital but we need to get somewhere where we can continue to be cared for.

Leah McNamara
It’s a lot harder when you don’t know your options. Even speaking to somebody who can offer you options and resources, that is what a social worker and a case manager will do. They work in tandem and they will look over your insurance plan if you have one. So they will look over what your insurance will accept. They will help determine the best place for this patient to end up, based off of their medical condition upon discharge. They might need a physical therapist evaluation. You know, they might need the physician of rehab to come and do their own assessment. That will ultimately place them into the recommended, the next recommended step.

Michelle Smalenberger, CFP®
Okay.

Leah McNamara
And, you know, contributing factors to the impaired ability to participate in independent activities of daily living are usually what ends up getting people to this point where they need more help. You know, it’s more than just a broken bone or a hip that needs healing. If it were just that, they could go home. But we’re talking about more than that. And so that’s when your resources are gonna be everything. Understand that you do have a choice in the matter and you don’t have to make it blindly.

What happens in the emergency room?

Michelle Smalenberger, CFP®
I think that’s helpful. Even those two situations, you fall and there’s a bone that’s broken and it needs to heal versus some of these independent living activities like the activities of daily living. I guess in this situation, you know, someone’s fallen, we know they can’t come home. What kind of happens immediately? So someone’s fallen. They’re kind of taken to the emergency room, walk us through kind of the immediate steps that you see.

Leah McNamara
Yeah, so likely either a family member or what we call EMS or Emergency Medical Services, 911, will take them to the emergency room. They’ll go through triage, likely an admission into the hospital. That’s when your stay looks like more than just an examination. Maybe you think you’ll have an x -ray taken from a broken bone, a splint, and they send you home. But you’re now actually getting admitted and they’ll do the classic lab draws and run their tests. That’s when they tell you that you’ll stay X number of days. We try to get that physical therapy on as soon as possible so that they can keep up their highest level of activity.

It’s quite surprising how quickly people can deteriorate if they are sitting in bed and not moving. Some might think that’s a good way for them to rest and heal up. But it’s very healthy for our body to continue to move at our highest level of functionality. So discharge planning as well, it ought to be started beginning day one at the hospital. It ensures proper setup of the patient needs.

How to prepare your expectations

Michelle Smalenberger, CFP®
So it is like you pointed out, kind of thinking about that starting on day one and trying to start to think of some of those answers is really helpful. What do you feel like people need to be prepared to decide or be thinking about after that?

Leah McNamara
You know what, I think that one of the biggest things I try to convey to patients and families is that this patient may never return to their baseline. They might have a new normal. It might look totally different. I hear a lot of families talking about their grandma or their mom. She was just out swing dancing last week and she was totally fine. It’s just a fall! But that fall really changed a lot for this grandma and she’s not going to get back to swing dancing. That’s really difficult to adjust those expectations but I think that’s something that people need to be prepared for is the adjustment of expectations.

You know and what are the limits of medical care during hospital stay. People need to be prepared to decide what the limits are for themselves if they’re the patient or if they are the, and you know we’ll talk more about this, but if they’re the healthcare power of attorney and they have the say or if they’re the surrogate, you know, what is the patient’s quality of life? Because only the patient can decide this unless they’re physically or mentally unable to voice it and there are no documents written up prior. So be prepared to decide what is the patient’s quality of life? What are the limits?

In the event of an emergency, respiratory failure or cardiac arrest, does the patient wish to be intubated or also known as placed on life support with the breathing tube? In the event of cardiac arrest, does the patient desire resuscitation with chest compressions and medications? If it’s cardiac arrest, they’ll also be likely intubated and put on life support. And so are we allowed to do those things? Is this what the patient would want? Or are they at an age or a place in life where they say, if something really goes wrong, I’ve lived my life and I’m comfortable with that being the end.

What documents to have in place?

Michelle Smalenberger, CFP®
I know we tell clients all the time have documents in place know and decide who it is that you want to make these decisions for you. So mom or dad is in the hospital. They have this health care power of attorney in place. So they have a document that’s been drafted as a medical professional. What is it that you’re looking for? Even as you start kind of working with this patient?

Leah McNamara
Well, operating procedure is that when somebody comes in, especially if we know right off the bat that they’re just elderly and they are looking very frail, does this person have any kind of advanced directive? Do they have any paperwork that tells us that we are not to resuscitate this patient–because that’s illegal! If we put our hands on them when they have paperwork that says do not resuscitate me, that’s some legal trouble and they might be pretty upset if they wake up.

Michelle Smalenberger, CFP®
Yeah.

Leah McNamara
So we need to know who’s the next of kin or who is legally in charge of this patient, who is the healthcare power of attorney. The healthcare power of attorney might not be the next of kin. Sometimes there’s a language barrier. Sometimes the next of kin maybe is not in their right mind enough to be able to make the decisions. It might be a daughter instead of a husband. And we can talk about the roles of those powers of attorney.

But especially it’s important for the doctors to know who is the next of kin or who is the one making decisions for this patient if the patient is unable. I wanna say as a rule, the patient is making the decisions for themselves and it does not matter what the doctors think is the best thing to do. It does not matter what the sister thinks is the best thing to do. What matters is what the patient wants as long as that patient is deemed fit to make decisions. If the patient is deemed unfit or disoriented, that’s when you start to get into finding who might be able to step in and make decisions for them.

Planning continued care

Michelle Smalenberger, CFP®
That’s really helpful. think that’s just like a good reminder to people that if you do have these things in place, they do actually get used. I guess, as we progress through this situation, what do you feel like people need before they leave? What are the things before you leave the hospital, this is what you need to have in place?

Leah McNamara
The patients and the families should speak with case managers and social workers. It’s in the right of the patient and or the healthcare power of attorney to ask for a consult to a social worker.

Palliative care is such a hidden gem and I wish they weren’t so hidden but this is a consult that I would highly encourage people to speak to before leaving the hospital to clarify quality of life because palliative care is going to specialize symptom management. So no matter what you have, you let palliative care know what your best quality of life looks like. And if you never want to be placed on a breathing machine, you can write that down and you can make sure that that never happens to you. If you want the best pain medication there is, even if it knocks you out, then they can put that on paper for you. So ask about that.

Know what resources are available for continuity of care. Here we’re talking about either medical care. This could mean rehab or it’s physical therapy outside of the hospital, or custodial care. That’s different. Does grandma just need a friend to sit with her while she’s home and help her get dressed and make her some food? That’s more of custodial care. It’s really helpful for people to get an up -to -date medication list. It’ll be necessary at their next hospital visit. And education.

Regarding new or ongoing medical diagnoses, that should be mandatory. Not every care provider that you come across will take the time to educate and to answer questions. It is your right to have your questions answered. So get the education for that diagnosis.

Related Resources

Listen to our full conversation in episode 53, “Healthcare for Aging Parents with Leah McNamara.” Find it by streaming the Behind the Designs podcast.

If you have more questions, then reach out! We specialize in complexities like executive compensation, tax planning, and investment management. Our team would love to see how we can help bring confidence to you and your family’s finances.

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Financial Design Studio, Inc.

We are financial advisors in Deer Park and Barrington, IL. A team with a passion for helping others design a path to financial success — whatever success means for you. Each of our unique insights fit together to create broad expertise, complete roadmaps, and creative solutions. We have seen the power of having a financial plan, and adjusting that plan to life. The result? Freedom from worrying about the future so you can enjoy today.