Navigating the healthcare system for an older adult can be challenging, especially during a crisis. For family members and caregivers, understanding the proper protocols for hospital admission is a critical part of ensuring their loved one receives the best possible care. The process can differ significantly depending on whether the admission is an emergency or a planned event. Having all the necessary information and documents prepared in advance can make the process smoother and less stressful for everyone involved.
Emergency hospital admission for an elderly person
In a medical emergency, speed and clear communication are paramount. An emergency admission bypasses much of the pre-planning, but preparation can still help immensely once you arrive at the emergency department.
When to call 911
Call 911 immediately if you suspect a life-threatening illness or injury, such as a severe fall, stroke symptoms, heart attack, or any sudden and critical change in condition. Be clear and specific with the dispatcher about the patient's symptoms and age. When paramedics arrive, provide them with a concise medical history and a list of all medications.
In the emergency department
Once in the emergency department (ED), the care team will assess the patient to determine if an inpatient admission is necessary. For older adults, ED physicians often look for complex conditions that require a hospital stay for safe and effective treatment.
- Provide full medical history: Give the ED staff a complete list of all medical conditions, surgeries, and allergies. This helps them understand the patient's full health picture.
- Bring a medication list: Carry an up-to-date list of all prescription and over-the-counter medications, including dosages and frequency. If possible, bring the actual pill bottles.
- Identify decision-makers: Make sure the staff is aware of who holds a healthcare power of attorney or is the appointed decision-maker.
- Advocate for your loved one: Older adults may be confused or in too much pain to advocate for themselves. Stay with them if possible to provide reassurance and ensure their needs are heard.
Non-emergency or planned hospital admission
For scheduled procedures or planned treatments, you have the advantage of time to prepare. A physician must order an inpatient admission, generally when care is expected to require a stay of more than two midnights.
Before the hospital visit
- Gather all paperwork: Organize insurance cards, identification, and any advance directives or healthcare proxies. Keep all information together in a single, easily accessible folder.
- Confirm logistics: Verify the exact date, time, and location for admission. Ask about pre-admission testing, fasting instructions, and parking arrangements.
- Manage home logistics: Arrange for pet care, mail collection, or other home needs during the hospital stay.
What to bring to the hospital
Pack a small bag with essential items to make your loved one's stay more comfortable. This can include assistive devices like glasses, hearing aids, and walkers.
Handling refusal of treatment by an elderly person
Dealing with an older adult who refuses medical care is one of the most challenging aspects of caregiving. In the U.S., a mentally competent adult has the legal right to refuse treatment, even if it has negative consequences.
Strategies for discussing care
- Be empathetic: Listen to their fears and concerns without judgment. They may be afraid of hospitals, procedures, or losing their independence.
- Try to persuade, not force: Explain the benefits of treatment and the risks of refusal. Frame the conversation around how medical care can help them achieve their goals, such as maintaining independence.
- Involve their primary care doctor: Ask their primary care physician to speak with them directly. A medical authority figure they trust may be more persuasive.
When is intervention necessary?
In cases where the senior is deemed mentally incapacitated or poses an immediate danger to themselves or others, legal exceptions apply.
- Call 911 for immediate danger: If their refusal leads to a life-threatening situation, call 911. The paramedics can provide emergency care and transport for assessment.
- Contact Adult Protective Services (APS): For concerns about severe self-neglect or safety that aren't an immediate emergency, contact APS. They can investigate the situation and determine the appropriate level of intervention.
Inpatient vs. Observation Status: A crucial distinction
When an older adult is admitted to the hospital, it's vital to understand the difference between inpatient and observation status, as this can affect financial coverage.
| Feature | Inpatient Status | Observation Status |
|---|---|---|
| Definition | A formal hospital admission for medically necessary care expected to last more than two midnights. | A temporary hospital stay, usually less than 24-48 hours, for close monitoring and diagnostic testing. |
| Physician Order | A physician must order and formally admit the patient as an inpatient. | A physician orders observation to determine if an inpatient admission is needed. |
| Medicare Coverage | Covered under Medicare Part A. Can trigger eligibility for subsequent skilled nursing facility (SNF) coverage. | Considered outpatient care, covered under Medicare Part B. Does not qualify as a formal hospital stay for SNF eligibility. |
| Patient Cost | Copayments or deductibles may apply, but costs are generally lower for SNF care after discharge. | Higher potential out-of-pocket costs for medications and services, as it's billed as outpatient care. |
It is essential to ask hospital staff, especially the admitting physician, whether your loved one is being placed under inpatient or observation status. A designation of observation status can have significant financial implications for follow-up care.
After the hospital stay: Planning for discharge
Discharge planning is a vital part of the process for elderly patients, who face a higher risk of re-injury or illness after leaving the hospital. Caregivers should be involved in this process from the beginning.
Coordinate with the discharge planner
Your hospital care team will typically include a social worker or discharge planner. Work with them to arrange for any necessary services, such as home healthcare, physical therapy, or transfer to a skilled nursing facility.
Arrange follow-up care
Schedule a follow-up appointment with the patient's primary care physician as soon as possible after discharge. This ensures a smooth transition and continuity of care.
Get caregiver support
Taking care of an elderly person post-hospitalization can be demanding. Seek support from family, friends, or professional caregivers to prevent burnout. Consider the services of a geriatric care manager for expert guidance.
Conclusion
Getting an elderly person admitted to the hospital requires careful preparation, especially for caregivers. In emergency situations, immediate action is necessary while having key medical information readily available. For planned admissions, thorough preparation of documents and logistics can reduce stress. When an elderly person refuses care, it's important to approach the situation with empathy, while understanding the legal and ethical boundaries of intervention. Finally, being aware of the difference between inpatient and observation status is crucial for managing post-hospitalization costs and care. Effective advocacy and proactive communication with the medical team are the most powerful tools a caregiver has to ensure their loved one receives the highest quality of care throughout their hospital stay.
