Being in the hospital stinks. There’s just no other way to describe it. Whether it is a knee replacement planned months in advance, or an emergency appendectomy that brings your senior family member to the hospital, the experience can be stressful and somewhat unpredictable.
In this 4-part series, we will explore the before, during, and after of a typical hospital stay. Today’s post is Part 2: What to Expect.
Knowing what to expect during a hospital stay can lessen stress and frustration for you and your senior loved one. It is helpful to be aware of common challenging situations that families often face in a hospital. This way, you can be mentally prepared rather than surprised and frustrated when these things happen. Here are some things to expect:
At first glance, it may seem that repetitive questions are due to incompetency, when in fact they are safeguards set up to ensure proper care. Hospitals have policies in place that require each person who enters the room to ask specific questions, even though the information may be already recorded in the patient’s chart.
If the person is using a computer, they are often required to go through a series of questions before the system will allow them to open up the screen they really need to see. In other words, they cannot skip over the questions.
Expect to be asked many of the same questions by registration, nurses, social workers, therapists, and doctors. Remember that it is a safeguard to prevent medical error. Even if the staff person knows the answers, they are still required to ask.
“Nobody told me that!”
Hospital staff will do their best to keep each other informed, but expect the occasional breakdown in communication. Hospitals are huge systems, and some information usually falls through the cracks at some point. It is your responsibility to fill in the gaps in communication (more on this later.)
Expect that sometimes, various doctors responsible for your family member will not have time to communicate with each other and may not thoroughly look over the patient’s chart before speaking with them.
Expect that during the chaos of shift change, the day nurse may forget to tell the night nurse that your uncle prefers to have a male nursing assistant help him to the restroom.
Don’t be surprised when the night shift nursing assistant walks into the room and flips on all the lights after you informed the day shift that bright lights hurt your mom’s eyes.
Don’t become frustrated when these things happen. Expect that they will happen, and educate/remind staff as necessary.
So many doctors!
What appears to be a simple issue on the surface, may in fact require the involvement of several specialists. Especially with the senior population, where many health issues may already be present.
Depending on the hospital, their primary care provider may or may not visit them in the hospital. Often times when several specialties are involved, the hospital will assign a hospitalist (a doctor) to oversee and coordinate your family member’s care amongst the various doctors.
Expect that each specialist will come in at different times and at different intervals depending on their individual schedules and the needs of the patient. For instance, the cardiologist might come every morning, the orthopedic surgeon may come every other day at some point during the day, etc.
Each of these specialists will have to sign off on the patient before they can be discharged. This process does not happen quickly. It may take a couple of days for the nurses to wrangle all the specialists in for a final visit and discharge approval.
The waiting game
Buy a book at the gift shop, because you can expect to do a lot of waiting over the course of a hospital stay.
Doctors are rarely able to give a precise timeframe for discharge, since leaving the hospital is dependent upon many factors. Your best bet is to just settle in, and know that pushing the staff won’t help hurry things along. Things will happen when they happen.
Expect that the doctors will visit when their schedules allow. Some doctors will round at the same time every day, while others round when they have a break in their schedule, or at the end of their day (whenever that is).
Physical therapy will come at some point but you won’t know what time, someone will come to take your loved one downstairs for a test, but you won’t know if that will be in 10 minutes or 3 hours. Test results will take time to process and doctors will interpret the results when they can (don’t expect a quick turn-around time).
Expect a lot of “hurry up and wait.” The nurse may come rushing into the patient’s room, stating that the doctor has ordered a procedure. She will hurry through her preparations, quickly getting your family member ready for the procedure. After she leaves, you might expect the aide to come in right away to whisk them away.
This might happen, but it may also be two hours later.
Once the aide arrives, they will quickly get them to the proper location, and then they will likely have to wait again until the machine is available or the doctor arrives. This is common. It is how hospitals work. There is no way to predict how long of a wait there will be or how long things will take.
Expect delays. Hospital staff are working hard and doing their jobs, even while you are waiting. It is also important to remember that discharge will be dependent upon how the patient progresses. Every person is different, and the body takes time to heal.
Seniors vary greatly in their recovery time, and if complications come up, their stay will be prolonged. It is a slow process. Many times, the doctors will tell you “We’ll just have to wait and see.”
This feels so frustrating for family members, but please understand that when a doctor says this, it means they are doing everything they can, but it is now time to wait on the body.
This is because on Fridays, doctors are wrapping up their work weeks, turning over their patients to the weekend on-call doctors, and unless it is emergent, nothing new will be happening until they return on Monday.
It is frustrating, but it’s just the way it is. Also expect that if you have questions over the weekend for the doctors assigned to your family member’s case, it will take longer to get answers.
This is because they have to page the on-call doctor. The on-call doctor is not the one responsible for your family member’s case, so they likely won’t have detailed answers for you about discharge dates, etc.
They will of course handle any problems that come up, but they are mostly there to hold down the fort until the attending doctors return. Again, if it’s not emergent, they will probably tell you to wait until the attending physician returns on Monday to discuss the issue in depth.
The plan is what, now?
Expect frequent changes. Your family member’s physician may round in the morning and order Test A, but the nurse may come in an hour later telling you the doctor decided to do Test B instead. This happens sometimes. Be ready for last minute changes.
Also, sometimes specialists disagree about the next step for the patient. Sometimes the surgeon may tell you one thing in the morning, then the GI specialist says something different in the afternoon. Be sure to ask questions and clarify what the plan is.
One doctor may simply be unaware of what the other doctor told you, so be sure to get clarification when you hear different stories.
Also expect the discharge date to change a couple of times. This happens because of the unpredictability of healing.
Sometimes, a new issue will pop up that has to be addressed before the patient can leave. Sometimes, a wound will take longer to heal than the doctor initially anticipated.
Often you will have all the specialists sign off on discharge except for one, who is stuck in surgery all day. You may have to wait an extra day for that doctor to sign off on your family member’s discharge. Try not to get your hopes set on a specific discharge date.
Expect it to change.
Stop bothering us!
You can expect your family member’s hospital room to be a revolving door throughout their stay. Many departments will need to come in to speak with you: social work, registration, billing, various types of therapists, specialists, discharge planners, etc.
In addition, nurses and/or their assistants are required to come in to check vitals and administer medications at regular intervals throughout the day and night. Sometimes it seems impossible to get any rest. It is true that the patient probably won’t get much rest until they get home.
Try to remember that the staff is not trying to send someone in to bother you every 5 minutes. They are just doing their job. However, you know your family member better than they do, and you can make requests for some staff to come at a better time, etc. (more on this later).
One thing leads to another
Be aware that when a senior citizen experiences a hospital stay, it is possible that the initial issue may lead to other issues either during the hospital stay, or later on down the road. It is not uncommon for doctors to discover more health problems while your loved one is in the hospital for a particular issue.
Also be ready for the possibility that depending on their age and overall health, they may not fully recover from the incident.
In addition, when a senior experiences a physical problem, their cognition is often affected as well. For example, if they have an infection or are in a lot of pain, they may become easily confused or experience delusions/hallucinations.
Sometimes this also happens after surgery and or a stay in the ICU. It is important to know that cognitive changes do not happen to all seniors who enter the hospital, but they do affect some. Sometimes these cognitive changes are temporary and resolve when the physical issue resolves, and sometimes the changes are permanent.