Join us at noon CT (1 p.m. ET/10 a.m. PT) on Tuesday, March 8, to chat about the transition from hospital to home, with Chicago Tribune's health reporter Judy Graham and panelists Robyn Golden and Madeleine Rooney.
Seniors often find themselves struggling when they end up back at home after a hospital stay. Sometimes, they don't understand which medications they're supposed to take and why. Sometimes, doctors have no idea what happened to elderly patients in the hospital and don't offer follow up care. Sometimes, older patients feel weak or disoriented and don't know where to turn for help. And these are only some of the challenges that can occur when older patients are discharged from a hospital and return home.
Medical experts across the country are looking at how to address these transitions and ensure that patients get better help. We talk to two experts from Chicago's Rush University Medical Center who have developed a model program and who will offer concrete, practical advice to older adults and their families.
Robyn Golden is a director of "older adult programs" at Rush. She has academic appointments at Rush's departments of preventive medicine and health systems management. Golden has more than 25 years of experience in the fields of aging and health, and a deep commitment to improving the health and well being of older adults and their families.
Madeleine Rooney is coordinator for Rush's "transitional care services for older adults" program. She has over 30 years experience in the fields of health and aging and a keen interest in psychological and social factors that affect health outcomes for older adults.
Good afternoon everyone. We're getting ready for the chat and will start in just a few minutes. Please feel free to send your questions along when you're ready.
Tuesday March 8, 2011 11:50 Judy Graham
12:00
Judy Graham:
It's noon and time for us to begin. Why don't we start by talking about some of the things that can go wrong when someone goes home after a stay in the hospital.
What about medications? What can happen here?
Tuesday March 8, 2011 12:00 Judy Graham
12:01
Robyn Golden:
Medication changes are common. Often, people are given a different type or a different dose of medication than the one they used to take before they came to the hospital. Getting prescriptions filled can be a challenge. For example, the pharmacist may discover that the prescribed drug is incompatible with another drug the individual is taking, or insurance does not cover it, or special approval is needed for the insurance company to pay. Or the drug may not be in stock.
Tuesday March 8, 2011 12:01 Robyn Golden
12:01
Judy Graham:
So, what can people do about this, Robyn?
Tuesday March 8, 2011 12:01 Judy Graham
12:03
Judy Graham:
While Robyn is answering, here’s a valuable guide on planning for the discharge of a loved-one from the hospital. It comes from Next Step in Care, a program designed to support family caregivers, especially when patients make the transition from a hospital or a rehab center to home. The program is sponsored by the United Hospital Fund in New York City.
People can communicate with their physician about a different drug that may be the same, just generic. They can work with their social worker, too. The social worker can work with their pharmacist, talk to their doctor, and work with their insurance company. Many pharmeceutical companies also have programs, called prescription assistance programs, that can help pay for your drugs.
Tuesday March 8, 2011 12:04 Robyn Golden
12:05
Judy Graham:
Those are really good suggestions, Robyn. Let's talk about follow up, which I know can be an issue here. Is it common to have a primary care doctor follow up when someone is discharged from a hospital -- or not?
Tuesday March 8, 2011 12:05 Judy Graham
12:05
Robyn Golden:
Typically it is recommended that people make an appointment with their primary care doctor within two weeks after being discharged from the hospital. The primary care doctor is the one who can oversee a patient's care, follow up on recommendations made in the hospital, make sure that the patient sees the necessary specialists, etc.
Tuesday March 8, 2011 12:05 Robyn Golden
12:06
Judy Graham:
We see we have people listening in. Now, we'd like to get your questions. Please send them in. Ms. Rooney is having technical difficulties at the moment but will be with us soon, we hope.
Tuesday March 8, 2011 12:06 Judy Graham
12:07
Judy Graham:
Robyn, on the primary care follow up issue, what should people have with them when they go to an appointment? How do they make sure that their doctor has the information he or she needs to provide good follow up?
Tuesday March 8, 2011 12:07 Judy Graham
12:10
Robyn Golden:
People should bring a list of all their medications including herbal and over the counter drugs, too. They should also bring a list of questions or concerns you want answered that day. It's good to keep a list going between appointments, and when you think of a question, write it down! That way, you won't feel as pressured to think of questions when you're in the doctor's office. We also recommend people talk about their problems in a way so that doctors can understand how those problems affect them in their day-to-day life. It's not just about your symptoms. It's about how they affect the way you and your loved one's live.
Tuesday March 8, 2011 12:10 Robyn Golden
12:11
[Comment From AdrienneAdrienne: ]
What about fears associated with being released?
Tuesday March 8, 2011 12:11 Adrienne
12:12
Judy Graham:
While our experts are working on an answer, here¿s a checklist meant to ensure that hospital discharges go smoothly from Next Step in Care: “Going Home, What you Need to Know.”
Fears are natural! Being release can be a scary thing. Patients and their caregivers should talk with the people caring for them about their fears: your doctor, nurse, discharge planner, social worker. It's common, and knowing it helps your "care team" know how to better take care of you.
Tuesday March 8, 2011 12:12 Robyn Golden
12:13
Robyn Golden:
Try to be as clear as possible about what your fears are. Is it about the fear of taking care of yourself when you get home? Is it fear about a new diagnosis? Worry about missing work? Be as clear as possible about what's causing that fear and anxiety.
Tuesday March 8, 2011 12:13 Robyn Golden
12:14
Robyn Golden:
Talk about those concerns as early as possible, too. Do not wait until the day of discharge. The earlier your care team knows about your fears, the earlier they can help you address them. Understand there may not be a lot of time to talk, but the earlier you mention these fears, the earlier you can start talking about them.
Tuesday March 8, 2011 12:14 Robyn Golden
12:14
[Comment From AdrienneAdrienne: ]
How can a family member (spouse, adult child) be supportive?
Tuesday March 8, 2011 12:14 Adrienne
12:15
Judy Graham:
While we're waiting for an answer, another useful guide to health care transitions, "Moving from Place to Place," comes out of Maine. It's a joint project of a large health care foundation, a regional medical center, and the University of Maine Center on Aging. The guide has lots of valuable information that applies to people living anywhere in the country:
Your family members and other loved ones can be supportive by being clear about what they can and cannot do to help take care of you. They can speak to health care providers on the patient's behalf about how you're feeling, what's worrying you, and what situations you may be facing after you leave the hospital. Remember, your family members are people, too. They may have limits to how much they can help you or their comfort level in caring for an ill family member, and that's okay, as long as you communicate about it.
Tuesday March 8, 2011 12:17 Robyn Golden
12:17
[Comment From PhilipPhilip: ]
Are you solely focusing on older patients? I am much younger and experienced a week long hospitalization and was completely disoriented after being discharged and experienced the same problems.
Tuesday March 8, 2011 12:17 Philip
12:18
Judy Graham:
I've had this question from some people as well. It's very clear that problems making transition from the hospital to home don't apply only to older patients.
Madeleine has joined us now and will be addressing this one.
Tuesday March 8, 2011 12:18 Judy Graham
12:18
Madeleine Rooney:
No, these issues and recommendations can apply to anyone.
Tuesday March 8, 2011 12:18 Madeleine Rooney
12:19
Madeleine Rooney:
Philip, tell me more about your situation.
Tuesday March 8, 2011 12:19 Madeleine Rooney
12:20
[Comment From PhilipPhilip: ]
I was in for a post-op infection that required high doses of antibiotics and pain relievers.
Tuesday March 8, 2011 12:20 Philip
12:21
Judy Graham:
I know that pain that isn't fully addressed can be a problem when people return home. Was this part of what happened with you, Philip?
Tuesday March 8, 2011 12:21 Judy Graham
12:22
[Comment From PhilipPhilip: ]
I was released to home with family, but was unable to accurately medicate myself for several days after
Tuesday March 8, 2011 12:22 Philip
12:24
Madeleine Rooney:
This must have been very hard for you. Pain we know is a very difficult thing for people to deal with. Did the nurses and doctors talk you about your care and what you would need at home? Did you have a visiting nurse or follow up once home?
Tuesday March 8, 2011 12:24 Madeleine Rooney
12:24
[Comment From JanJan: ]
My mother experienced disorientation at night at the hospital. This has never happened before or at the hospital. I was told this should go away once she is home. Can you talk abt this issue and how I might help her make this transition?
Tuesday March 8, 2011 12:24 Jan
12:24
Robyn Golden:
Disorientation can be really common after a hospitalization, but it's scary when it happens to you. Disorientation can be caused by a lot of different things: medication, urinary tract infection, hearing or vision difficulties. All of those need to be looked at since disorientation can usually be cleared up before someone leaves the hospital. If it happens at home, be sure to call your doctor and explain how you're feeling.
Tuesday March 8, 2011 12:24 Robyn Golden
12:25
Judy Graham:
Is everyone who leaves the hospital for home equally at risk? If not, who's at greatest risk?
Tuesday March 8, 2011 12:25 Judy Graham
12:28
Robyn Golden:
Actually, not everyone is equally at risk. Those most at risk are people who may not have much support from friends and family or don't have many people around them. People who have many different health issues are also at higher risk because there's a lot of different things to manage at once. People who have a hard time understanding the instructions their doctors give them are also at higher risk. It's hard to follow a plan if you don't understand what it all means!
Tuesday March 8, 2011 12:28 Robyn Golden
12:29
Judy Graham:
We're open to questions from our audience. Please send them in!
Tuesday March 8, 2011 12:29 Judy Graham
12:29
Robyn Golden:
There are non-medical things that can put you at risk, too. Financial problems, feeling alone, worry, and even things like not having transportation can all put someone at risk, especially if they are not feeling like their typical self right after getting home from the hospital. There's a lot that needs to be done right after getting home, and that's why having someone to help you when you go home can be so important.
Tuesday March 8, 2011 12:29 Robyn Golden
12:31
Judy Graham:
We're going to circle back to Philip one more time because he has another issue we'd like to address.
Tuesday March 8, 2011 12:31 Judy Graham
12:32
[Comment From PhilipPhilip: ]
My pain was adequately controlled but I had to have a family member lay out all my medications for me and set alarms for me to make sure I was getting correct dosages.
Tuesday March 8, 2011 12:32 Philip
12:32
Madeleine Rooney:
Here's an important thing for everyone to know. When you are in the hospital, be sure to let the staff know that you might have problems at home with followup care -- like taking medications. That way, they might be able to arrange for a visiting nurse, or have the pharmacist see you, or other kinds of assistance.
Tuesday March 8, 2011 12:32 Madeleine Rooney
12:32
[Comment From StanStan: ]
I have a loved one still in a rehab facility, refusing to take his meds complaining of an upset stomach. we're not sure he's improving. at what point does depression/will to live come into play, and is there an approach suggested?
Tuesday March 8, 2011 12:32 Stan
12:33
Judy Graham:
I'm so glad you brought up rehab, Stan. Discharges from rehab to home are also a big issue,
Here's a guide for patients who are discharged from a rehabilitation facility to home, also from Next Step in Care.
Our experts are working on an answer, Stan. Hang on....
Tuesday March 8, 2011 12:36 Judy Graham
12:37
Madeleine Rooney:
I'm not sure how old your loved one is, but adjusting to being in a facility and not getting better can result in depression. We usually tell families to talk to the facility social worker or nurse about their concerns. A family meeting with your loved one and staff is often helpful to address goals and concerns. It might be helpful to talk to the staff about mental health support at the facility. Also, rehab facilities sometimes have support groups for family members as well.
Tuesday March 8, 2011 12:37 Madeleine Rooney
12:37
[Comment From StanStan: ]
thanks
Tuesday March 8, 2011 12:37 Stan
12:38
[Comment From AdrienneAdrienne: ]
How long would you say is a typical time to have someone "with you" if you live alone? Are there services that provide such?
Tuesday March 8, 2011 12:38 Adrienne
12:38
Robyn Golden:
Great question, Adrienne! As frustrating as it sounds, there is no typical time. The right time for you or your family member depends on a lot of different things: the ability to be able to do things around the house, the ability to get around inside and outside, how safe you feel, and how you feel emotionally about being alone. There are services that can come into your home and help, either helping you with housework or just being there. Here's where a social worker can help. If you or your family member is an older adult, you can call your local Area Agency on Aging. This is where technology may play more of a role in the future, too, helping us to "be there" even when we can't be there.
Tuesday March 8, 2011 12:38 Robyn Golden
12:39
Judy Graham:
I know hospitals are developing programs to address these kinds of issues. What about the program you have at Rush? How does it work?
Tuesday March 8, 2011 12:39 Judy Graham
12:41
Robyn Golden:
Rush is very concerned about the well-being of our patients, both inside our walls and once they leave. That's why Rush Older Adult Programs developed the Enhanced Discharge Planning Program, a service that starts right after you leave the hospital with a call from a licensed social worker with experience dealing with many of the issues patients face (Madeleine is one of these social workers!).
Tuesday March 8, 2011 12:41 Robyn Golden
12:43
Robyn Golden:
The social worker is concerned about how well a patient is doing once they get home. Are they getting the services they were supposed to get? Is anything new or surprising happening now that a patient is home? Are there any other programs going on in the local community to help people feel safer or more in control of their lives? These are only a few of the questions we ask when we call patients at home.
Tuesday March 8, 2011 12:43 Robyn Golden
12:43
Judy Graham:
By the way, here are some materials from the "Care Transitions" program created by the University of Colorado at Denver Health Sciences Center. A core component of this model is a patient centered medical record:
Great resource, Judy! We know Dr. Coleman's work well. We work closely with Dr. Coleman to think of new ways to meet the challenges of going home. There's a lot going on right now about this topic!
Tuesday March 8, 2011 12:45 Robyn Golden
12:46
Robyn Golden:
What's unique about the Enhanced Discharge Planning Program is our focus on the non-medical things that can bring people back to the hospital. We think those are just as important as your diagnosis, and may even be the reason people return to the hospital unnecessarily. That is why our model uses social workers as "transition managers".
Tuesday March 8, 2011 12:46 Robyn Golden
12:46
Judy Graham:
We may be coming to an end here. I'm wondering, what if an older person resists efforts to help after going home from the hospital? What can you do?
Tuesday March 8, 2011 12:46 Judy Graham
12:49
Madeleine Rooney:
Great question -- and often asked!! It is hard but important to understand that sometimes people resist help because they are struggling to remain independent. Most people admit that accepting help is hard. I think it also depends on how they have adjusted to loss or the need for help in past. It is important to be open and honest about your concerns and to include them in decisions that are made. Sometimes someone outside the family can talk to your loved one -- perhaps a minister or rabbi, or someone else they trust. Sometimes, despite your best efforts, your loved one may refuse. So you may need to get help for yourself on how to accept those decisions.
Tuesday March 8, 2011 12:49 Madeleine Rooney
12:49
Judy Graham:
I'm wondering, what if you can't get in touch with the people who cared for an older parent in the hospital after they've been discharged? What can you do to prevent this problem and make sure your older relative's physicians get information they really need?
Tuesday March 8, 2011 12:49 Judy Graham
12:51
Robyn Golden:
A lot of new research is showing that having a name of someone to call and their contact information when you leave the hospital can go a long way to preventing a rehospitalization. It's so important to make sure you have that name upon leaving the hospital, whether it's your primary care physician or someone who's working as a transition coordinator. Once you find a way to link back to the hospital system, it's easier to get the information you need to be safe at home. Also, you will get a discharge summary when you go home. Since more often than not you're not cared for by your primary doctor while in the hospital, they may not know what happened while you were there. Be sure to bring your discharge summary to your follow-up appointment (hopefully within 2 weeks!) and talk with your doctor about your hospital stay.
Tuesday March 8, 2011 12:51 Robyn Golden
12:52
[Comment From JohnJohn: ]
Can you give a quick real life example of when a person was discharged and a social worker under the Discharge Planning Program had to intervene due to something that was lacking or didn't take place like it was supposed to including how they resolved it?
Tuesday March 8, 2011 12:52 John
12:54
Madeleine Rooney:
Sure, would be happy to. In one case I know about, a senior went home with recommendations to get home health services, which she refused. We were worried about her because there were questions about the support she had at home and her ability to manage medications, make followup appointments, etc. When we spoke with her, she stated all was fine, but called us back hours later to say that she had forgotten to take her antibiotic. She didn't know what to do. We were able to connect her with our in-patient pharmacist, who helped her understand what to do. Because she had memory loss, we contacted her primary care doctor's office the following day, and connected the nurse there with her, to assess how she was handling her medications and to arrange a followup appointment.
Tuesday March 8, 2011 12:54 Madeleine Rooney
12:54
[Comment From StanStan: ]
this was great - and really helpful. Thanks to the three of you for taking the time.
Tuesday March 8, 2011 12:54 Stan
12:54
Judy Graham:
Thank you, Robyn and Madeleine, for a very informative, very stimulating chat, And thank you to our participants. Tune in to Bruce Japsen's chat on Thursday, March 17, 11 am, on how neighborhood pharmacists' roles will change under health reform.
Join us at noon CT (1 p.m. ET/10 a.m. PT) on Tuesday, March 8, to chat about the transition from hospital to home, with Chicago Tribune's health reporter Judy Graham and panelists Robyn Golden and Madeleine Rooney.
Robyn Golden is a director of "older adult programs" at Rush. She has academic appointments at Rush's departments of preventive medicine and health systems management. Golden has more than 25 years of experience in the fields of aging and health, and a deep commitment to improving the health and well being of older adults and their families.
Madeleine Rooney is coordinator for Rush's "transitional care services for older adults" program. She has over 30 years experience in the fields of health and aging and a keen interest in psychological and social factors that affect health outcomes for older adults.
