Just about everyone with an aging parent anticipates the possibility of a medical emergency. The circumstance you are likely most concerned about is that moment when you learn your mother or father has suffered a significant event and aggressive intervention is necessary. That moment changes your parent’s life and yours.
If and when it happens, try to remain calm and remember that the sooner your parent receives medical attention, the better his or her chance for recovery. Your objective is to get that attention as soon as possible.
911 to the hospital
If you are present when a life-threatening event occurs, immediately call 911. If you are alerted to the emergency by a third party, instruct them to hang up and dial 911, or if you prefer, hang up and do it yourself.
Under no circumstances should you attempt (or instruct a family member or friend) to drive a seriously ill older adult to the hospital in a personal vehicle. Transporting an ailing parent without the benefit of medical support adds unnecessary risk to an already perilous situation.
Once you know help is coming, contact your parent’s doctor and let that individual know what happened and that your parent is on the way to the hospital. Then call the hospital and confirm that they have the correct name and telephone number for your parent’s physician.
When the 911 operator answers, the caller should be prepared to (a) provide the operator with your parent’s full name, the complete address of his or her current location and the telephone number, or as much of that information as you have when you place the call; (b) give them the name and telephone number of your parent’s doctor; (c) if you have emergency medical information available, tell the operator where it can be found; (d) be sure to ask where your parent will be taken.
Finally, notify other family members of what has occurred. One family member should be selected to act as a liaison with the hospital to avoid chaos and confusion in the emergency room.
When the ambulance responds to the emergency call, the EMTs will confirm the information relayed from the 911 operator, then request specifics from you about the event and/or your parent’s condition. They will inquire as to allergies and medications. The EMT also will take possession of pertinent documents in preparation for transport to the hospital. Medical orders are received from consulting physicians via the radio, so they will be engaged in a dialogue with a doctor as they work. The EMT’s objective will be to stabilize your parent’s condition as best they can before heading out to the hospital.
Subject to ambulance service policy and your parent’s condition, you may be permitted to ride in the ambulance to the hospital. However, keep in mind you will need to find another way home, which may be difficult depending on your location and the availability of friends or family to pick you up.
Hospital admission and your parent’s treatment
After arrival, the next steps depend on the nature of the emergency. When the time comes and your parent is slated for admission, find the admitting physician and ask for a rundown of your parent’s condition and why he or she needs to be admitted (request a written copy of the diagnosis, as well).
After that conversation, take the time to visit the admissions office. If you had an emergency information packet prepared, most of the material required will already be in the hands of hospital personnel. If that is not the case, you will need to produce copies of insurance cards, advance directives and other documents. If need be, missing information also can be transmitted to the hospital via fax or email from your parent’s doctor’s office. You may wish to discuss room and/or roommate considerations at that point, before a room assignment is made.
During your parent’s stay in the hospital, be a strong advocate and make every visit count. One of the most effective strategies for "staying in the loop" is to introduce yourself and befriend the nurses charged with your parent’s care. Nurses can provide a wealth of information. Be kind and respectful, but do not be afraid to ask questions. Learn all you can about your parent’s medical problem during your "off hours" to inform your dialogue with the professionals about treatment, both present and future. Begin to educate yourself on the kind of care that will be needed after discharge.
If you can, be present when your parent’s doctor conducts rounds. You will not only strengthen your relationship with the physician, but also you will pick up details about diagnosis and treatment. Keep a small notebook with you at all times and write everything down – including any questions and concerns that arise through the day, or simple observations about your parent’s behavior and demeanor. It’s easy to get overwhelmed in a hospital setting, and a written record of certain details will help keep you focused and better able to process and deal with the situation.
At any point during a parent’s hospitalization (it is never too soon), pay a visit to the discharge planner or social worker, and ask that person to spell out the options available to you and your parent after leaving the hospital.
Discharge and the return to home (or rehab)
If your parent is going home, ask the hospital’s discharge planner to work with you to make sure the space he or she returns to is safe and comfortable. The planner can help you to understand the services necessary for an effective in-home recovery and also will identify the local agencies that provide those services and treatments. (In some cases securing these services is also a part of the discharge planner’s job.) The Eldercare Locator (http://www.eldercare.gov), maintained by the National Association of Area Agencies on Aging, is an online resource that provides referrals to area agencies on aging, along with information on eldercare issues and services available in local communities.
If your parent requires a nursing home or rehabilitation facility, tell the planner you wish to approve the facility prior to transfer. Plan to visit the facility or at least call and speak to the facility’s director.
Many experts, including Beerman and Rappaport-Musson, suggest that if you can afford it, hire a geriatric care manager to deal with this transition. Making decisions concerning treatment options and the best qualified facility can get complicated and may require negotiating with an insurance carrier over the services covered. A professional is equipped to facilitate that process. But with or without a paid manager, before transfer to any type of step-down facility, be sure to determine exactly what services the insurance company will cover. Keep in mind your parent will be responsible for the rest.
Important information to have on-hand
To be prepared for a medical emergency, the Mayo Clinic suggests a caregiver know 10 things about an aging adult:
Strongly encourage your parent to prepare and execute an advance directive, living will and a health care durable power of attorney. The advance directive and living will spell out your parent’s preferences regarding medical treatment in a variety of circumstances, while the health care durable power of attorney authorizes an individual to made medical decisions on your parent’s behalf when he or she is unable, and it also grants that person access to important medical records.
Keep this information in a safe place where it can be easily accessed in the event of an emergency. The Vial of Life Project (http://www.vialoflife.com) offers a way to save and store essential medical information in distinct packaging that is easily identifiable by emergency medical personnel. The project is promoted and supported by local fire departments, EMT squads or senior citizen organizations.