{"id":6518,"date":"2021-04-21T07:25:18","date_gmt":"2021-04-21T11:25:18","guid":{"rendered":"https:\/\/www.silvercentury.org\/?p=6518"},"modified":"2021-04-22T07:22:45","modified_gmt":"2021-04-22T11:22:45","slug":"his-medical-crisis-took-us-by-surprise","status":"publish","type":"post","link":"http:\/\/78.142.243.82\/~silvercentury\/2021\/04\/his-medical-crisis-took-us-by-surprise\/","title":{"rendered":"His Medical Crisis Took Us by Surprise"},"content":{"rendered":"

Journalist Judith Graham reveals what happens when problems that have always been hypothetical suddenly become real and need immediate solutions. Graham writes the Navigating Aging column for <\/span><\/i>Kaiser Health News (KHN)<\/span>. Her article was posted on the <\/span><\/i>KHN<\/span><\/a> website on<\/span><\/i> August 20, 2020, and also ran on <\/span><\/i>CNN<\/span><\/i><\/a>. Funding from the Silver Century Foundation helps KHN develop articles (like this one) on longevity and related health and social issues.<\/span><\/i><\/p>\n

Earlier this month, my husband picked up the phone and learned his 92-year-old father had been taken to the hospital that morning, feeling sick and short of breath.<\/span><\/p>\n

We were nearly 2,000 miles away, on a vacation in the mountains of southern Colorado.<\/span><\/p>\n

No, it wasn\u2019t COVID-19. My father-in-law, Mel, who has diabetes, high blood pressure and kidney disease, was suffering from fluid buildup in his legs and around his lungs, and excruciating knee pain. Intravenous medications and steroid injections were administered, and he responded well.<\/span><\/p>\n

Doctors monitored Mel carefully, adjusted his medications and recommended a few weeks of home health care after eight days in the hospital.<\/span><\/p>\n

In other words, this was not a life-threatening emergency. Yet we realized how poorly prepared we were for a real crisis, should one arise. We needed a plan.<\/span><\/p>\n

Why didn\u2019t we have one already? The usual reasons: denial, avoidance and wishful thinking. It was easier to imagine that Mel would be all right until it became clear that we couldn\u2019t take that for granted.<\/span><\/p>\n

Although I routinely advise readers about preparing for changes in their health, I didn\u2019t want to be a know-it-all with my husband\u2019s family. Their assumption seemed to be, \u201cWe\u2019ll deal with whatever comes up when that happens.\u201d<\/span><\/p>\n

Now, eyes wide open, we got organized.<\/span><\/p>\n

Some background:<\/b> Mel lives in a well-run continuing care retirement community in upstate New York, in the independent living section. His three sons all live at a distance: one out West, one overseas and one a few hours away.<\/span><\/p>\n

Hiring a care manager.<\/b> Last year, as Mel\u2019s kidney function declined, I suggested we hire a geriatric care manager who could look in on him regularly. After a few visits, Mel let her go. Her services were too expensive, he complained. In truth, we understood, he didn\u2019t want someone interfering in his affairs.<\/span><\/p>\n

My husband respects his father\u2019s autonomy and didn\u2019t press the point.<\/span><\/p>\n

So when Mel went to the hospital a few weeks ago, he was alone, with no one to turn to for assistance.<\/span><\/p>\n

This was especially problematic because Mel has hearing loss, and it is almost impossible to talk with him by phone. \u201cHow are you, Dad?\u201d my husband yelled on twice-a-day calls to check on his father in the hospital. \u201cWhat?\u201d Mel replied querulously. This was repeated a few times, with mounting frustration and no useful information exchanged.<\/span><\/p>\n

Now a care manager who could serve as our eyes and ears on the ground was necessary, not optional, and we hired back the professional we\u2019d already found.<\/span><\/p>\n

Finding companion care.<\/b> What kind of assistance was Mel going to need when he left the hospital, deconditioned and weaker than when he went in?<\/span><\/p>\n

When we spoke with the physician overseeing Mel\u2019s care in the hospital, he suggested that \u201ccompanion care\u201d for at least a few weeks would be a good idea. Mel needed someone to help him up out of the chair, stay at his side while he walked to the bathroom and bring him a glass of water, among other tasks. (Also, we realized, we needed to arrange for meals to be delivered to Mel and for someone from his senior community to buy groceries for him\u2014a service they\u2019d started during the pandemic.)<\/span><\/p>\n

An excellent organization that works with older adults in Mel\u2019s area supplied me with a list of 21 agencies that provide these kinds of services\u2014a dizzying array of choices.<\/span><\/p>\n

Fortunately, the senior community where Mel lives recommended an agency that often works with its residents. We hired 24\/7 care for several days after Mel left the hospital with the understanding that we\u2019d continue services if necessary. Now, this agency is on our list of essential resources.<\/span><\/p>\n

Understanding the options.<\/b> Mel\u2019s senior community incorporates assisted living and a nursing home for residents who need short-term rehabilitation services or longer-term, round-the-clock care.<\/span><\/p>\n

But it was clear Mel wanted to go home after being in the hospital instead of going to that rehab. Medicare would pay for a few weeks of visits from nurses and physical and occupational therapists. Would that be enough to set him on the road to recovery? We had no idea.<\/span><\/p>\n

If Mel couldn\u2019t return to his previous level of functioning after returning home, he might need to transition to assisted living, where he could receive more medical oversight and assistance. How would this work? We didn\u2019t know and asked the geriatric care manager to find out.<\/span><\/p>\n

Getting paperwork in order.<\/b> Years ago, Mel assigned power of attorney for his health care decisions and financial and legal affairs to my husband. So long as Mel can manage on his own, he makes his own decisions: The legal papers were a backup arrangement.<\/span><\/p>\n

But Mel hadn\u2019t prepared a document naming all three sons as his <\/span>\u201cpersonal representatives<\/a>\u201d<\/span> under the Health Insurance Portability and Accountability Act of 1996. This waives privacy concerns and gives them access to his medical information. It went on our to-do list.<\/span><\/p>\n

The brothers also didn\u2019t have a complete list of Mel\u2019s doctors, the medications he was on and why he was taking them. Another item for our list, especially important since Mel left the hospital with prescriptions for 14 medications, several of them new. While he\u2019d always managed on his own before, in his post-hospital fog it was clear he was nervous about managing this complicated regimen.<\/span><\/p>\n

Understanding the prognosis.<\/b> Before Mel\u2019s hospitalization, we knew his kidney function was worsening. But what lay ahead? Was dialysis even an option for a 92-year-old in this time of COVID-19?<\/span><\/p>\n

Who was best prepared to help us understand Mel\u2019s prognosis and the big picture?<\/span><\/p>\n

I\u2019ve written for years about geriatricians\u2019 comprehensive approach to the health of older adults. It turns out there\u2019s a top-notch group of geriatricians affiliated with the hospital where Mel was being treated.<\/span><\/p>\n

After several calls, I reached one who agreed to see Mel after he was released from the hospital. Now, we have another new team member who can help us understand Mel\u2019s health trajectory and issues that might arise going forward.<\/span><\/p>\n

Having the conversation.<\/b> What has yet to happen is the conversation that my husband hasn\u2019t wanted to have. \u201cDad, if your health takes a turn for the worse again, what do you want? What\u2019s most important to you? What does quality of life mean to you? And what can we do to help?\u201d<\/span><\/p>\n

With Mel\u2019s hearing problems, doing this over the phone won\u2019t do.<\/span><\/p>\n

My husband would have to fly cross-country and, ideally, meet his New York brother at Mel\u2019s place for a conversation of this kind. Before that happens, the brothers should talk among themselves. What\u2019s their understanding of what Mel wants? Are they on the same page?<\/span><\/p>\n

Also, no one has discussed financial arrangements.<\/span><\/p>\n

Each time we explain to Mel one of the new services we\u2019ve arranged, his first question is \u201cWhat\u2019s the cost?\u201d His impulse is to guard his cherished savings and not to spend. My husband tells him he shouldn\u2019t worry, but this too is a conversation that has to happen.<\/span><\/p>\n

Being prepared.<\/b> Professionally, I know a lot about the kinds of problems families encounter when an older relative becomes ill. Personally, I\u2019ve learned that families don\u2019t really understand what\u2019s involved until they go through it on their own.<\/span><\/p>\n

Now, Mel has a new set of supports in place that should help him weather the period ahead. And my husband is keenly aware that planning doesn\u2019t stop here. He\u2019ll be attending to his father far more carefully going forward.<\/span><\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

Earlier this month, my husband picked up the phone and learned his 92-year-old father had been taken to the hospital that morning, feeling sick and short of breath.<\/span><\/p>\n

Read more His Medical Crisis Took Us by Surprise<\/span> ›<\/span><\/a><\/div>\n

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