Help Aging Parents: Partnering With Parents in Healthcare

Do we help aging parents by becoming parents to our parents, especially when they are of sound mind?  Are we supporting feelings of control and independence–feelings that help parents age well? In Tuesday’s post family members basically took over–either to persuade or make a unilateral decision regarding very serious health care for aging parents.  That made me pause.

In the first example, the stroke victim was not able to advocate for herself initially.  Someone had to step in if the outcome was to be any better than the ultimate nursing home option her doctor envisioned.  She was never left out of the loop.  She knew the reason for each action, presented in a way that offered hope….an attempt to empower so she wouldn’t lose the will to regain as much normalcy as possible….Happy ending.

In the second example, family members put pressure on the colon cancer relative. While not feeling well, and do doubt having countless thoughts about well-being, comfort, life and death (to name a few), the relative was of sound mind and realized  the merits of getting a second opinion….even if it meant a long plane ride…..happy ending.

As we impart information and try to help older and aging parents accept our advice and recommendations, we have a better chance of success when we pull mentally- capable elders in psychologically to work with us. And even when they don’t seem mentally capable, doesn’t keeping them in the loop show (at the least) respect? And at the most could it possibly activate something positive from within.

With that in mind, having called attention to best hospitals and best specialty departments, it’s still likely not everyone will/can take advantage.  As a fall-back position–or even a front-line position–it would seem an advantageous to know which are the best hospitals in aging parents’ and grandparents’ hometowns.

Check out the Hospital Quality Alliance’s website: http://data.medicare.gov/ run  by the Centers for Medicare and Medicaid Services. According to AARP’s June 2010 bulletin, it measures and records patients’ outcomes at local hospitals.

The site links to sections that compare hospitals, tell you how patients with certain conditions fared after hospital care, whether they had to be readmitted within 30 days, and the death rates in certain cases.  The quality of care they received during a recent stay is also provided from answers to a survey.  Only hospitals that agreed to release this information to the public are included in this government data site.

In answer to: “I just moved to a new area.  How can I find out which hospitals are considered the best in town?” for example, the AARP Bulletin’s “Ask the Experts” section provided the information.  When aging parents are making decisions to move, it could even figure into a decision about where to move.

Having and sharing objective (not emotionally-loaded) information is important for so may reasons as we try to help parents age well.

Helping Aging Parents Find “Best” Hospitals

When  there’s a serious medical emergency it’s probably safe to say few aging parents live near a hospital specializing in whatever caused the emergency.  Most of us–even those living near aging parents–don’t know the particular specialties at hospitals located nearby. A sudden emergency may leave little time to do the homework.

Three no-doubt-common scenarios follow, involving different situations and actions taken.  All happened in my family; all caused great concern; all turned out well.  All present strategies to help parents continue to age well.

#1.  Mother’s stroke experience: initially memorable for the emotional stress; equally memorable for the relief and sense of some control we felt once we found out–and got her to a place– where she could obtain appropriate treatment.

It began with phone call. Parents in California for the winter. Mother’s speech sounded “funny.”  Phoned my brother with concerns and a plea to fly to California immediately if possible (he was moving into a new home that day).  He got there quickly, phoned saying Mother was on her way to the hospital. I should fly out asap.

When I arrived at Mother’s bedside her speech was still garbled. Dinner was on a tray. She was eating the food with her hands. I’ve forgotten other details. A  terrific nurse updated me and said Mother’s physician would be in the next morning with test results. We learned they had limited the “damage;” there was nothing more they could do. Mother could go home later that day or the next with a caregiver, or go to a nursing home.  Dad would be unable to manage her care alone…a nursing home would be inevitable at some point.

I needed time to think.  Decided not to get a caregiver for that day.  Knew Mother would be safe overnight at the hospital.  I called a NY friend knowledgeable about medicine.  After some research, he phoned back. He said get her out of that hospital, which lacked neurology expertise, and to a neurologist at UCLA asap, and gave me a phone number. With great difficulty I got an out-patient appointment for the next day.

The next morning we picked Mother up at the hospital and drove to UCLA with films and reports. UCLA had newer technology.  New films were taken. The extent of the damage was clearly pin-pointed and Mother was given different medications, a prescription for physical therapy, and an appointment to return in a month.

There have been many advances in stroke treatment since.  I know Mother benefited from some because the neurologist said some were not widely used yet.  I also know a month later the improvement was so dramatic most people wouldn’t have known she’d had a stroke. Nor did she have any further strokes.
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#2.  A family member, also living in the west, was diagnosed with advanced colon cancer there. Treatment was about to begin. “Not there,” said my husband, who wanted to check Sloan-Kettering and knew we could be supportive if the family member came back.  Indeed Sloan-Kettering had top colon cancer people. Convincing someone to come all the way to NY, however, isn’t easy.  It’s easier when offered as “leaving no stone unturned”–making the trip to get a second opinion. That works.

While chronic health issues complicated things, Sloan-Kettering took charge: a top oncologist; an 8+ hour difficult surgery performed by a top surgeon (who had done complicated surgeries countless times); a while to recuperate in NY.  Instructions for additional “whatever” were given to the doctors in the west. Routine check-up visits show the surgery was a success.  Note: insurance often covers most everything done in hospitals.

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#3. Then there was Dad’s heart event in California shortly after his 76th birthday.  At the movies he began feeling dizzy, went to the theater lobby and sat down on the floor.  Someone came over to see if he was alright.  He wasn’t; his blood pressure was low. Paramedics were called. He was taken to the hospital where his internist practiced.  While it wasn’t the right hospital for my mother, it had a first-rate heart team whose surgeon did heart surgery on a former president several years later.  Dad had 5 bypasses on a Friday and went home the following Wednesday.  He aged well, lived to be 94, and his death was not heart-related.

So how do we generalize? When helping aging parents is a part of our life and our parents live long enough, the odds of serious medical problems necessitating hospitalization are great. Getting them to a hospital with the appropriate experienced specialists can increase the odds for a successful result that helps parents continue to age well…and medical insurance may make it more affordable than one might think.

Aging Parents, Best Hospitals, 16 Specialties, 5 Reasons to Consider Them

Mt. Sinai Hospital Ranked #1 in Geriatrics–2010-2011

PLEASE GO TO JULY 2013 POST FOR MOST RECENT UPDATES

Mt. Sinai Hospital’s Geriatrics Department, started by Dr. Robert Butler in 1982, (last Tuesday’s post) was ranked #1 in the August 2010  US News & World Report’s “Best Hospitals” issue, on news stands this week. An additional 49 hospitals’ geriatric departments complete the list.

Fifteen other specialty departments are also ranked. And Johns Hopkins Hospital ranks #1 as the top hospital in the country–having 15 of the 16 specialties ranking at or near the top. US News & World Report compiles this list every year (and has done so for over 20 years) “to guide patients who need an unusually high level of hospital care” (which includes high-risk patients).  Can’t this information be of enormous benefit to help aging parents?

Life takes on a more delicate balance as people age.  Making well-informed decisions ups the odds in our efforts to help parents age well.

5 reasons to consider the best hospitals’ specialties to help aging parents

1. Approximately the same time is involved, be it for procedures done in excellent hospitals or less than excellent hospitals; with excellent doctors or less excellent doctors. Only the outcomes may be different.

2. Quality of life is at risk; the more experienced the hospital and medical professionals are (the more times they’ve done your parents’ needed procedure) the better the odds to have encountered  and handled well unexpected problems.

3. Older people don’t bounce back so quickly. Patients lose independence in hospitals. It’s important they gain the confidence to feel some control. Ideally professionals working in the best hospitals’ specialties departments should have done “it” (what ever your parents’ medical situation is), worked with “it,” handled “it”–over and over and over.  Thus, they can instill confidence in you and your parents based on countless experiences with the expected and unexpected.

4. It takes hard work to recover well from certain procedures.  The skill of the professionals in the follow-up is a significant factor in hastening recovery and instilling a positive outlook. Elderly parents need to do whatever is necessary to move forward so the hospital experience doesn’t take then down a notch.

5. And yet–there are emergencies when we do what we must in a hurry. And there are times when we know the decisions we make are crucial and we may get only one chance to do it right. But even then, the professionals in the best hospitals can come to the rescue.

Have you had this experience?

Two true stories will bring the “best hospitals” theme to life in this coming Tuesday’s post. One an emergency (stroke); the other a well-thought out (after arguments and pressure) plan to treat advanced colon cancer. While not planned at the outset of the each health crisis, the best hospitals figured prominently in both. In the meantime, US News & World Report is at your newsstand now.