Hope for living, loving, and caring with no regrets!

Self-care is Self-preservation

Episode 81

Rayna Neises, ACC, host, reflects on the thoughts shared during last week’s interview with Beth Suereth regarding caregiving during hospital stays.  Although you might not be there right now, the odds are that a hospital stay will be part of your caregiving journey with your loved one.  This week Rayna expands on the suggestions Beth provided:

  • Find out what the hospital’s regulations are related to COVID.
  • Know these three terms and be able to communicate with health care professionals the information related to them:
    • Baseline
    • ADL (Activities of Daily Life)
    • HAD (Hospital Associated functional Decline)
  • Help your loved one to stay oriented during their hospital stay.
  • Watch for signs of Hospital Induced Delirium and take the necessary steps to intervene.
  • Bring items from home to personalize the room.
  • Discharge from a hospital stay can mean just that they do not require acute care any longer vs. they are fully recovered.
  • Find out what support is available to help you through the recovery stage.


*Transcript is an actual recount of the live conversation

[00:00:00] The best preparation for tomorrow is doing your best today. This is a quote from Jackson Brown, Jr. And it can be applied to so many different things. But today we’re going to talk about your loved one and the hospital. Welcome to A Season of Caring Podcast where there’s hope for living loving and caring with no regrets. This is Rayna Neises, your host. And I’m really glad that you’ve joined me today.

[00:00:33] Hospital stays are difficult. There is no other way to describe them. With COVID, it’s made it to a whole new level. And keeping in mind, the COVID regulations vary from hospital to hospital it is important to know if you are facing a hospital stay with your loved one to learn what that hospital’s regulations are.

[00:00:58] I visited the CDC website, hoping to find more information to share with you about the regulations and really it was just the general information. Be aware of the correct exit and entry for visitors. Make sure that you are not visiting the hospital if you have any symptoms at all, that could be COVID related.

[00:01:20] And then those basics that have been drilled into our head over the last year and a half, wash your hands distance, and definitely make sure that you are doing the best that you can to avoid exposure either for yourself or the person that you’re visiting in the hospital. So there are the basics. I really appreciated our podcast last week with Beth Suereth.

[00:01:43] Where she talked more in detail about how to navigate the hospital with your loved one. Both with the staff members and for yourself. So if you haven’t listened to that podcast, I would really recommend that you check out Beth Suereth interview.

[00:01:58] So as I was doing some additional research about hospital stays and looking for information, that would be helpful to you as a family caregiver. I ran across a ,Geriaterian, Elizabeth Eckstrom’s book, The Gift of Caring. And she recommends that you know, three key medical terms. And I found this really interesting, and I do think it will be very helpful to you.

[00:02:22] The first medical term that is really important for you to understand in dealing with, especially elderly who were in the hospital is the baseline.

[00:02:32] All of us have a baseline. And when we think about what the word is, we probably go to a place that actually, yeah, it makes sense. Our baseline is what our normal everyday ability is. And this is the normal before we got sick, that caused us to enter into the hospital. So the normal, physical and cognitive abilities of the person who is in the hospital, that is the baseline. And it’s important to be able to communicate with the doctors, what the baseline was.

[00:03:05] From there. She went on to mention the second term, and that was A D L, which is activities for daily living. And these are daily living things, those things, which you can or can’t do for yourself. Before you enter the hospital. This is a list of physical and cognitive activities. Driving a car, balancing the checkbook, making phone calls, cooking bathing, all types of daily living activities. That your loved one were capable of before or after the hospital stay. So understanding ADL’s, these can be used even with communication with insurance companies. Or long-term care facilities or rehab facilities. ADL’s is a language that’s used when they start to struggle with those activities for daily living.

[00:03:58] The third one that she emphasized was HAD or Hospital Associated- functional Decline. In her book, she mentioned that 30% of patients over 70 will be discharged with permanent decline associated with this Hospital Associated- functional Decline. If your loved one is over 70 and they go into the hospital them coming out of the hospital with the same level of ADL’s the same ability to be independent in those activities for daily living, it’s not good. So the best way to protect them, she goes on to say is to help them stay oriented in their stay at the hospital. And this again comes in to play. When we think about being able to visit them and spend time with them.

[00:04:53] Some of the things that you need to do to help them to stay oriented are make sure they have their hearing aids. Make sure they have their glasses, on not just with them in the room. But help them assist them in being able to use these devices so they can stay engaged in their environment. Make sure the lighting is good. If they could have a view out their window of nature or life in general, that helps them mentally speed stimulated and stay oriented. Help them to get up regularly, if it is safe for them to do that. And as soon as it is safe, And then surround them with familiar items, things that they really love from home. So those were all things that Elizabeth Eckstrom’s book mentioned can really be helpful. And I thought those are some really practical tips for you as a family caregiver, to be able to be aware of in your communication with the medical field, as well as to help your loved one, not suffer from decline while they’re in the hospital.

[00:06:00] Some additional reading that I did talk to about the hospital induced delirium, which often triggers these declines. Commonly hospital induced delirium is caused by sensitivity to new medications or unfortunately pain medications. Oftentimes pain medications can trigger these reactions in our loved ones. So really being aware of any of these types of symptoms that bring on this delirium can be really helpful to get an intervention quick.

[00:06:33] So knowing as well that some of the things that can cause the delirium include the busy environment, if your loved one’s used to living at home in a quieter space with less in and out, just being aware that that busy-ness can be really difficult for them. And possibly limit the number of people visiting or other activities that are not related to their medical treatments. The noisiness of the environment, even the very bright lights and the continually disrupted sleep. These are not all things you can control. But let’s think about some things that might be able to soften the impact of these things.

[00:07:14] If your loved one loves music, having that soft music in the background, or even headsets on can be really helpful to quiet the noise that could be stressful to them and help them to be able to relax. What about a sleep mask at night? They’re going to be interrupted. Blood draws are going to happen, vitals need to be taken, but if they can maybe black out some of that visual clutter that’s impacting them at night from all of the monitors and the lights, that can really interfere with sleep. So if there’s a way to help them get better sleep with a night mask or earplugs. Or ear phones with music those things can really help.

[00:07:56] Also offering them comfort of the temperature. I know my dad was really sensitive to cold. So making sure that they have blankets, maybe a favorite blanket from home or a sweater that they really like. Asking if they can wear their own clothes versus the hospital gown. So that they can be as comfortable as possible.

[00:08:17] Moisturizing those arms and legs, even lip balm to help because the environment can really dry them out. Think about how you can bring them comfort while they’re in the hospital. One of the things, as I was reading about this topic, I really hadn’t thought much about was bringing those personal items from home. As dad was in the hospital, his longest length of stay was when he had surgery

[00:08:43] It was a long, long, nine days. I believe that he was in the hospital and he was delirious that part of that with the infection. But as he continued to improve, we definitely brought in some puzzles. Had some card games. But we’re like, we didn’t think a lot about bringing in other items from home to make it feel as homey as possible.

[00:09:04] So when I read this tip, I thought that was really helpful. Pictures of family members, again, comfy things that just bring them the feeling of home can really help keep their spirits up help with that orientation.

[00:09:19] Some additional tips are things like helping them to know what day it is and staying engaged in the time of day. These things can really help their mind stay with you and have less struggles with delirium or other issues of decline while they’re in the hospital. So I hope you found some really great tips to hold onto when I think about preparation and I think about hospital stays to me having those med lists available, knowing what some of their favorite items are that could be easily taken to the hospital, just putting on some different lenses to view their world, to see how you could really help them to be as at home as possible.

[00:10:04] And then also maybe making that list today of the ADL’s, the living activities that they are able to do independently at this point. So you have a baseline in case something happens. Checking that information frequently. And just knowing that you have things up to date in case that emergency happens. And your loved one finds themselves in the hospital.

[00:10:27] Now we often think about the hospital stay and how difficult that can be communication, all of those things that we talked with Beth about. But the other thing that I was reading up about is just helping us to really grasp the concept of that hospital stay, the purpose of the stay and the discharge.

[00:10:47] So we know our loved one has ended up in the hospital because they’ve been in crisis. If there’s any way possible, not to admit that is usually what happens. So if your loved one is spending time in the hospital, there is a medical crisis that needs attention, that required of a hospital. And that means that once they recover to a point that that level of care is not required then they will be discharged.

[00:11:18] Well, when we think of being discharged from the hospital, honestly, we think of being better, right? But the truth is discharge means that we’re being released because we’re actually not needing that level of care any longer. It doesn’t necessarily mean that we’re fully recovered. And really understanding that can help us to be more realistic in our expectations of what life is going to be like after this hospital stay.

[00:11:47] Is there a decline that we’re going to need to continue to improve in order to reach the same level of independence that was there before? For example. When my dad had the blood clot and was admitted to the hospital, he had to have surgery. And part of that surgery included leaving some incisions on both sides of his calf muscle. There was a lot of pain involved in that. And so walking was not something he was able to do independently when he left the hospital. Before the medical event, he was able to walk without a problem, but leaving the hospital just because he was discharged, did not mean he was now walking on his own again.

[00:12:31] So he was discharged to a rehab facility where they worked on helping him to get his strength back and be able to safely navigate his home. But understanding that just because he was released did not mean that he was fully recovered. Rather he needed to spend some time working on that recovery. And even once he was released from the rehab facility, he had not recovered to the same level in which he was at when he went to the hospital. I give you that example, just so you can kind of see how sometimes we find that our thinking is that we will get back to where we were before the event happened. And sometimes that’s not going to happen.

[00:13:14] In our case with dad’s age and other medical conditions, he actually never recovered. Obviously, that’s not what happens most of the time, but it does happen. So understanding the physical strain on the body can really create a setback that they’re not able to come back from.

[00:13:33] So I really thought it was helpful for us to think about the importance of discharge and understanding that really a successful hospital discharge means that they leave the hospital and they continue their recovery without major problems.

[00:13:51] They’re still going to need extra care and understanding what the doctor anticipates that extra care will look like. For some, like my dad, it will be a rehab facility for others there’ll be able to come home with in-home health care coming in to offer some basic physical therapy or assistance at home until they get their strength and navigation back.

[00:14:14] But it’s extremely important to follow the doctor’s discharge orders and be realistic of what the new situation is, not just for you, but for your loved one. So having those conversations with your loved one, making sure that they really do understand what the doctor’s telling them, what their limitations are. What their need is to do rehab in order to get back to where they want.

[00:14:39] Hearing that information from the medical professionals will often make it easier to hear and more likely to be followed through on. So helping your loved one, really grasp what they’re looking at. What is this recovery look like and how long, how much of it is going to be on their shoulders. Much of this recovery is a physical recovery and it does take being willing to do the exercises and go ahead and push them to walk, build their stamina, that type of thing. And sometimes that can be a real bone of contention between family, caregivers and their loved one. So really making sure they understand and have a realistic expectation of their recovery and length of recovery can be helpful.

[00:15:25] This comes right back to what I always am talking about caregivers. It is about getting the support that you need. If you were not in an active role of needing to be with your left one all the time before their hospital stay. You probably have found yourself in a place where you needed to be there a lot during their hospital stay, but you also need to be prepared for what they will need when they’re out of the hospital.

[00:15:53] As I always say, if you’re trying to put it all on yourself and you’re not asking for help, you’re going to find yourself in a situation that isn’t good for either of you. So make sure you’re considering what support is available, asking for the support that you need, understanding the options that are available to you and having those blunt conversations with your loved one. You cannot continue to work and do everything that you have been doing before if you are now committing to being with your loved one all the time in their home. Make sure you’re asking neighbors, friends, family members to help you with a new load of caring for your loved one as they are in the recovery stage.

[00:16:40] I think just that mindset shift, from being in the hospital and having all of that attention and all of those needs really upfront and urgent in your mind to realizing that when they’re released, they’re coming home, but many of those needs are still there. That friend who’s offering to bring a meal or drop off some food for the freezer or pick something up at the grocery store can really make an impact on both you and your parents. As you are adjusting to their recovery or possibly the new normal.

[00:17:15] As a family caregiver, as usual, there are so many things to know and learn in this season. And I just hope that listening to this podcast today has helped you think of some things that maybe you’ve never thought of before, been willing to make a shift in your mindset when it comes to recovery and getting out of the hospital and understanding more what this season’s going to look like. Like I said, you might not be there right now, but the odds are good, that there will be hospital stays in the future for your loved one. And I hope the best for you and your family as you learn to work together through this season to support your loved one.

[00:17:58] Thank you again for joining me today, just to reminder A Season and of Caring Podcast is created for the encouragement of family caregivers. If you have financial medical or legal questions be sure to consult your local professionals and take heart in your season of caring

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Meet Your Host

Rayna Neises, ACC

An ICF Certified Coach, Author of No Regrets:  Hope for Your Caregiving Season, Podcaster, & Speaker, offering encouragement, support, and resources to those who are in a Season of Caring for Aging Parents.

Her passion is for those caring and their parents, that they might be seen, not forgotten & cared for, not neglected.

Rayna Neises, ACC

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