Preparing for Transitional Care

        Buddy Up!

 

Feeling secure and cared for when you return home after a medical emergency assists in your recovery and required some planning today.  Fifteen percent of all discharges result in re-hospitalization due to lack of discharge planning by hospital staff and patients alike.  Talk with your friends and family. Let’s buddy-up and agree to care for each other.   And remember, every patient has the right to refuse discharge until they can be returned home safely.

 

·       Think. Plan ahead. Talk with friends. BUDDY UP!

·       Complete essential legal documents: Trust, will, Advanced Health Care Directive (aka Power of Attorney for Health Care) and a “springboard” Financial Power of Attorney (only goes into effect once the patient/client lacks capacity to make their own decisions).

·       Do you have a Long Term Care Insurance policy to help pay for home care or extended skilled nursing care? 

·       Due to Federal HIPPA regulations (re: confidentiality), consider having medical information release forms signed and filed with your doctor.

·       Mail or email your Advanced Health Care Directive to your attorney, doctor, and local hospital today, asking them to keep them on file and in your chart. 

·       Keep your medical records current and available, including information on updated medications.  (Is your File of Life on refrigerator for first responders?)

·       Make arrangements for who will take care of the following needs:

o   If it’s a 911 call that takes you to the hospital, who’ll clean up any mess before you return home? Put clean sheets on your bed? (Who now has a key to your home?)

o   After a long stay in the hospital, who’ll clear out your refrigerator and stock it with fresh, healthy and easy to prepare foods?

o   Who’ll collect your mail (and email?) and go through it for bills and time sensitive information?

o   Who can pay your bills (springboard financial Power of Attorney)?

o   Who loves animals and can take care of and feed your pet(s)?

o   Do you have a friend or neighbor who can water your garden and/or houseplants?

o   Who is available to transport you safely from the hospital to home? (Someone should spend the first night or two with you.)

o   Can they pick up your medications and medical supplies before you come home or immediately after?

o   Who will know which family, fiends and neighbors to call to let them know you’ve been hospitalized?

o   Who knows which friends and family you’ll want as visitors (and those you won’t want to see) and can be your gatekeeper?

o   Who has the ability to become your medical advocate both during and after a hospitalization?  They should talk with the hospital discharge planner early in your hospital stay.

o   Can they oversee the installation or delivery of durable medical equipment (DME)?

o   Who understands Medicare and/or MediCal and can assist you throughout your illness?

o   Do you know someone who can assist or oversee setting up services such as In Home Support Services (IHSS), Visiting Nurses, Hospice, etc. before you’re discharged from the hospital?

o   Who’d be good as your social networking hub for disseminating information about your recovery as the days and weeks pass?

o   Can someone coordinate meals for the first days or weeks once you’re home?

o   Who’s comfortable assisting with medications and medical assistance such as changing bandages, cleaning wounds, etc?

o   Do you have an emergency savings tucked away that they can access for groceries, medications, medical supplies, pet food, during the first days back home?

 

At the end of the day your safety is paramount. Help others help you by communicating requests and agreeing to reciprocal and shared responsibilities.  Let’s build a supportive network of caring LGBT seniors in our 60+ program and our LGBT community.

Other resources on the internet to assist coordination of care:

 

·       Share the Care - http://www.sharethecare.org/

·       Lots of Helping Hands - http://www.lotsahelpinghands.com/ltc/home/