My dad arrived home from Florida on May 15, in preparation for a June 1 surgery date for a Total Hip Replacement. During that brief period, we attended two physician appointments, an educational class specifically on the topic of hip replacements, and pre-admission testing. We also prepared for the remote possibility that following the surgery, he would need short-term rehabilitation in a skilled nursing facility.
Whew, there was a lot involved! And I knew that the only way we could accomplish it all was to prepare way in advance and for me to take time away from other things. So let’s take a look at some of the details of our experience, to help you think through the kind of preparation required should you find yourself in similar circumstances…
After finding the right surgeon and hospital, going through a comprehensive diagnostic process and outlining an appropriate plan of care, we embarked on reviewing his insurance policy. He had elected a Medicare Advantage Plan in lieu of traditional Medicare, so we went right to the detailed Certificate of Insurance or Evidence of Coverage to review coverage levels, network parameters and what was required so that the policy would pay his claims to the maximum potential. He knew he would have some responsibility for deductibles and inpatient co-pays, so he wanted to budget appropriately.
Because dad lives in Florida and has a summer residence in Rhode Island, we had to switch his insurance to a Florida-based plan (all Medicare plans are driven by county/zip code). But we searched for one with a national network and an out-of-network benefit so that he could access care in RI and MA where I selected the specialist and hospital for him.
Preparing for the surgery itself required a 70-minute, three-way phone call to the insurer to activate his “Passport benefit” and to check that both the hospital and the surgeon were considered in-network.
Whenever possible, a three-way call is an efficient way to check on insurance benefits for someone else as they can grant permission, in real time, for information to be shared with you. Remember to have the insurance ID card and pad and paper in hand so you can document the conversation during the 30-45 minutes you’ll probably be on the phone.
Care From Different Health Systems
When, as in my dad’s case, you receive healthcare from different healthcare systems, don’t depend on medical information being efficiently transferred to the right place at the right time. Instead, we requested and hand-carried the diagnostic tests he had in Rhode Island (including a CD of X-Ray images); a comprehensive summary of my father’s health status and a detailed medication list.
Medical history and medication lists must be shared with the specialist performing the surgery and will also be requested during pre-admission testing and on the day of surgery. Although frustrating for the healthcare consumer to have to repeat the same information over and over, many of our medical record systems are not streamlined enough to prevent this. So be prepared with duplicate copies of documentation and anticipate requests for the same information from different providers.
Education From Providers
While preparing for elective surgery, you should expect to be educated by every professional that you encounter (if it is not forthcoming, ask for it). When possible, participate in any formal classes made available or do some reading. All of this will only benefit you.
During the pre-operative surgical appointment, my dad’s surgeon did a fabulous job reviewing the X-Rays so that my father could fully appreciate the advancement of arthritis and see how his anatomy was going to be manipulated to insert an artificial joint. Understanding the physics of it all relieved any anxiety he had about bearing weight on the hip post-operatively.
Attending the class allowed him to know the options for anesthesia and make a conscious choice of one form over another. Because he then understood the risks and benefits, he could superimpose his individual preferences onto the available options. He also felt reassured by the discussion of pain management and the rating scale of 1-10. This helped him make appropriate choices about pain medications so that it would be kept under control.
Lastly, he knew that upon arrival in the hospital the case manager would help him prepare for discharge. The remote possibility of short-term rehabilitation in a skilled nursing facility was explained, so we made it a priority to visit two facilities ahead of time so that we’d have a list of preferred places in hand in the event it was needed.
Other Family Members
When one member of a couple is experiencing physical decline, we must also be conscious of the impact on the other member. In our case, for example, I had no idea that my dad was no longer able to put on his socks or tie his shoes and that my mom was performing these functions for him. Thankfully, mom was able to pick up some of these chores (and many others). In many cases, that’s not possible and provisions must be made.
We chose a hospital and doctor close to my home so that mom and I could accompany dad on the day of surgery and be there both in the recovery room and in his hospital room. She stayed overnight with me and, between the two us, one was able to be present to observe his physical therapy sessions and speak with the nurses and doctors. By the time she drove him home on June 3, I felt comfortable that she’d gotten some rest, as her duties as primary caregiver would ramp up again as dad recovered.
I am thrilled to say that my dad’s successful surgery is behind him. He went home two days following the procedure using a walker and will be transitioning to a cane this week. The physical therapist who treats him at home because of his Home Care insurance benefit has been fabulous. He continues to walk increased distances every day.
But it’s a lot to manage, I understand. And so as you prepare for a healthcare situation with your own parents, consider the following questions:
- Where will the time for you to do all of this come from and what will suffer as a consequence? Will it be your own family, your work or leisure time that must accommodate? Do you have any family members with whom you can share the responsibilities?
- What do you know about your parents’ insurance coverage and the provisions required to activate coverage and maximize benefits?
- What do you know about your parents’ health status and medications? Have you ever met their providers, both primary care and specialists?
- Do you know if one parent is performing caregiving tasks for the other and, if so, what’s the toll on the “healthy” parent?
- Do you know how to assist them with accessing medical information?
If you don’t have the answers to all these questions, I recommend initiating conversations with your parents now. The sooner you begin doing some homework, the more prepared you’ll be should the need arise.