In some ways, when you are an only child (like me), it’s easy. Because I need to care for all the responsibilities associated with a sick or hospitalized parent – including taking care of the second parent that I’m so fortunate to have – there’s no discussion and no coordination of effort required. It’s all mine!
Sharing these responsibilities, on the other hand, while certainly offering some relief and assistance from the amount of work involved, comes with its own assortment of stress, anxiety and the potential for miscommunication. That’s why I suggest to my clients that in advance of any crisis (and as our parents age, crisis becomes nearly inevitable), they conduct a family meeting at which the agenda item is: “Emergency Plan If One of Our Parents is Hospitalized.”
Here are some things to consider in that meeting…
Health Care Proxy
A health care proxy is a person legally designated to make medical decisions in the event a given individual cannot make them for themselves. If you have one in place, terrific. But… does that individual actually know what the ill parent does and does not want in terms of healthcare intervention?
Note as well that couples often designate each other as their respective proxy. But as time has elapsed, cognitive decline may have occurred and that may be an impediment to good decision making. So make sure that if this arrangement is the case, the other parent is able and willing to make these critical decisions.
(Check out the March 2016 issue of this newsletter for more detail on health care proxies.)
Power of Attorney
This is the person who has been legally designated to make financial decisions, again, in the event a person cannot do so for themselves. The same questions apply: Does that person know what the first person wants and are they fully capable of making such decisions?
Emergency Room Liaison
At a time of crisis, this role moves to the forefront: Who will go to the emergency room to be present as care is initiated? In this role, this person must relay healthcare information to medical personnel as well as represent the baseline of what your loved one’s abilities were prior to becoming ill. In the case of Phyllis, my client mentioned earlier, she suffered a stroke, so it was important that her son relay that prior to the incident she was completely independent at home and fully able to communicate.
The Emergency Room Liaison’s role is to answer and ask questions until they know what the outlined plan of care is. In Phyllis’s case, and following many diagnostic tests and conferring with a neurologist, she was admitted and an MRI was scheduled for the next day.
Too many people descending on a healthcare setting can be overwhelming. The purpose of this role is to keep everybody in the loop. Phyllis’s family already had a texting group set up that included the parents, all the siblings and spouses, and all the adult grandchildren. Texting was their mode of communication. Another option may be a conference call at a designated time that any family member can call into.
Family Team Leader
Every effective team has a leader! Yours needs one too. This person serves as the daily conduit of communication with the healthcare team, a role which may include defining a set meeting or phone call time following morning rounds (ideally between 11:00 AM and noon); setting expectations for a review of the previous day’s events and tests; and planning for the current day. In my experience, healthcare teams appreciate it when a family is organized enough to ask for a standard mode of communication as it alleviates questions from multiple sources.
In addition, and if geography and schedules allow, it may be possible to have a family member stay with the admitted loved one, continuously, in shifts. The Family Team Leader can take on the role of coordinating these efforts and the person staying with your loved one can track every professional that comes into the room as the plan of care is executed. (Having a notebook in which things are documented is key to the success of this role. It helps the first person to review what went on and update the next person covering, as well as for communication back to the Family Team Leader.)
Who will call to introduce themselves to the case manager and be the point person for discharge plans? This should happen almost immediately following admission so that you are not caught off guard from the rapid transitions that can occur.
You’ll also want someone to visit rehabilitation or skilled nursing facility settings beforehand and confer with other family members on the criteria by which they will be evaluated. In Phyllis’s case, and in addition to overall quality of the facility, her family was looking for a setting that had a specialty caring for individuals with strokes and that was close enough for their dad to easily drive to.
With a loved one in the hospital, somebody needs to be in charge of the home. Mail could be piling up; bills could be going unpaid; food could be spoiling in the refrigerator; pets could be left uncared for.
Even if a second parent is present at home, somebody should be focused on that person. Do they need assistance at home with their own care, meal preparation, transportation, groceries, care of the house?
Whew! That’s a lot, I know, and in many families, some of these roles will be combined. However you decide to manage these tasks, keep in mind that just as we are all advised to have emergency plans in place for harsh weather or other unforeseen natural events, families need a plan to care for their loved ones too. Be proactive – your extended family members will appreciate it!