Long-Term Care Planning: Hospital Stays
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Hospitalization for an elective (planned) surgery for an older adult is in theory easier than an admission through the ED because you have time to get ready. But there's a lot to think about for your long-term care plans, no matter what the reason for the surgery.
All surgery has risks, and you want to be sure that the potential benefits are worth the risks. Someone's age alone should not be a reason to decide against surgery, but a very frail person in poor health and perhaps with moderate or advanced dementia is probably not a good candidate for surgery. Be sure to ask about and consider alternatives.
The surgeon is generally a specialist recommended by the geriatrician or the primary care physician. An orthopedic surgeon replaces hips and knees, a cardiac surgeon replaces valves and inserts pacemakers and stents, and a renal surgeon takes care of kidney problems. They are expert in their specific area, but you need someone to look after the whole person, and that is the geriatrician or primary care doctor.
It is important that these doctors talk to each other, not just in the initial referral but also as the surgery is approaching and definitely afterward. The time spent in the hospital may be very short, which is a good thing, but it also means that the recovery time needed at home is longer, and care must be taken to avoid complications.
Older people react differently to anesthesia, may experience more pain, and take longer to recover than younger people undergoing similar surgery.
Many hospitals will inform a primary care doctor when one of his patients is admitted, but this doesn't always happen. If you are the patient, ask a family member to call your regular doctor's office to give that information and the name and contact information of the hospital doctor in charge of your care.
And ask the hospital doctor — probably a hospitalist — to contact your regular doctor to discuss your diagnosis and treatment. This is especially important as you get ready to be discharged because you will need follow-up at home. Both hospital and primary care doctors are busy and may need some reminders about making sure they both know the specifics of your care.
Because so many older adults are undergoing surgery, the American Geriatrics Society and the American College of Surgeons worked together to create a series of guidelines for surgical teams. These best practice guidelines are intended for surgeons, but they are also useful for the person undergoing surgery and family members. Here are some of the key points:
Talk to the surgeon about what to expect from the surgery:
What are the treatment goals? Will the surgery fix the problem or will there still be limitations?
What kind of anesthesia will be used? Are there common side effects?
How long will the surgery last? How long will the person be in the recovery room?
How will pain be treated? (Don't be misled by the common response, There won't be much pain, just a little discomfort. )
Will there be physical limitations such as being able to climb stairs, get in and out of bed, and use the toilet? Even a generally successful surgery like hip replacement is always followed by a period of restrictions on mobility. Can the person follow instructions so that the surgery is not undone by a fall or other accident?
Ask where you or your parent will go after surgery. You may expect and want to go home, but the surgeon may recommend a short stay of a few weeks in a rehabilitation program, probably in a nursing home rehab unit. There you can recover more fully and get therapy to restore and improve function.
Even that new hip takes time to get used to, especially if you have been in pain and not walking properly for some time before the surgery.
Ask about costs. Medicare or other insurance will cover some or all of the surgeon's fees (but there will be a copayment) and the hospital fee. But the anesthesiologist will submit a separate bill.
Review Medicare's policies if you are in Original (fee-for-service Medicare), and if you are a member of a Medicare Advantage plan, ask the plan for details about costs. For Medicaid and other insurances, ask the case manager.
You or your relative may be eligible for some skilled nursing visits and possibly physical therapy at home after discharge from the hospital or rehab program. Ask about those services as well, because it will take some time to get used to being at home, and everyone can benefit from some extra help.
Make sure the surgeon is aware of any special problems, like depression or alcohol use that may affect responses to surgery or recovery. For a comprehensive list of the guidelines, go to Next Step in Care.