We pick up with Mrs. Jones a week later, and she has had a couple falls in the last week. She has some confusion and trouble urinating. Her children take her to the urgent care, and the doctors decide to send her straight to the hospital. At the hospital, Mrs. Jones undergoes urinalysis and complete blood count testing, and it is found that she has a blood infection and will need intravenous antibiotics.
While at the hospital, Mrs. Jones’ family takes turns to ensure she is supported and that they stay informed as to her health and developments. In this setting, if things aren’t going as planned or if the family has issues with the care, it is important to remember that any complaints can be reported to the Joint Commission, which is the hospital-accrediting body in the United States. Together Mrs. Jones’ son and daughter speak with the physicians and nursing staff and explain their feelings that their mother needs rehab in a facility setting prior to returning to her own home. At this point in time, it is important for Mrs. Jones’ family to understand the Medicare guidelines regarding the need for a three-day qualifying hospital admission to access her Medicare benefits for skilled nursing care in a facility.
Mrs. Jones now has to struggle with the decision on next steps. She must be self-aware of her care needs to help her make the decision to go home or proceed to a facility for inpatient rehab. This is where many people get into trouble. Choosing a rehab facility is not as simple as looking at reviews and trusting word of mouth. Mrs. Jones and her family must think through all possible scenarios, including the possibility of the need for a long-term stay should her rehab not achieve the desired results.
This is where Mrs. Jones will need to do her homework. She asks her children for help researching facilities in the area and finding one that has quality rehab and long-term-care beds should she need to transition to a long-term stay. Her family gathers information from multiple sources to make decisions. They begin trying to identify an appropriate facility that will meet Mrs. Jones’ needs by reviewing the 5-star ratings and comparing services via Nursing Home Compare on the Medicare.gov website. They also call the Long-term-Care-Ombudsman Office, make in-person visits to facilities, and ask their friends and other family members for suggestions.
Next month we will look at how Mrs. Jones and her family will use the information collected to make the best decision for her next steps. Mrs. Jones is lucky; she has a great support system. That isn’t always the case for all seniors. As such, we will also examine how a person who may not have a strong support system or advocate can access the same information to choose a facility that best meets their needs and health goals.
Christopher Stieben is Director of the ABLE Long-Term-Care-Ombudsman Program, which can be reached at 419-259-2891 (http://ombudsman.ablelaw.org). ❦