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North Carolina Division of Aging and Adult Services

Hospitalization Happens

A trip to the hospital with a loved one who has a memory disorder can be stressful for both of you. This brochure can relieve some of that stress by helping you prepare for both unexpected and planned hospital visits. In it you will find steps you can take now to make hospital visits as easy as possible, tips on making your loved one more comfortable once you arrive at the hospital, and advice on working with hospital staff and doctors.

Share this information with family and friends, keep this brochure in a handy spot and prepare now for the future.

• Hospital Emergencies: What You Can Do Now
  
• At the Emergency Room
  
• Before a Hospital Stay
  
• Before Going to the Hospital
  
• During the Hospital Stay
  
• If Anxiety or Agitation Occurs
  
• Working with Hospital Staff
  

Hospital Emergencies: What You Can Do Now

Planning ahead is the key to making either an unexpected or a planned trip to the hospital easier for you and your loved one. Here is what you should do now:

• Register your relative for a SAFE RETURN bracelet. People who are lost may be taken to an emergency room. The bracelet will speed the process of reconnecting you and your loved one.

• Know who you can count on. You need a family member or trusted friend to stay with your loved one when he or she is admitted to the emergency room or hospital. Have at least two dependable family members, neighbors, or friends you can call on to go with you or meet you at the hospital at a moment’s notice so that one of you can take care of the paperwork and the other can stay with your loved one.

Pack an "Emergency Bag" containing the following:

• A sheet of paper listing: the person’s name, nickname, address, insurance companies (include policy numbers and pre-authorization phone numbers), Medicare and Medicaid card numbers, doctors (include addresses).
• A list of important phone numbers such as doctors, key family members, minister and helpful friends.

• A list of all current medicines and dosage instructions. This list should be updated when there is any change.

• A list of medicines taken that have ever caused a bad reaction and a list of any allergies to medicines and foods.
• Copies of important papers such as Durable Power of Attorney, Health Care Power of Attorney, Living Will.
• Extra adult briefs (i.e. Depends) if the person usually wears them. These may not be easy to get in the emergency room if you need them.
• A change of clothes in case the person’s clothes become soiled or torn and a plastic bag for the soiled clothing.
• A card that says, "Please Understand - My companion has a memory disorder - Let me help with specific questions." You should avoid talking about your relative’s memory changes or behaviors in front of him. This can be upsetting and embarrassing to your relative.
• Moist hand wipes such as Wet Ones.
• A reassuring object, a walkman with a favorite tape or a portable radio.
• A writing pad and pen so that you can jot down information and directions given to you by hospital staff. You will also want to write down your loved one’s symptoms and problems. You might be asked the same questions by many people. Show them what you have written instead of repeating your answers.
• Pain medicine such as Advil, Tylenol or aspirin. This is for you, the caregiver. A trip to the ER may take longer than you think. Stress can lead to a headache or other symptoms.
• A sealed snack such as a pack of crackers and a bottle of water or juice for you and your loved one. You could wait for quite a while.
• A small amount of cash.
• If you have a cellular phone, put a note on the outside of the "Emergency Bag" to take the phone with you.

By taking these steps in advance you will greatly reduce the stress and confusion that can often accompany a hospital visit particularly if the visit is an unplanned trip to the emergency room.

At the Emergency Room

A trip to the emergency room may tire or even frighten your loved one. There are some important things to remember:

• Be patient. It could be a long wait if the reason for your visit is not life-threatening.
• Know that results from lab tests take time.
• Offer physical comfort and verbal reassurance to your relative. Stay calm and confident.
• Realize that just because you do not see staff at work, does not mean they are not working.
• Be aware that emergency room staff often has little training in Alzheimer’s disease so help them understand your loved one.
• Do not assume your loved one will be admitted to the hospital.
• Do not leave the ER to go home without a follow-up plan. If you are sent home, make sure you have all instructions for follow-up care.

Before a Hospital Stay:

If your loved one is going to the hospital for a planned stay, you have time to prepare and ask your doctor questions. Ask your doctor if the procedure can be done as an outpatient visit. If not, ask if tests can be done before going to the hospital to shorten the hospital stay. Ask if your doctor plans to talk with other doctors. If so, find out if your relative can see these specialists before going into the hospital.

You should also ask questions about anesthesia, catheters, and IVs. General anesthesia can have side effects. Ask if local anesthesia is an option and if you will be allowed in the recovery room.

Before Going to the Hospital:

• If your insurance allows, ask for a private room if possible. It is more quiet and calm.
• Let your loved one take part in the planning for the hospital stay as much as possible.
• Don’t talk about the hospital stay in front of your relative as if he is not there.
• Plan ahead. Make a schedule with family and friends to take turns sitting with your relative during the entire hospital stay.
• Shortly before going to the hospital, decide the best way to tell your loved one that the two of you are going to spend a short time in the hospital.
• When packing, include a copy of important papers such as a living will and health care power of attorney.
• Pack comfort items. Things to help your loved one feel safe and secure such as favorite clothes or blankets and photos.

During the Hospital Stay:

• Have someone with your loved one at all times if possible – even during medical tests. This may be hard to do, but it will help keep your loved one calm and make the hospital stay easier for him.
• Ask doctors to limit their questions to your relative who may not be able to answer. Instead, answer questions from the doctor outside your relative’s room.
• Ask the staff to avoid using physical restraints.
• Help your relative fill out menu requests.
• Open food containers and remove trays.
• Talk with your loved one in the way he will best understand.
• Remind your relative to drink fluids. Offer fluids and have him make regular trips to the bathroom.
• Know that a strange place, medicines, tests and surgery will make a person with Alzheimer’s disease more confused. He will need more help with personal care.
• Assume your relative will have problems finding the bathroom and using his call button.
• Sudden confusion can be caused by a medical problem. Ask the doctor if your loved one seems suddenly worse.

If Anxiety or Agitation Occurs:

Try some of the following:

• Remove street clothes from sight.
• Post reminders or cues if this comforts your relative.
• Turn off the television, the telephone ringer and the intercom.
• Talk in a calm voice and offer reassurance. Repeat answers to questions.
• Give a comforting touch or distract your loved one with offers of snacks.
• Listen to soothing music or try comforting rituals.
• Slow down, try not to rush your loved one.
• Give your loved one something to hold in his hands such as a book, photos or a favorite item.

Working with Hospital Staff

Remember that not everyone in the hospital knows the same basic facts about memory loss and Alzheimer’s disease. You may be their best teacher of what works with your family member.

You can help the staff by giving them a list of your loved one’s normal routine; personal habits; likes and dislikes; possible behaviors, what might cause them and how you handle them; and signs of pain or discomfort.

You should:

• Make the list easy to read with headings and short, simple statements. Have a copy with the chart and at the nurse’s station.
• Decide with the hospital staff who will do what for your loved one. For example, you may want to be the one who helps your family member get a bath, eat or use the toilet.
• Think about placing a poster above the head of the bed with key information, including names of people important to your loved one and the relationship (spouse, cousin, friend).
• Tell the staff about any unusual behaviors, hearing problems or communication problems your relative may have and offer ideas for what works best in those instances.
• Make sure your family member is safe, tell the staff about any previous problems with wandering, getting lost, suspiciousness or falls.
• Not assume the staff knows your loved one’s needs. Tell them in a nice, calm manner.
• Ask questions when you don’t understand hospital procedures, tests or when you have a concern.
• Realize that hospital staff are caring for many people and practice the art of patience.

Just the Facts-Hospitalization, Alzheimer's Association, Chicago, IL, 1992.

Making a Trip to the Emergency Room Easier, Rush Alzheimer's Disease Center, Summer, 1998.

For more information, contact Karisa Derence at the NC Division of Aging and Adult Services at 919-733-0440.

This brochure was supported by grant # CSH000176 from the Administration on Aging to the North Carolina Division of Aging and Adult Services as a product of the federal/state Alzheimer’s Services Demonstration. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration on Aging policy.