What To Do If Your Ageing Parents Are Hospitalized While You Are Abroad
Jane Allison Austin
I know what a joy it is to live overseas – and I also know the difficulty of living 3,000 miles away from an ailing, ageing mother, even if you are living in the same country. If you are living abroad and your parents are ageing back home, it is important to prepare yourself before a crisis hits.
Maybe you have siblings living nearby back home, or (like me) maybe you do not. I moved back east for college and stayed there. Though we invited my mother to move back with us after my father died from Alzheimer's, Mom wanted to stay in Southern California where I was raised. I have since learned that many older ladies will not leave southern California for parts colder to be with their kids!
My mother's debilitation in her mid 80s brought me to leave my husband caring for our horses and beloved Newfoundlands at our farm in Virginia, for me to move back "home" to watch over my mother. I became her advocate with the physicians, hospitals, nursing homes, Medicare, secondary insurance and issues that I never knew anything about until I "crashed" into the medical system. Even having practiced law for 20 years did not prepare me. Only living through it really taught me what to do.
Education
If you are living abroad and your parents are ageing back home, I highly recommend that you prepare yourself for all probabilities before anything happens. Education is key. First, talk to your folks. Do they have their estate planning in place? Apart from wills and trusts, from my experience, the most important documents regarding healthcare (in the United States) are: a Durable Power of Attorney and an Advanced Medical Directive (also called a Living Will, or Power of Attorney for Healthcare, depending on your parent's state of residence).
A Great Physician
The next step is to make sure your parents have a great physician. Follow your parents every day in the hospital, especially since in today's world of increasing healthcare costs and cuts, the trend (in the United States at least) is toward a hospitalist system where physicians work solely for the hospital and who do not know your parents. This lack of continuity of care can be confusing and unsettling both to your parents – as well as potentially being disruptive to their medical care.
Help and/or encourage your parents to find a physician who knows their history and will follow them to the hospital throughout their stay if they are ever hospitalized. Introduce yourself to the doctor when you go home, or at least by phone, so you have a relationship in case the unexpected happens. If you have a medical team already in place for your parents, you can at least have the comfort from far away in knowing that they are being well cared for until you or your family members are able to get there.
Four Important Steps When Your Parents Are Hospitalized
Here are the three first steps that are important if your parents go into hospital, even if you are far away from home.
1. Do not panic. It is natural to be fearful and overwhelmed when one of your parents is rushed to the hospital. Accept your feelings as natural, but put them aside right away. You are your parents' best advocate and you need to focus on what comes next. If you live far away, immediately call a friend or sibling, even a friend of your Mom or Dad, who can go to the hospital and be your liaison on the ground until you get there. You will quickly get frustrated and angry trying to get information about what is happening with your parent(s) unless you have someone on the scene looking out for you and letting you know what is going on. If you cannot get to the hospital, there are also elder care advocates like myself who can be your eyes and ears and fight through the system so your parent gets the best care and you can make informed decisions.
2. Contact your mother or father's normal physician immediately. It is very important that your parent have a general internist physician (preferably a gerontologist if you can find one) who is willing to follow your parent(s) to the hospital if necessary. This is obviously something to arrange now, before any unforeseen hospitalization occurs.
3. Do not be intimidated by the hospital system. The reality is that hospitals have their own protocols and systems which may work for them, but may not necessarily work for you. You land in a place that is all new to you – and they have got the advantage. Do not be afraid to ask questions of the nurses, other staff or the physicians. Hospitals tell us that their mission is to take the best care of their patients, but the reality is the only person who will be looking out for the best interests of your parent is you or your advocate.
When my mother was in the hospital, I walked up to the nurses' station behind which about ten people were chatting away, and the one who was sitting at the desk right in front of me refused to look up. I finally called out in desperation, "Hello, anybody home?" They all turned in disbelief, but I got what I needed.
4. If warranted, keep your parent in the hospital for three overnights. True, you do not have complete control over this, that is why the presence of your parent's own physician can be so important. However, if your parent will have to go to a rehab facility or go home for therapy, and he or she is on Medicare, Medicare will generally only pay for follow-up treatment if your parent has spent three full overnights in the hospital. Not days, but overnights.
Do not let them try to push your parent(s) out too early. If it is legitimate for them to stay in the hospital, make sure they stay. I had a friend who unfortunately did not know the three-day rule at the time and her mother wanted to leave the hospital early. She needed therapy at home as the doctor prescribed but had to pay for it herself because she did not meet the three-overnight rule.
More Articles To Come
I hope these insights have been helpful. Stay tuned for my follow-on articles in future months about: more important steps when your parents are hospitalized; manageing the hospital discharge planners; following the continuing care of your parents after they leave the hospital; and how to plan and pay for the costs of caring for your ageing parents.
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