Hospitalizing a Loved One with Dementia

Whether it’s for a planned procedure or a medical crisis, hospitalization can be chaotic and confusing for both family caregivers and a patient with dementia.

Hospital admission is the process of getting the patient set up for a room and bed, and clinically with the right medical orders and care plan. The admissions desk takes care of the first part: paperwork regarding insurance, contact information, and internal hospital planning.

The clinical admission is then done by the hospital doctors. This includes taking the patient’s history and conducting a physical exam. Next, orders for monitoring and treatment are written based on the patient’s needs. If your loved one begins in the emergency room, these evaluations will first be done there. But if an overnight admission to the hospital is necessary, the steps will be repeated, because the hospital itself has a different structure and staff, as well as a longer-term treatment vision than the emergency room. Although this process can seem confusing and redundant, think of it as dealing with two separate entities

To help get your loved one’s hospital stay off to the best start, take these steps during the admissions process:

1. Explain the person’s dementia status.
Make sure it’s clearly marked in your loved one’s patient chart that he or she has dementia as well as the stage of dementia. It can also be helpful to explain what your loved one can usually do and not do for him or herself.

2. Bring a summary of ongoing medical conditions.
Be sure to make an up-to-date list of all of your loved one’s conditions, which you can give to medical personnel. Hospital doctors need to understand which other conditions and treatments might affect care.

3. Bring all medications the person has been taking.
An up-to-date list (including the drug’s name, purpose, dosage, and timing of doses) is important, but much better is to bring the actual containers with the medications. Don’t forget any regularly used over-the-counter meds, herbals, or supplements.

4. Stay available to give needed information.
Especially throughout the admission process, but also afterwards, it’s best for a patient with dementia to have a caregiver (or other person familiar with his or her case) around at all times to provide his or her case) around at all times to provide an accurate history and to answer hospital staff questions.

5. Make clear who the medical decision makers are, and specify a point of contact for the hospital.
Be sure to let staff know which family member has been helping to make medical decisions. If your loved one has paperwork related to a durable power of attorney for healthcare, an advance directive, or a living will, bring copies to the hospital staff.

If your loved one has never filled out paperwork designating a durable power of attorney for health care, in most states the default surrogate decision-maker is the legal spouse. If there’s no spouse, it’s the next of kin, usually adult children or siblings. Especially when there’s no paperwork on hand, specifying which family member has been taking on the medical-decision support role is helpful. Streamline the process—and avoid dangerous crossed wires or missed information—by identifying one spokesperson.

6. Let hospital staff know what should be done in the event of a life-threatening medical emergency.
Most hospital doctors will check at admission to see if a person prefers to be “DNR,” or “do-not-resuscitate.” This means that if the heart stops, the person does not want to have CPR. (The alternative is usually to be “Full Code,” which means that CPR, defibrillation, and breathing machines can be used if needed to revive a person.)

If you have any other paperwork providing guidance about medical care, such as an advance directive, living will, or POLST form, be sure to give a copy to hospital staff.

Leslie Kernisan, M.D. and Paula Spencer Scott, Caring.com. www.senioritylifecare.com/caring-checklist/