Your Senior Mom is in an NYC hospital. What Should You Do?

First, let me extend my sympathies and encourage you to channel all your patience because this journey will most likely be a bumpy one.  Keep reminding yourself that it is not the staff’s fault for the inefficiencies, the patient-to-staff ratio, the terrible food, the lack of coordination among doctors, the waiting, the list is endless, but it simply is the way it is.

Some NYC facilities (hospitals, emergency rooms, etc.) will be better than others. Hopefully, every home care professional you encounter is trying their best to keep your senior parent safe and onto the road of recovery as quickly as possible.  The reality of the situation is you are not in a hotel. You are in a HOSPITAL.

There are three main ways your elderly mom could have been admitted into an NYC hospital: planned admission, direct admission, or emergency room admission.

TYPES of Hospital Admissions

Planned Admission

Planned admission refers to a pre-planned or “scheduled” in-hospital stay after you and your doctor decide that you need hospital-based treatment.  Examples of planned admissions are scheduled childbirths (like a scheduled cesarean section), scheduled elective surgeries, etc.

If your admission was prescheduled, normally, NYC hospitals will proactively reach out to you from the Admissions or Patient Services Department (or a similarly named department).  A hospital representative will ask you to provide personal and insurance information during that call. Most likely, they will also tell you what you should expect when you arrive, what to bring, where to go, and answer any questions you might have.  This type of admission typically does not apply to seniors in NYC.

Direct Admission

A senior can get directly admitted into a hospital without going to the emergency room when your elderly loved one is sent directly by their physician or primary care physician who has admitting privileges at the hospital.

Most NYC-based hospitals have doctors who work for the hospital (i.e., employees of the hospital) and also have a private practice.  These physicians most likely have to admit privileges at the hospital they also work for.  Typically, if your physician or primary care provider admits you to the hospital, you should report to wherever they tell you to go.  Sometimes they will send you to the emergency room, and other times they will send you to the information desk.  Every hospital in NYC is different, so be sure to ask specifically the admitting doctor where your elderly loved one should go.

Hopefully, your admitting doctor will call the hospital ahead of time, so they will be expecting you.  The doctor will provide the hospital with your medical information and reason for admission, and this should (in theory) speed up the process.

It is worth noting is, more often than not, your admitting doctor (even if they are your primary care doctor) will NOT follow you in the hospital.  The hospital employs doctors called “hospitalists,” and they will follow you. On rare occasions, the hospitalist might consult with your primary care physician or specialists, but typically in NYC hospitals, you will be seen by a hospitalist and hospital specialists.  Upon discharge, you will be told to follow up with your community doctor and specialist for follow up, which we will discuss in more detail later.

This type of admission is an excellent example of why it is critical that your elderly parent has a primary home care doctor with admitting privileges to an NYC hospital.  Your elderly parent’s doctor can circumvent the stress and drama otherwise known as an emergency room.

Emergency Admission

Emergency room admission occurs when a life-threatening illness or injury requires immediate hospital care.  Typically the admission decision is made by an emergency department doctor or a hospitalist, and usually, elderly patients are admitted.  If your doctors decide you should stay in the hospital after emergency care, we will admit you to the hospital as an in-patient.  You can be admitted to a specific floor (usually specializing in a department like an intensive care unit or medical floor) or transferred to an observation unit.  An observation unit is NOT a hospital admission.  This is an important distinction if you are trying to gain admission to an acute or sub-acute facility.  Typically an NYC hospital will hold a patient in an observation unit for 24 hours to do what it says – observe the patient.

A Deeper Look at Emergency Rooms

For the elderly, hospitalization usually begins in the Emergency room.  Once the medical team decides that you need to stay in the hospital for one night (or more) you are admitted into the hospital.

Why are Emergency rooms so slow?

Usually, if you are in the emergency room, you are waiting (sometimes more than 12 hours) because the emergency room is out of beds and/or the treatment room. It is important to realize that emergency rooms do not see patients based on arrival time but based on the seriousness of the condition they present with.  In NYC hospitals, it is not an uncommon sight to see gurneys lined up head to toe in the hallways of emergency rooms.  Further, the emergency medical team will treat patients in the hallways.  The few emergency rooms in the hospital have been saved for true medical emergencies.  In emergency medicine, the name of the game is triage:  they will assess who is able to wait and who isn’t.  Generally speaking, if you are not the sickest or the oldest, you wait, so being in the NYC emergency room with your elderly parent does have an advantage as you will probably not wait as long.

Tip: If you have any control over when you go to the emergency rooms, the busiest time starts around 6 pm and continues until midnight.  Mondays and holidays are the worst days of the week, and the mornings and early morning (3 am – 9 am) are the slowest.

Preparation for the emergency room or NYC hospitalization

As a senior or a loved one of a senior, you can make life a little easier in the hospital by being prepared.  In the emergency room, during the pre-admission process, the information they will ask for is always the same.  Demographic information (name, address, date of birth) is the obvious question, but beyond that, you will need to know:

• List of medications currently being taken, the dosages, how often they are taken, and the reason for taking them
• List of over-the-counter medication
• List of doctors currently been treated by, the last visit, and the reason why
• Allergies to food and/or medication
• Medical insurance information

Also, if your elderly parent is admitted you will want to bring a small bag with a change of clothes and personal items like a toothbrush, comb, etc.  Also, if your parent wants their cell phone, bring a charger!