Becoming a Caregiver Overnight

Monday, January 26th, 2009
This post was written by Melanie Matthews

The chances of both parents becoming housebound at the same time are probably slim, but it happened to our family this month. After separate falls, my parents were each hospitalized briefly, then sent home to recover at their Florida condo. From the Northeast, my five siblings and I organized a round robin of visits to help get them back on their feet.

Here are some random observations on caregiving and the healthcare system from my weeklong visit:

  • Do not wait for your parents to need this type of assistance before assembling a list of their neighbors’ contact information, especially if your parents live far from you. Also, make sure your parents’ neighbors have a way to reach you or a sibling in an emergency.
  • Start today to help them organize medical records into a convenient and preferably electronic format that can be easily shared with providers and other trusted family members. I began gathering their data last week and am evaluating the four PHRs Medicare has tapped for its PHR Choice pilot program for Arizona and Utah beneficiaries — PassportMD, NoMoreClipboard.com, Healthtrio and Google Health — for my parents.

    This list includes PHRs that are free as well as ones that offer “concierge” services, for an extra fee, with additional features such as adding notes from healthcare providers and other sources of health information. I will share my thoughts on their functionality and ease of use in future postings.

  • The need for medical homes for Medicare beneficiaries has never been greater. Had one provider been managing my father’s care and medications, some drug interaction flags might have been raised that could have averted his fall and the costly care that resulted.
  • As large pharmacy chains replace mom-and-pop drugstores, there are huge opportunities for error and inefficiency. My father spent the better part of two days trying to track down two separate prescriptions that had been faxed to a local store but forwarded to the chain’s central facility for fulfillment, which then had no record of either one. The physician practice had to fax the prescription three times before it could be processed — a huge waste of providers’ time and a drain on my father’s energy during this recuperative period.
  • Bulk prescriptions by mail from a central location may be more cost-effective, but distributors should include specific instructions for pill-splitting when this is necessary. During my stay we had to split a portion of 270 tablets to create the correct twice-a-day doses. I am still going over the math in my head to make sure we did this correctly.
  • Help your parents catalog the medications and herbal supplements they take and discard any expired medication. Ask their primary provider and/or dietician to review the list for possible negative interactions.
  • Have the difficult but necessary conversations about long-term and end-of-life care with your parents and make sure you understand their wishes. Ask them to prepare the necessary legal documents so you can carry out their wishes. The Mayo Clinic has a checklist to help you do this.
  • Conduct a falls assessment to make sure their home and yours are relatively risk-free.
  • Do all of these things in a sensitive way, being careful to respect their methods of doing things, their privacy and their need to remain independent.
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