When Your Loved One is Admitted to the Hospital

This Week on Sage Aging

For most caregivers, going through the experience of having a loved one admitted to the hospital is an inevitability. It’s just one of those things that come along with the territory when you’re caring for an aging loved one. So knowing that’s the case, are you prepared for when that happens? Do you know what to do and how to be the best advocate possible for your loved one? I know those are all loaded questions, but I ask them because I want you to give them some serious thought. Being prepared and knowing what to do will make a hospitalization far less stressful for all involved. You’ll learn a lot in Episode 44!

My Guest

My guest for this episode was Maggie Lazarre. With 36 years in the healthcare industry under her belt, Maggie knows a thing or two about what happens when a hospitalization occurs. An advanced practice registered nurse, Maggie has experienced all types of medical environments and in this episode, she shared valuable insights and practical advice for older adults, caregivers, and families.

My Takeaways
  • Have the conversation – Don’t wait for an emergency to happen before you have a discussion with your loved one about how they want to handle emergency situations. Ideally, this conversation should happen well before your loved one even needs assistance, but it’s never too late! In Episode 27 we covered “Having Tough Conversations With Aging Parents” with Catherine Hodder, Esq., author of Estate Planning for the Sandwich Generation (If you need a step-by-step guide, this book will be helpful to you).
  • Prepare – Having your ducks in a row is important! Having your loved one’s wishes in writing and the necessary documents in place will make a hospitalization a less stressful event. If you haven’t already, you should consult an Elder Law Attorney to put important assist you with this. Our 5 part Elder Law Series is a great overview of what you need to discuss with your Elder Law Attorney.
  • Connect – Don’t be afraid to ask for help! It’s impossible to try to do everything by yourself. Connect with other caregivers, friends, family, church family, and other organizations and build a support network for yourself. You will be thankful for the help.
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When Your Loved One is Admitted to the Hospital

Episode 44…

Recorded February 10, 2021


hospital, caregiver, doctor, people, nurse, home, physician, mom, person, maggie, loved, patient, day, aging, care, liz, conversation, providers, understand, homecare


Liz Craven, Maggie Lazarre


Liz Craven  00:00

The Sage Aging podcast is brought to you by Polk Elder Care Guide. Your guide to all things senior care and resources. Find the 2021 guide in English and Spanish at Polkeldercare.com.


Liz Craven  00:27

Welcome to the Sage Aging podcast. I’m your host Liz Craven. Sage Aging will connect you to information and resources that will empower you to master the aging and caregiving journey. Weekly, I’ll bring you education, inspiration, amazing industry guests and caregiver spotlights to shed some light on topics of aging. There’ll even be some freebies and giveaways too. So grab a cup of coffee, sit back and relax as we chat. Are you ready? Hit subscribe now and let’s get started.


Liz Craven  01:03

Hello, everyone, and welcome to Episode 44 of the Sage Aging podcast. For most caregivers, going through the experience of having a loved one admitted to the hospital is an inevitability. It’s just one of those things that comes along with the territory when you’re caring for an aging loved one. So knowing that’s the case, are you prepared for when that happens? Do you know what to do and how to be the best advocate possible for your loved one? I know that those are all loaded questions, but I ask because I want you to give it some serious thought. Being prepared and knowing what to do will make a hospitalization far less stressful for all involved. My guest today is someone who’s going to be able to really educate us on all of these things as she has more than 36 years experience in the medical industry. She’s an RNP and I’ll let her tell you more about what she does in a moment. But I also want to let you know that I’ve known Maggie for a long time. We go all the way back to when our kids were in elementary school and I’ve seen this lady at work. She’s got a heart of gold, and has a passion for helping older adults and their families to navigate all things, eldercare. I’m so excited to share her with you today. And I’d like you to help me welcome Maggie Lazarre. Welcome, Maggie. Thanks for joining me today.


Maggie Lazarre  02:35

Thank you, Liz, that was so sweet. I know. I’m just thinking now I remember when your kids used to go to that ice cream shop. Yes. 548. You remember?


Liz Craven  02:46

I remember. It’s no longer there. It was so delicious.


Maggie Lazarre  02:49

Yeah. Oh my God.


Liz Craven  02:52

You know we really kind of grew up in this community together. In the elder care community where I live in Central Florida. Maggie has now moved on and is here working sometimes, but doesn’t live here anymore, but my goodness, we have come such a long way in our community. And I think all over the country as it relates to creating awareness around issues that caregivers and those that they’re caring for are facing. It is no longer a conversation that has been swept under the rug. These are things that people are confronting more today than any other time because of aging baby boomers. And so here we are. We’re here to talk about it.


Maggie Lazarre  03:39

Right, well, we’re getting close to that age ourselves. I know you don’t want to think about it, but that’s the reality. But anyway, thank you for having me, Liz. I’m so excited to be talking to you and your listeners about the topic of caregiving and hospitalization and everything that goes with aging and living longer. Well, as Liz says, I’ve been a registered nurse for over 30 years. I actually wanted to be a doctor when I was growing up but circumstances says happen and I went to nursing school and I find I think I’m a better nurse and I would have been a physician. So I went to nursing school, got an associate degree then get a bachelor’s and get a masters. But anyway, right now, I am licensed as a advanced practice registered nurse. And it was funny because my passion in nursing has been cardiology, I love the heart and anything that goes with it. And I’ve been working in long term care as a supervisor, dealing with dementia in the families and then when COVID here, it was just oh my god this portfolio is for families. And many times when families would come to visit I found myself spending more time with the family more than the patient because for them, just dealing with the overall stress and magnitude of everything they had to do and how exhausting it was, and the knowledge deficit, like as Liz referred, you know, exists with these families not knowing where to turn. And I was like, You know what, I think I would love to do mental health. So when the opportunity presented itself, for me to go back to school to get my master’s in nursing, it was like, that’s where I wanted to go. So when this opportunity presented for me to do the psychological, the psychiatry part of it within the elder community, it was a marriage made in heaven because I’m still going to the facilities where I know people. I have connections. So when I walk in there, it’s like, Maggie, what are you doing here? So that’s what I do right now. I go in long term care facilities, and I look at patients, I look at their records, look at their medications. Because again, I’ve been on the other side, I’ve been the nurse, I’ve been the supervisor dealing with the behaviors or the family conflict and dynamics and everything that goes with it. So now I’m more empowered as a provider to be able to do something, you can refer them for psychological treatment, psychotherapy, or you could prescribe medication. So it’s nice to have the knowledge that I have, as a nurse, having been a provider dealing with them day in and day out. And then being on the other side, being the provider who is going to have a little bit more, I don’t want to say authority, but ability to look at the problem from a multifaceted approach. It’s not just a pill, but I’m looking at the family dynamics. I understand homecare, I understand respite care, I understand hospice care. So I feel like all those years, it’s like the culmination of everything that I’ve learned over the last few years.


Liz Craven  07:06

It makes you the perfect person to help a family get through a time like this. And to have the conversation here today, because you’re right, you’ve touched every piece of it. And so when you look at a family, you know exactly what they’re going through. And I think that’s part of the disconnect sometimes, you know, you might have a professional who is always in the hospital, and they don’t work on the care side, outside of those walls, they really don’t know what’s happening in the home, they don’t understand the dynamic that can be so different in the home. And the needs are so different family to family, it’s not a cookie cutter kind of thing,


Maggie Lazarre  07:50

I know. I did a short time with hospice care, before I got this job, which I found kind of rounded up my experience as a clinician, and to understand how somebody qualifies for hospice care, what services we can offer a family, and doing that education piece in providing that support. So it is just such a need, and physicians I’m finding are really not the best providers to refer patients because their understanding of what Hospice is, may not be what it is actually, because everything is fluid, everything is changing every day, like in home care, the you know the criteria for admission and payment. So I really get a good grasp of this whole process of managing chronic care. Because unless you are entering the healthcare system, you have a loved one, you don’t really have a clue how complicated and convoluted everything is.


Liz Craven  08:48

That is so true. And I think you’re going to see the rise in the use of healthcare advocates for that very reason, because things are changing. And frankly, our society is not equipped to handle the aging Baby Boomers. It is going to be crazy trying to figure things out, because right now there are not enough beds in assisted living communities and in nursing homes, to accommodate what we’re going to see. And so what we will end up having is more family caregivers taking charge more homecare agencies providing some of that hands on care within the home. And that’s going to create a real gap as it relates to knowledge. And so, as caregivers. The whole conversation today is how do we prepare people to take on that role as an advocate for their loved one who is aging, especially when they are admitted to the hospital. So let’s start there. Tell me about the role of the caregiver as an advocate and maybe when should they consider bringing in outside help?


Maggie Lazarre  10:05

Well, I can start with an example. I was driving home from a facility the other day, and good friend of mine had some friends with her. And they wanted some advice as to how to deal with a loved one who was admitted to a rehab facility after a hospital stay. And I had to really clarify for that family, the expectations of what that entails. So, as a caregiver, I think every one of us is going to be a caregiver at some point, I took care of my mom for a couple of years before she passed. And the whole challenge of what then. What do we do if. So, what any one of us, it doesn’t matter how you know what your age is, or the age of your loved one, or sometimes you caring for a younger family member, it doesn’t always have to be, you know, an older adult. So I think educating yourself as to what services or how the system works, I think that’s the that’s the biggest thing. The American healthcare system is so complicated, and so disjointed. It’s not coming from a central point, I remember I was in England, and I was studying about the system, the NHS system over there. And the coordination is nothing that we have right here. In England, when you move into a neighborhood, you’re automatically enrolled in a clinic. That’s your designated clinic. That’s where you get your healthcare. And friends, when you have your baby, you get calls as to when your baby needs that immunization, the nurse visits regularly, so you feel connected. So there is not really a good chance of you falling through the cracks. We don’t have that system in the United States. We all know you’ve read about it, that primary care, preventive care is just not something that we focus on. So we are out there doing our own things. We’re watching TV, we’re taking supplements were exercising, you know, we’d become vegan or vegetarian trying to stay healthy, but what we need to understand is that the lifespan, yes, we’re living longer because we have better care, better medication, better interventions, but the aging process doesn’t stop. Okay, so our body is going to start to slow down. And we can go into a long drawn out explanation as to the aging process and how it affects every single body system. Now there is a genetic component where some people can age at a faster rate than others. It’s not something that we actively can control right now, even though there’s a lot of research going into genomics and looking at genes and how we can slow and reverse, whatever. So when you are not even entering a certain decade, but I think everybody should understand that the American healthcare system, if you’re lucky enough to have a primary care physician, you can get preventative care. That means you do your screening, you check your blood pressure, they do your lab work. But we all know the inequities that now have some people just did not have access to that primary preventative care. So what happens is, when somebody, Oh, my gosh, just got a book out the other day, they were talking about the effects of the pandemic on people. And this young man, to me is young, 37 years old. He said people at work see me laughing and smiling. They just don’t realize I haven’t seen the physician for 17 years.


Liz Craven  13:43

Oh wow.


Maggie Lazarre  13:44

As I’m saying this right now It’s like, I’m ready to cry again. Because I’m thinking here is a young person. He’s working, but you know, a lot of jobs don’t offer health coverage, so he doesn’t have it, so he doesn’t go to the doctor. And this is the main problem we have in the American healthcare system. People do not have preventative care. So things that could have been managed very easily become an emergency. So they all end up in the emergency room. And by law, thank God, people cannot be turned away for having no insurance. That’s a federal law. So we’re thankful for that much. But then what happens you have the hospital footing the bill for the uninsured. So when they’re doing their books, they putting like millions of dollars in uncompensated care. So hospitals or business, it doesn’t matter if it says it’s non for profit or for profit, like our local hospital, they still have to balance their books, right? So if they have a large portion of people, they can appeal health insurance, they can’t pay out of pocket. So this is they’re gonna write it off, so they’re gonna have to make it up somewhere. So this is where the cost of insurance goes way up. Because those who don’t pay, then it’s passed on to those who can pay. So you can guarantee that every year your health insurance is gonna go up.  So okay, if you’re looking at the elderly population, a lot of them do have Medicare, right? And a lot of times people don’t even understand how Medicare works. When they go to their physician, the physician says, Oh, yeah, because you have Medicare Part A and Medicare Part B, that could be another, you know, topic for you for your program people to understand that Medicare is not paid all of it, you still end up having to pay. So when you say you have a senior who has Medicare, what does that mean? That means that if they go into hospital, Medicare is listed as a primary insurance, then they can have a secondary supplement, or they can have a Medicare Part D. And then you have to go into the medication. So it gets too convoluted. So I’ve always went talk about health advocate, this is where especially this time of the year like we just passed, where they were supposed to enroll or re enrolled into their part D program. Yeah, I’ve had people who live in California, and they have their 89 year old little mama who lives here in Florida. And then they say, Oh, yeah, tell your mom to go sign up and re enroll.


Liz Craven  16:19

Easier said than done!


Maggie Lazarre  16:20

Seriously, okay. And you know, I’ve had patients that be taken advantage of because of that there are people who are creditors on the phone, and they just badger them until they give it so they don’t know what they’re signing up for. The reason it gets so complicated is again, you have a sociological issue. Okay? You have older folks, let’s say retire here to Florida in their 60s. Oh, yeah. When we calculate the Florida and the sunshine, going to have fun, okay, they buy a house over here. And in their in their little clubhouse community, everything is good. Well, one by one, some of those seniors start to die. They’re getting older. So now you’re in your 80s. In your 70s, you’d have no close relatives, right? Your children are scattered throughout the United States. They have their own families. So you end up with an open heart surgery, and you’re getting ready to go home. And I ask you, I’m like, Okay, how are you going to manage that home? Oh, I don’t know. Do you have any children close by doing? Do you have any friends? Who can check up on you? No, I do not. So now you have a whole dilemma on your hand as to how you’re going to safely discharge this person home. So let’s say you have a caregiver, that we’re talking about hospitalization, the fact that to say that they’re going to go to the hospital, it’s a given, okay, we talked about the aging process, things are gonna start breaking down, instead of matter of if it’s when I remember when my mom was getting older. I’m the oldest, and my siblings and I, we always had conversation about what are we going to do if I was lucky that we were all in sync? But a lot of times, that’s not the case. A lot of times you have families, maybe they had some negative interactions and are talking to each other. They don’t, they don’t agree. It’s oh my gosh, that’s a whole different setup situation. Yes, it is. So let’s assume you have one caregiver who is dedicated to this person, you have an older parent, and she’s relatively healthy. And then slowly things starting to happen. Maybe she had a fall, she broke her hip. So now how do you prepare yourself? I think you need to have the conversation early enough as early as you can. First of all, understanding what this person perception of health is. I have this conversation with my daughter all the time. I said, you know i to what I would want. And then she asked me the other day, she said do you have it in writing? Okay, that’s another thing. Have the conversation with your loved one, understanding what she would want? Okay, my mind if anything happens like this, what would you like to do? Do you want us to do everything possible to keep you alive? You know what I’m saying? Because, right, I was talking to a family member the other day she was struggling with making a decision for her mom was really sick in the ICU had been sick for a long time been through a lot. And of course, they were trying to push her towards hospice. And she was struggling. So I looked at her and I said, Did you ever have a conversation with your mom? And what did she tell you? She said, she told me to fight like hell. I said, Well, there’s your answer. Because that way, it releases you from the guilt because it’s not about what you want. It’s about what a person would want. And that’s why they want you to be their representative that you can, you know, respect their wishes. So I guess yeah, so you have the two trains of thought. Mom says no, I want you to keep me alive for whatever reason it is worth it. No, no, I don’t want you to force anything. Let me go naturally. And that’s why you want to get with the attorney, you know, the elder care law attorney to draft the papers for you.


Liz Craven  20:08

And I’ll direct people to episodes 10 through 14, we did an entire Elder Law series. So circle back and listen to those and everything that Maggie is talking about right now, you’re going to hear more about that there, definitely get that done, if you’ve not done it yet,


Maggie Lazarre 20:25

Perfect. Because that relieves a lot of stress on the part of the caregiver, and healthcare professionals. Because if it’s written down, then it makes it easy. Okay, so I won’t go too much into that. So have the conversation. And this is not a time for you to try to impress your ideas. This is not about you. It’s about your loved one what they want, okay. So you have those documents, make sure your doctor has a copy and you have a copy, I think everybody should have like a little kit. I remember someone was telling that one time, it was like a binder, where you keep all that stuff and it’s separated, you know, you have the Advanced Directives there, you have a list of the medications there. Maybe you have copies of the insurance cards there so that if anything coming, you just grab back and you go, okay.


Liz Craven  21:15

As matter of fact, Episode 29, we in detail went through creating a binder in an episode Yep, that was that episode was titled to being a great advocate for your loved one. So refer to that and circle back, if you’ve not listened to that you need one of those binders.


Liz Craven  21:33

Very good. So in addition to a list of your active medication, you want to list and you want to make a list of the physician that the loved one is because you have your primary care doctor who is kind of the central person, and then you may have other specialists, maybe she has a cancer specialist, maybe she has an endocrinologist, you know, all these doctors and their contact information. Because when you go into a hospital, you go to the ER, and you present a doctor with this. I’m telling you, they think you’ve given him a gift. Because I have had doctors call me you know, in ER doctor would say, well, this person comes in and I don’t know anything because they may not be in a condition to even talk to the physician. And sometimes they don’t have a caregiver present. But if they know the person had a friend or home health or they coming from the facility, then we can fill in the gaps. Because this is where we have problems when we don’t know the whole story.


Liz Craven  22:32

That’s a gift to yourself. Honestly, if you’re giving a gift to the doctor, you’re empowering them to take much better care of you.


Liz Craven  22:38

And this is one of the reason that you know, our healthcare system is so fraught because it’s like we do a lot of duplication. Multiple doctors are giving orders. Sometimes the medications are conflicting with each other. It’s like no one is manning the ship. I know with EMR electronic medical records, we are trying to do that. And you know, it’s funny because I was listening to a COVID podcast the other day, and they were saying the EMR is creating problems for them. Because they’re not talking to each other. You know, they can’t track where this person got the first dose. Maybe they were in Arizona or they were in Florida. So they don’t know. So even though we have the EMR, it’s still not coordinated to the point where it’s accessible. It’s seamless, everybody can get the same informatio n. I mean, it can’t be that difficult, but


Liz Craven  22:42

That’s what I’m thinking, Oh, my goodness.


Liz Craven  23:32

I know, with all the knowledge that we have, it just frustrates me to no end. All right, well, let’s get back to the practical. So if you have your binder, this is a gift to yourself and try to keep it updated. Okay, let’s say change your medication dose, you want to go and do an update that you don’t want to present the physician with, with information that is five years old. That’s not good. So it has to be kept up to date. Again, if it’s an emergency, what is an emergency what is not an emergency. And I think this is where the physician needs to do a good job teaching the patient and the caregiver. So if you have an older adult, and you go into your physician, I would encourage you to try to make an appointment where you can go with your caregiver, okay? Because you don’t want the doctor to tell you one thing and you forgot what he told you then you’re trying to translate for your daughter later on. It doesn’t work well. So it’s better if both of you are present at the visit. That way you can get the same information is not lost in translation. When I try to remember to interpret what the doctor said, Okay. And I know doctors are limited in how much time they can talk to you but the nurse when they checking you out, ask this question. I tell people before you go see your doctor, write down your question. Now don’t go to the doctor with a 15 item questionnaire. They don’t have time to answer it. Okay? But whatever is more important to you. That’s the burning question. I tell patients all the time, oh my god, talk to me. Well, you know what, change doctors, if you need to change your doctor change it. Because our job as practitioners is to listen to you. Now, we’re not going to sit there and talk to you for an hour, it’s not practical. Okay? We have to always try to bring you back to Okay, what is the most pressing problem concern you have right now? And we are trained to ask that question. What is it that I can address with you at this visit? What is the problem? Not the whole laundry list of what’s been going on with you for 20 years? It’s not ready to go. Okay. So when you go into a hospital, now, you guys know this is without COVID. Okay? Right your throat. When you throw COVID in the mix is a whole different ballgame. When you go to the ER, first of all, understand that hospitals are not places you want to visit, this is not a social gathering. These places are full of bugs and stuff. So you try to go in there as little as possible. So leave the hospital for the times where you absolutely have to go. And that’s why you always want to call your doctor to say, this is what I’m experiencing. What do you suggest, okay, even if the doctor is not really working, there is somebody on call, well let the doctors have nurse practitioners that are ourselves. And if you put over Google the practice, we do have access to your record, even though we’re not your adopted, okay? So when you call and you say, Oh, my doctor wasn’t working, I don’t want to talk to anybody else. Well, you’re doing yourself a disservice. Because when we log on to the system, we can see exactly what medications you’re on. We can read all the visit prior what happened. So we are in the know, so we want you to feel comfortable that whoever is answering your question knows something about you about your case. So don’t be rushing to go to the hospital and sit in the ER for like 20 hours. Because when COVID at the height of COVID, they didn’t have beds, they were sending people rerouting people to different places, different hospitals, it can be a nightmare. Okay? So unless it’s an emergency, you’ve fallen, you’ve broken something, those are the reasons why you go to the emergency. But if you say I have a headache, my blood pressure is up or something like that. Those are things that your primary care physician can handle for you over the phone, they can call some medications for you, you don’t need to go to the ER for every little thing. Okay. So once you go to the ER, you’re being treated by the ER staff. Remember, these practitioners are trained to deal with emergencies. So if you’re present with like a sore throat and a cough, you might end up staying there for hours, because they’re trained to deal with the motor vehicle accidents. There’s somebody who’s having a heart attack somebody who is seizing somebody who’s bleeding, okay? We also have urgent care, places that you can go for something minor, right? Let’s say you sprained your ankle or something like that. You need to go in the ER for like, you know, two days to be seen by a physician. You can go to urgent care and get the same level of care, something that is not an emergency. So let’s say it was something major, I see an example. You’re having chest pain. Now as a cardiac nurse, I will tell you, if you have chest pain, you make sure you go and get checked. Okay, this is not one of the things that you want to sit on and say, Oh, let me see. I’ll take a Tylenol and see if it’ll go away. No. I always say if it’s nothing, they do an EKG. If it’s nothing, they’ll send you home, but don’t play with chest pain, man or women? Doesn’t matter. Good advice. That’s right. It doesn’t matter. Okay. Because we all know about women go to the hospital and they say, Oh, are you anxious? Are you depressed? You know? And they send you home. And then next thing you know, you’re having a major heart attack. Oh, yeah, it’s well documented. They don’t listen to women as much as male. So if you are, if you are a woman, you having chest pain, trust me, it doesn’t matter if you’re in your 30s make sure you get it checked. In February is Heart Month. We don’t play around with chest pain, especially if you’re obese, you smoke, you have diabetes, all these things are really high risk factors for cardiac event. So you go into in there you having a heart attack, hopefully if you are in a center where they really trained well, they will triage you, we call that and then you’re gonna go up the line and they will see your first you get hooked up to the monitor, they can tell a little bit if you’re having a heart attack, they’ll drill sometimes they’ll do an EKG boom, at least you’re being treated. The weight in the ER can be a little long, depending on how busy they are, depending on Bed Availability. Now understand that sometimes you end up in the emergency room on a little Gurney on a very thin mattress that is quite often comfortable, you will be there for hours. And I hear that so much. And I think a lot of emergency rooms have really spent a lot of money trying to shorten that time, you know, I’ve seen the billboard, you know, your wait time is only 20 minutes now,



Because typically Some people go in there and expect to be seen right away, you know, and it you’re sitting there, you’re like, I don’t see anything going on, how come they’re not taking me in. But you know, because the backlog could be on the floor, you know, they may not have a room available, So if your situation warrants being admitted, that’s it, they need to monitor you more closely. Do you know there is a lot of algorithm that physicians go through that they have in their processes to decide whether they admit somebody or not. So let’s say you’re having a heart attack, and they say, Okay, you go into the cath lab, you’re going to be whisked up there and taken care of right away. But if it’s something a little minor, you might stay in observation. Now they even have observation units, where that kind of closer to the ER, where they can keep you and see if you get better in a day or two, and then they send you home. But if you need to be admitted, then you admitted to the floor. So when you’re in the ER, if you are the person we call the legally authorized person, the LTP. So when you go into a hospital, they always want to know, who is the person who is legally authorized to speak for this person. Okay. That’s why if you have your advance directive, you have cancer Good for you, what’s your thing, I could give them making a copy you legal, so they’re going to talk to you about your mom, your mom could still be, you know, alert and but then you end the conversation. Okay. So they’ll telling you what they’re thinking what they found out, and what the plans are, slowly whisk you up to a room. Now, with COVID, there are restrictions. Right? It used to be you can go and sit with your mind, sometimes they let you spend the night Not anymore. We COVID First of all, you have to stop there, they have to screen you take your temperature, I asked you these questions, whether you travel, you know, the screening form, and then they’re only limiting people, some hospital to one visitor per day. So from eight o’clock to let’s say, nine, or 8pm, those are the visiting hours and only one person per day, you can have two people in that work. If that person is admitted with COVID, that’s even worse, they’ve been more restricted. And we have to understand that they’re doing that to protect themselves, and you ever could worse. So understand what those restriction might be and try to work with the staff. Okay. And also, I was talking to this person, and she’s talking what I’m waiting for the doctor to call me and no one’s calling me, oh, the nurse called me and said this and that. And he was like she dismissed whatever the nurse said, and was waiting for the doctor. I said, let me tell you something, this is not the way it works. There’s a reason why you have nurses around the clock, right? The doctor might come in once a day. Now, he may not be the same one coming because most physician groups have multiple providers. So you don’t have like, an authority on who the doctor is. And this is the only one where you don’t have any control over that. Right? So when you say oh, I’m a doctor to call me back and the doctor said, okay, call her and tell her this and this and that. And then you’re dismissing your nurse, I say you’re doing yourself a disservice. You want to become friends with your loved ones caregivers. When I say friends, I mean friendly. Okay, you come in you say thank you, you smile, you think that let me tell you, your loved one will get much better care, than if you go in there with an attitude, or you’re upset about something and you’re treating the staff like, you know, writing that I can


Liz Craven  34:09

Right, that is such a key point that I think we don’t ever mention. And it’s true because the nurses are the ones who are there 24 seven, caring for your loved one they know that mom has been with no appetite or that she you know, has had a headache all day. The doctor really doesn’t know all of those things. He’s just getting a synopsis from the nurses.


Liz Craven  34:33

That’s it. Anyone in a in a hospital or nursing home your nurse’s aide? Oh my God, we as nurses rely on them to tell us how these patients are because they’re the one again that’s spending more time with the patient. So we will go to them and we’ll say how so and so. Did she sleep last night? Did she have a fall? Is she complaining of anything? This is a team effort and you as a caregiver become part of Team, if you want good, accurate information from your caregivers from your providers, you need to be open, you need to be respectful. And you need to thank them for what they’re doing.


Liz Craven  35:12

Yeah. And honestly, human nature comes into play. I mean, how many times do you get approached by a negative person before you say, oh, my goodness, I need to avoid that, because that’s not good for my mental health. That’s right, but it’s true. What do they say honey attracts more bees?


Liz Craven  35:32

And, you know, I don’t think providers nurses are seen either expecting anything unusual from you. Just a little bit of respect, and a little bit of appreciation. That’s all we know, is how a job, right? Okay, that’s


Liz Craven  35:46

A very, very good key point. Yeah. When is it appropriate to be expecting to have communication with your doctor?


Liz Craven  35:56

It’s very difficult to predict. So what I usually suggest if a caregiver is not comfortable. Now, the thing is, if it’s something major, I don’t think as a provider, I want to ask a nurse to have a conversation with a family member. That’s your responsibility. Okay? If you have abnormal labs, abnormal test results, and my personal feeling is the physician needs to be the one to push your family to say, this is what the results are. Okay. And this is what the plan, that’s what I’m suggesting, I’m recommending we do this and that, okay, we can go after, as nurses, we can go after the doctor, sometimes the doctor talks in big words, and the families like when did he say, you know, it just went over their head, we can kind of paraphrase and explain. So we go behind the visit, I used to have a doctor who would come to this hospital, somebody who’s going to have a major heart surgery, and he had we had a board in the room that’s facing the bed, and he would take a chocolate, he’s like, I’m gonna scrape all the two things up there. And the patient is sitting there with a with her mouth open. And then I said to physicians, good 99%, she said, Why did you say? So we have to go explain in simple term, right? We don’t need to use medical terminology to explain to you what the doctor said. So I think this being in the know, you could say, you know, I’m really appreciative of what you guys are doing for my mom, thank you so much for caring for her. I know, she could be a little difficult, but Oh, no problem. You know, is it okay, if I call you in the morning, and I can get an update on how she’s doing? Now? Which nuts is gonna say no, no one’s gonna say no. Especially now in hospital? All the nurses have portable phones. If somebody calls you, you don’t answer it’s on you. Because when they do the assignment, you know, in the hospital, they have your name, they have the room numbers, and your phone number and your extension. Okay. So if the Secretary and says the phone, she’ll transfer the call to your phone. So unless you know, you indisposed, then you need to talk to that family about their loved one. And then like I said, you may want to draw the line as to your, you know, your willingness to talk to the doctor, especially if you’re uncomfortable about something sensitive, or, like a really bad result from a test. I’m gonna say, I can have Dr. So and So call you this is the best way, if you want to talk to the doctor themselves. You could say this is my phone number, would you please have him talk to me, I really want to talk to him. And I think most physicians are very open to that. Now they have a lot of meetings, they have a lot of things they have to round. So it may not be at eight o’clock in the morning, it’s not gonna happen. But if he has your number, he will call you back. Most fishermen will call you back. I’ve heard family members say all the time, well, I left my number, nobody calls me. Most of the time the doctor does try to call. So and also, don’t be hung up on you want the doctor? Most physician groups have lots of practitioners working for them. And they’re like in line with the physician. So if the doctor doesn’t call you, they’ll say this is Maggie administration. And I work with Dr. So and so he asked me to give you a call because he’s tied up. Hopefully you okay with that. And I know some families are not that way you making more stress for yourself.


Liz Craven  39:16

You know, I have to be honest, when the use of nurse practitioners first was coming on the scene, and you began to see that as you were going to your doctor’s appointments and being pushed to a nurse practitioner instead. I have to admit, in the beginning, I was not really happy with that. That was scary to me. But over time, you know, now you have PhDs and you have nurse practitioners. And I gotta tell you, my interactions with those folks are good every single time. Like feel like I get the attention that I’m looking for. And I feel like the knowledge base is there. I have absolutely no problem dealing with them anymore.


Liz Craven  39:59

Well, that’s good. I’m gald to hear that. I thank you for saying that, but you know, it is a process, you know, because the nurse practitioner movement started because of a lack of primary care physicians, okay, the doctors just had a load that was they are manageable, they could not manage it. and nurse practitioners NPS have really good outcome, they’ll measure the satisfaction of the patient. It’s really high. So, again, you know, in our world, I know people don’t trust data, but you got to look at the data. Are they doing anything less? Are they giving you you know, good care, like your doctor, so be open minded. So now, if I don’t know if you want to talk about when they discharge, because this is a whole different process?


Liz Craven  40:40

Yeah. So we’ve been in the hospital and as an advocate, a caregiver advocate and an advocate, you have been providing all of the information to the medical team. Mom is good, she’s been well cared for, and they tell you, okay, Mom’s going home tomorrow, she’s going to need one of a couple of things, she might need some aftercare, meaning she will have to go to rehab, let’s say she broke a hip or something and needs rehab. Or when she comes home, she’s going to need XYZ care. So there’s the possibility that you’d want to engage homecare agency to help you with some hands on care. Or perhaps she needs some wound care, based on whatever it was that happened while she was at the hospital. So as the caregiver, you know, how do you even begin to explore what comes next?


Liz Craven  41:35

Well, first of all, we always say discharge planning starts on admission. This is what we as nurses think, that’s why you have discharge planning social workers in the hospital. As soon as your mom or dad is admitted, they’re going to ask you, what are your plans for discharge? Okay, is she able to come home? Yes or no. And if she does come home, what support or services might you need, but again, it depends on what the hospital costs was. If if something was simple, you know, many times complications occur while you’re in the hospital, you can go in for one reason, and then it kind of mushrooms into multiple problems. And the length of stay is letting so you think your mom is just wanting you to do the therapy, but then at the end, she’s got multiple things going on with her that makes her a little bit more of a hand, not a handful, but to requires a lot more care than what you were prepared for. So that’s why if you keep talking to providers, you know every step of the way, then they keep you in the know as to this is what we’re looking at. Okay? If it’s changed, they’ll tell you. So you would be in the know, very rarely did I do I hear somebody say, well, they just sent her home, I had no idea she was going home. I know it’s happened sometime, but it should not. So if they’re not addressing it as a caregiver, you should be asking the question, okay, what are the plans? When do you expect her to go home? What do you think she’s gonna need when she goes home, so that way, you can have that frank conversation, please do not try to paint a rosy picture, if you if she needs a ramp, you don’t have it, you need to say I’m gonna need help with this. If she’s gonna need equipment, you’re gonna say, Oh, I’m gonna need, you know, help with this. So you have to be very open minded as to what you are able to provide. And I think this is one of the thing caregivers do. Sometimes the patient is demanding to go home, and they’re not safe going home, or you’re not able or available to provide all the services, you have to be very practical about that. And sometimes it creates a little friction between you and mom or the aging parent. But you have to say, Mom, I’m looking for your safety. I don’t think you safe. I’m not comfortable with you going home yet. And this is where we have comes in where you get therapy every single day you get stronger, a little bit quicker. But again, now we have COVID it kind of makes things a little bit more difficult. Most people don’t want to be in those nursing home because of COVID they want to come home so it creates a whole different, you know level of stress for caregivers.


Liz Craven  44:15

Absolutely. That’s that’s a whole different conversation, isn’t it? Because Yeah, I think about falls and the potential for that coming out of a hospital stay and you don’t want to get readmitted.


Liz Craven  44:28

Or hurting yourself too. You hurt yourself sometimes caring for someone because you’re not a trained professional. You don’t want to have to be the one you know lifting them up and transferring her. I can tell you how many times the caregiver become sicker than the patient.


Liz Craven  44:45

Yes, that’s very common.


Liz Craven  44:47

Because it is so overwhelming. So like I said, Be very realistic about what you physically what kind of care you can physically provide and sometimes You have to have a strong conversation with the patient themselves to say, Mom, I love you. But so this is that tough love, you got to do it sometimes. Sometimes it says true, exactly. Sometimes older people have a way of manipulating the situation making you feel guilty. But then again, you get yourself in a situation, Nick, like you say they they fall again. And then the second time is always worse than the first. So be very realistic talk to the social worker, they’re very knowledgeable about explain your home situation, your work situation, can you take FMLA to take care of your care of your loved one, this is very important. And I want to interject in here a little bit about being connected. One of the major issues we have in this country is as we age, people isolate, they think like I said, you move into an older community, people start dying. Now think about it. You’re living with 80 other 80 year olds, so they’re not going to be able to do much assistance if you need it. So if you’re in a church, and I think one of the things I wanted to push one time when I was when I was in Polk County that is the community has to step in. You can’t rely only on the hospital and the homecare companies because that’s another conversation about what’s covered what’s not covered. And I know you know a lot of it, Liz, because you have publications about that. Because people expect that a physician would say oh, I’m gonna write for you for home health. In the patient’s mind, they think somebody is going to come home with them and stay with them for 24 hours. Right? When you as the homecare person go in there and you say, Oh, no, man, I’m gonna come three times a week for an hour. That’s just so upsetting.


Liz Craven  46:44

It’s a rude awakening.


Liz Craven  46:48

But I can give you a couple of numbers for private pay they can afford it is super expensive care. Right? Oh, and then I like always anybody in the community? Well, you know how the waiting list is for these type of services. No, be connected in your community. And I tell people, if you’re if you’re an empty nester, you’re not working, you know, create something like that in your church or women’s group where you guys can provide some of that services to the seniors, or to even support a caregiver who’s probably stressed out and overwhelmed, and just in a couple of hours to go get her hair done, get her nails done. Those things, that partnership between the healthcare system and the community, you talk about the baby boomers, 1000s of them, you know, turning 65 every single day in this in this country. This is the only model in my mind, that is going to work, like you say the caregiver understand that you’re going to be a caregiver, whether you like it or not. So get ready. You know, get your mind straight, because Mama’s not going anywhere. And she’s your responsibility. Have the conversation, prepare, get ready and then connect. Connect. Yes. Even if you don’t want to start it stop talking to other women. Other What do they call it? The sandwich generation? We have the teenager? Yes. Oh, and then the the parents start talking among yourself and say, Okay, ladies, my mom, my parents know that the street, but they are getting old? What are we going to do? How can we make this work? You know, and you do have those healthcare, they call them a healthcare advocate, but they’re the ones that kind of help the family manage your care managers, you know, yes, like their managers, exactly. You have some of those people to kind of help you sift through all of that. But understand that you’re going to need some help. And you have to be open to saying, you know, yeah, I wish I could have somebody come stay with mom, and for a couple of hours where I can go grocery shopping or something like that. That’s the only way we’re going to make it. And I think for me, and my mom, the only way I met is because my siblings were involved. You know, because he can’t be my, you know, just me. You can do you can do that, you know, but you’re gonna make yourself get sick yourself, then you won’t be Well, that’s true.


Liz Craven  49:10

Okay. So All right, everybody listening, go ahead. They’re gonna laugh at me when I say this, because it is a common thread here; self-care. You must practice self care. And what Maggie’s saying just drives that point home. Because I mean, honestly, Are you overwhelmed by the conversation that we just had, there’s a lot that goes into it. And if you are not at your best, you cannot give your best. And so you know, we always end up finding that in every conversation, the importance of self care for so thank you for bringing that up again.



And we women are the worst, you know, we just give for everybody, the babies, the kids, the husband, the Mom, what about us? If you’re not well, you cannot care for anybody else.


Liz Craven  49:59

Yes, take off the Wonder Woman cape. Take it off. You don’t need it.


Maggie Lazarre  50:04

You know, we’ve got this lie that we can be everything to everybody, it is such a lie. You know, you can’t. And then it’s true, something is gonna suffer, whether it’s your health or your relationship, something is gonna get.


Liz Craven  50:21

So good. Good words of advice. Hey, do you have any favorite resources like websites or books or anything like that, that you’d like to recommend


Liz Craven  50:30

Oh, I saw that point. That’s what you sent me. And actually, I don’t have any particular resource. I know, for anybody dealing with dementia, or Alzheimer’s Association has a lot of resources online. Yes, um, I don’t think I’ve been to the care.com website. But I think a lot of those places have links to different other organization. But I think even if your primary care doctor, they have a lot of inflammation in the office also. So go ahead and ask him and say, What do you suggest? Do you have any ideas? Do you have anybody in the community that you can refer me to the social workers, let me tell you, I have a lot of respect for these ladies and gentlemen, because they have so much information much more than I could ever I mean, I have the medical stuff, but they know a lot more ways of like I saw a patient yesterday, and I’m trying to figure out how to get him a cell phone. Because with him, you feel so disconnected. So I’m like, how can I find this minute cell phone so he can regain a sense of control? You know, that makes his job easier. So a social worker is such a great resource. So like I said, don’t be afraid to ask, because if one person doesn’t know it, the next person might. So open your mouth and us.


Liz Craven  51:48

Maggie, thank you so much for taking the time to share today. This was incredible, and so much information to one hour. Wow, gosh.


Liz Craven  52:01

Well, thank you so much. You’re welcome, Liz. I really enjoyed doing it.


Liz Craven  52:05

And thank all of you for listening. I know that we threw a lot of information at you today. And I hope it was helpful. And I’m going to quote an old cliche here and tell you that failing to prepare is planning to fail. So don’t be that person. Get your stuff in order, and be ready to take care of whatever situation might come your way. And check back next week for another new episode. If you’re receiving our weekly newsletter look for that in your inbox first thing Tuesday morning. If you’re getting the newsletter, you may have noticed that we’ve added an additional Tip of the Week in there just some extra information to support the episode and topic of the week. Most of the time, that’s what it’s related to but sometimes also some helpful items and things that will make your life easier. If you’re not getting the newsletter. That’s your homework this week. Just go to Sageagingcom. Scroll to the bottom of the page and click subscribe. Finally, let’s connect on social media. Look for Sage Aging on Instagram, Facebook, tick tok and you can find me Liz Craven on linked in. Thanks again for listening, everyone. We’ll talk real soon.


Liz Craven

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As I’ve been preparing to launch this podcast I’ve enjoyed revisiting stages of my own life and reflecting on how this topic became such a passion for me. While I’ve built my career on helping older adults and their families connect to needed education and resources, my connection to the aging and care process goes much deeper.

Some of my earliest childhood memories are of my own multi-generational family living together in one home. I was 4 or 5 when my grandmother moved into our home to help care for my sisters and I while our parents worked. Soon after, her father and grandfather moved in as well. We had 5 generations living under one roof! That was a beautifully chaotic adventure and knowing what I know now, I have so much respect for what my parents and grandmother did.

Fast forward to age 24. Newly married and pregnant with our first child, I spent several months with my in-laws to help care for my husband’s grandmother who had Alzheimer’s. Fast forward again to about 2009 – Wes and I have two teenagers about to head to college and his mother is diagnosed with cancer. Several years later, my mother is diagnosed with cancer. Several years after that Wes’ stepdad is diagnosed with Alzheimer’s disease and his father is suffering from severe dementia. You can see where this is going right? For the better part of the last 10 years we have been the caregivers. We see it as an honor and privilege to have been able to do that for our parents.

The key to navigating our later years is being proactive about gathering information before we get there and staying engaged once we do. To be sage is to be wise. There is wisdom in taking the time to ask questions, seek solutions and know your options before the need arises.

Each week we will discuss relevant topics of aging with experts who can help us to understand and be better prepared for aging. We’ll also introduce you to some Sage Agers who are totally owning their journeys through life. No topic will be off limits and we will deliver open and honest conversation meant to educate and empower our listeners. Each episode will also be available in video and blog formats.

Whether you are proactively seeking to broaden your own knowledge, a caregiver for a loved one or a professional working in the aging care industry, this podcast is for you. We hope you will join us as we explore and celebrate Sage Aging.