Managing Medical Care At Home

Post emergency information

To start, fill out the Emergency Information Form to organize and consolidate important emergency information. Make sure that you list contact numbers, including the patient's doctors and other members of the health care team. This information should be photocopied and put in places that are easily accessible, such as next to the telephone and on the refrigerator.

Know when to call for an ambulance

There are certain instances in which recognizing an emergency and calling 911 can save a person's life. However, since ambulance service can be extremely expensive when not covered by insurance, it is important to know exactly when it is necessary. Always call for an ambulance if a person...

	is unconscious
	has chest pain or pressure
	has trouble breathing or is not breathing
	has no pulse
	is bleeding severely
	is vomiting blood or is bleeding from the rectum
	has fallen and may have broken bones
	has had a seizure
	has a severe headache and slurred speech
	has pressure or severe pain in the abdomen that does not go away
- OR -
	moving the person could cause further injury
	traffic or distance would cause a life-threatening delay in getting to the hospital
	the person is too heavy for you to lift or help

If you know CPR or other emergency procedures, you should call for an ambulance before doing anything else. Once you make the call, you can care for the patient until help arrives.
(Adapted from Meyer, et al., 1998)

Going to the Emergency Room (ER)

Most people try to avoid going to the ER at all costs. However, there are times when the patient's need for care is urgent, and you must go to the emergency room. Here are some things that you can do to make going to the ER more satisfying:

	If you think that the patient's condition may lead you to the ER, pack a bag in advance.
	Make sure you are familiar with the patient's medical history, in case the patient cannot speak for him/herself. Keep a list of important information, such as past health problems, allergies, and current medications and dosages.  Click here to print and fill out a Medication Schedule.
	Be able to describe exactly what the patient's problem is, when it started, what may have caused it, and if the patient was given any medication or other treatments.
	Know the patient's legal rights and responsibilities while in the hospital. "A Patient's Bill of Rights" is a document developed by the American Hospital Association outlining the patient's rights regarding health care and appropriate treatment from staff within the hospital.
	Use good communication skills. Though the ER can be a frustrating place, it will not serve you well to take your anger out on the staff. Try to be understanding and patient, while being assertive. To do this, follow these tips for better communication: - Don't be afraid to speak up if you feel that the patient's rights are being violated or if you are not satisfied with the patient's care. - Tell the health care professional about your dissatisfaction with care in a direct way that is not demanding or disrespectful. - Speak in a way that does not put the health care professional on the defensive. When talking, use "I" statements, such as, "I don't like that my mother is in so much pain," rather than, "Why won't you do something about my mother's pain?" This sounds less accusatory, and expresses how you are feeling to the other person. - Be clear about what you and/or the patient need in order to feel comfortable and content with the care. - Listen carefully to what the health care professional has to say and ask for clarification to make sure that you fully understand what is being said before responding. - Be sensitive to the health care professional's limitations in his/her ability to help you and the patient. ER staff members are usually very busy, over-worked and tired. Don't assume that they are just unpleasant or unwilling to help.
	For patients who go to the ER frequently (e.g. sufferers of sickle cell disease), try to develop good relationships with familiar ER staff members.
	Know the ER chain of command. If you are not happy with the care the patient is receiving or if there is a problem with a particular staff member, identify the appropriate person to speak to. There is a nurse manager who oversees the nurses and a chief physician who supervises the residents and other physicians. You should speak to one of these two people for problems with staff on the floor. If you still are not satisfied with the patient's care, you can always make a complaint to the hospital patient representative or administrator.  Click here to see a list of hospital staff.

Learn first aid and basic emergency procedures

If you are not familiar with CPR or other emergency procedures, and would like to learn, you can take a course from the American Red Cross. You should always call 911 or an ambulance before performing CPR or first aid.

To locate a Red Cross near you, contact:

American Red Cross
431 18th Street, NW
Washington, DC 20006
(703) 206-7090
www.redcross.org

Coping With Home Care

Some of the duties required in caring for your ill loved one can be difficult for you to handle on your own. The patient may require technical medical care for his/her illness, disability, or injury, which you may not feel prepared to handle. In certain cases, home care services are covered by the patient's insurance. Other times, it is necessary to hire a home care nurse or health aide privately to help with medical and/or personal care of the patient. While these people can help to reduce much of the nervousness that you may feel, they can also add a certain amount of stress. Having a stranger in your home takes some getting used to. It takes time to get to know the home care worker and to feel comfortable with him/her. There are some things that you can do to help make the transition as smooth as possible.

Consider home care when the patient needs:

	Home Assessments for an unstable physical illness, such as cardiac, respiratory, or kidney diseases
	Wound care
	Incontinence care, including Foley catheters and ostomy care
	Diabetic instruction
	Home rehabilitation
	Medication monitoring or education

What to expect from the home care nurse:

	On the first visit the nurse will: - Review the patient's medical history and medications - Perform a physical assessment of the patient - Identify patient needs - Develop a plan of care with you, the patient, and the patient's doctor
	During return visits, the nurse will:
	-	Review the patient's plan of care
	-	Coordinate services that the patient may need
	-	Educate you and the patient as needed
	-	Report to the patient's physician about health status

Tips for Preparing for Home Care:

	Participate in making the care plan with the hospital staff and home care agency.
	Familiarize yourself with the home care plan and know what to expect, when the nurse or aide will be in the home, for how long, and what services will be provided.
	Determine how the home care nurse, aide, or others will be paid. If this service is not covered by insurance, make sure you discuss and agree on the fee for each home care team member.
	Know who to call if you need help when the home care worker is not scheduled to be there. There should be someone from the home care team/agency available for you to contact 24 hours per day.
	Have all medications, insurance cards, and hospital discharge information available at the first visit from the visiting nurse.
	Ask to be educated about the patient's needs and anything you can do to help when the home care worker is not in the house.
	Keep important patient information handy for the home health care worker. This includes emergency information, as well as current medications and advance directives (e.g. home DNR order, living will, or written information about the health care proxy).

Troubleshooting:

Many issues can arise when you are dependent on someone else for the care of the patient. You need to know the proper way to handle and resolve these and other problems with home care professionals in order to make the care plan work.

	Find out who is the target person/supervisor you should speak to about any complaints or problems. This is usually a nurse who is assigned to the patient's case. Write down these important contact numbers below.
	If there is a problem, tactfully raise it with the home care worker. If you do not feel comfortable with this, or the problem persists, discuss it with the supervising nurse who can tell you how to handle the problem or take care of it for you.
	Do not hesitate to speak to the home care agency if you feel that you need more help in the home. There may be other resources available to you through your insurance or other means that can be of help.

Click here to find home health care services in your area.