Who Is In Charge?

by Letha Sgritta McDowell
June 3, 2011
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I recently met with two gentlemen who had sought my advice regarding their mother. Their situation was typical. The mother was living independently at home while her two sons were leading busy lives nearby. Although the mother was relatively healthy, she did suffer from uncontrolled high blood pressure and high cholesterol. She was not, however, what would be considered elderly ‒ she was able to work, cook, clean, mow her lawn, garden, and participate in other activities. Then, unexpectedly, she suffered a massive stroke.
On the day of the stroke, her sons met her at the hospital. For quite some time they were unsure whether she would survive. The hospital provided excellent care, and she saw a variety of specialists and nurses. The hospital staff made sure she was stabilized and not in any immediate danger. Once she was stable, they discharged her to a rehabilitation facility. Her sons provided what little information they had about their mother’s health. They were largely unaware of her medical conditions, the medications she was taking, and any recent medical problems. Because none of their mother’s medical conditions had resulted in a hospital stay or episode that would cause them concern, the mother and sons had not felt the need for the sons to be informed about her health conditions. The only person in a position to provide information to the hospital was the mother’s primary care physician, and that physician was never consulted while the mother was in the hospital.
The mother’s discharge form the hospital happened with almost no notice to her sons; this too is all too typical. One of her sons went to visit his mother, and it as only then that he was informed that the hospital was moving his mother to a rehabilitation facility. The sons were not given a choice regarding the facility to which she would be discharged. They also were not given any information about what to expect or to whom to talk once their mother was admitted to the rehabilitation facility. The mother was moved to the rehabilitation facility, and, once again, her primary care physician was not consulted.
After their mother was admitted to the rehabilitation facility, the sons tried to determine what would be the best long-term plan for her. I met with the sons and spent quite a bit of time with them to determine their goals and objectives, what they saw as the long-term plan for both their lives and their mother’s life, and I tried to get an idea of what would be feasible for them. I quickly realized that they had no idea of their mother’s capabilities since the stroke, where she was in the rehab process, and her prognosis. The sons had tried to ascertain this information ‒ they spent time with their mother during normal working hours, while taking time off from their jobs. They tried to speak with the physical therapist, but that person was never available, so the sons obtained opinions from anyone to whom they could speak. They never were able to speak with a physician, they never met any type of director, and they never received any real answers.
Because the sons were trying desperately to devise a plan for their mother’s care, we met several times over the course of several months, and each time I asked about their mother’s progress. It became obvious that the sons were still unaware of her real progress, and they did not even know what questions to ask. While I am not a physician or a social worker, I realized that they needed the help of someone with medical knowledge and knowledge of the health care system ‒ a health care advocate.
I referred the sons to a local medical social worker. She met with them at the facility and met with their mother. She was able to interpret the information they provided, and she gave them an honest assessment of what their mother’s needs were at the time. I then met with the medical social worker and both sons and began to try to get a sense of what the sons needed to achieve their goals and objectives. The medical social worker began to ask questions such as: “Was your mother’s primary care physician consulted?” “Has your mother been seen by a neurologist since she left the hospital?” “What has the psychiatrist said about her progress?” “Who was present at her team meeting?” The questions she asked boiled down to one question, “Who was in charge of leading their mother’s medical team and who was in charge of pulling everything together?”
In a perfect world, the mother’s primary care physician would remain in charge. Unfortunately, our medical system is fragmented and that does not always occur. The second choice for the person in charge is someone in the family. In the situation described here, the sons were unaware of any of their mother’s health condition. In addition, they had no medical knowledge, they did not know what questions to ask, and they did not know to whom they were supposed to pose their questions. They were under the impression that progress reports such as “Your mother is improving,” were standard. The medical social worker was able to ask the right questions, and she was able to point out that the question “Who is in charge?” was the most important question to ask.
As a result of their conference with the medical social worker, the sons discovered that their mother was not seen by the necessary specialists. The medical social worker also gave the sons a realistic view of their mother’s capabilities and what she would be able to accomplish with further rehabilitation. With this information and with the assistance of a gerontologist, the sons have come up with a plan to bring their mother home with assistance. She has been given the opportunities she needed to rehabilitate as much as possible, and the medical social worker was able to help arrange the right type of in-home care. All of this has been overseen by the gerontologist acting as the team leader in conjunction with her new primary care physician.
The lesson to be learned from this example is that the medical system is fragmented. While it may seem that a loved one is getting the right type of care, only an expert and an advocate can point out what is missing.
Oast & Hook’s life care planning program is designed to assist families by helping to put you in charge of your life or a loved one’s life. We can assist you in finding the right health care advocate. In addition, we have certified care coordinators who can assist with the management of chronic illness and aging outside of the medical field. Our certified financial planner can assist in planning for the financial aspect of aging, and our attorneys serve as the team leader to help organize a family and the specialists with whom they are working, so that you never have to ask the question “Who is in charge?”

Ask Allie

O&H: Allie, please tell us about another dream job for animal lovers.
Allie: Sure! Assisted Animal Therapy (AAT) is a growing field ‒ volunteers take their cats, dogs, or other animals to facilities to help with rehabilitation and health for people with disabilities. Some educational institutions now offer programs in AAT management, because there is a need for paid individuals to design, implement, manage, and administer these programs. Traditional fields, such as nursing, social work, education, physical therapy, speech pathology, and geriatrics, can incorporate AAT. The activities director in a facility may be the person who organizes AAT for the facility. People over the age of 10 years interested in a career in AAT may want to see if they and their pet can qualify as a Pet Partners with the Delta Society. (You can take courses by e-mail.) Once the person and pet graduate from training, they can visit nursing homes, rehabilitation centers, hospitals, and schools for children with disabilities to provide AAT. For more information on Delta Society and how to become a pet partner, please visit its website at www.deltasociety.org. That sounds like a great idea! I had a great experience as an assistant office manager at Oast & Hook, almost like being a therapy pet. All this talk about work has made me ready for a nap. See you next week!


If you are interested in having an Oast & Hook attorney speak at your event, phone Katy Lorince at 757-399-7506 or e-mail her at lorince@oasthook.com . Past topics include estate planning, long-term care planning and veterans benefits.

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