Recently, my mother’s 88-year-old sister fell.

As she went down, her husband said, “You just broke your hip.”

I am not sure if being a medic in the army sixty years ago qualified him to make that diagnosis, but he was right.

My aunt and uncle live about 90 minutes from their only daughter, my cousin Beth.

As Beth rushed to the hospital, I am sure she was thinking of her mother, but also about her husband who was currently receiving chemotherapy and radiation for a tumor in his throat. He had been having an extremely difficult time eating and lost almost twenty pounds in a matter of weeks. The doctors were talking about inserting a feeding tube that week.

Beth arrived at the hospital and learned her mother’s surgeon wanted to perform a total hip replacement. They were checking her heart to ensure it was strong enough for the surgery.

The surgery was planned for the next day. Fortunately, my aunt sailed through with no complications. The doctor recommended a few days of recuperation in the hospital and then a move to a skilled nursing facility to gain back strength and undergo physical therapy.

My cousin called me to ask about finding a good skilled nursing facility near her. I explained that because she lived 90 miles away, the hospital discharge planner who normally would make arrangements for the move, may not be familiar with the facilities near my cousin’s home.  I encouraged her to go to https://www.medicare.gov/care-compare/ and search skilled nursing facilities in her zip code.

I explained that Medicare has a scoring system for each facility with an overall rating of five stars, five being the most highly rated. So, looking at five-star facilities first, was a good place to start.

I then explained that her mother’s admission to any facility would be predicated on the services of the facility matching what her mother needed, whether the facility takes her insurance, and if they have a bed available.

Beth gave her wish list of facilities to the discharge planner, and it appeared two of her preferred facilities may have a bed available. This is not always the case; I told my cousin she was very lucky.

The next day was Sunday, with hardly any notice, at 3 pm the discharge planner was ready to make the move, but my cousin and my aunt were not. Transportation had to be arranged (the facility was 90 minutes away); my cousin needed to go to her parents’ house to pack up, and her mother was still in significant pain. Beth disagreed, but the discharge planner said my aunt had to be “out that night.”

My cousin called me to ask if she had to agree to the discharge. I explained that you can appeal a discharge especially if there is not a safe plan in place. Beth could request a second opinion or ask for a patient advocate or submit a formal written appeal as a last resort.

Beth disputed the discharge to the planner citing her mother’s pain not being under control, the stress of a 90-minute ambulance ride on top of the pain and the fact that she (her mother’s care partner) could not be at the facility when my aunt arrived to advocate for her.

Given my cousin’s challenge, the discharge planner was able to secure an additional night in the hospital for my aunt and plans were made to transport her the next day.

This gave my cousin a chance to go to her parent’s house with her father, gather their important belongings, pack up, and arrange for care for her husband until she could return home to help him. This also allowed her to get a good night’s sleep and arrive fresh at the skilled nursing facility the next morning.

I am happy to report after five days at the skilled nursing facility my aunt is home at my cousin Beth’s house.

As a family caregiver, my cousin Beth has many challenges ahead of her, working full time, caring for her husband who now has a feeding tube and continues to go through radiation and chemotherapy, managing her mom’s recovery, and having the tough conversation with her parents about where to live in the future.

Navigating the challenges of care for loved ones is rarely easy. Keep in the back of your mind that you can reach out to organizations like Senior Concerns for help and guidance, we are here for you and your loved ones.