Barbara Garwood

Special to the Post

Mom fell. It was bound to happen. You just didn’t think it would happen today. You have been in the emergency room for around eight hours, waiting to learn what your mom’s injuries are and what those injuries will mean to her future. What will this fall mean to her future and life as she knows it, and how will it affect you as her caregiver? No doubt the injuries from this fall will require more of your time, more of your attention, more of your patience, more of you. As you are given the diagnosis and prognosis, trying to digest the implications, you are hit with a bowl of alphabet soup.

Here it comes. “Do you have HCPOA? OK, then we can talk. I’m sure someone has already explained HIPAA to you. Your mom has a fractured hip and will be admitted to the hospital for surgery. At D/C she will go to a SNF for rehab and then transitioned back home with DME. If she continues to need assistance with her ADL’s, she may need additional PT and OT. You may want to consider help in the home. Oh, by the way, is she a DNR?”

Confused yet? Of course you are! Let’s translate.

HCPOA stands for healthcare power of attorney (what you need to have in order to discuss your mom’s medical conditions with her health-care providers and to make decisions on her behalf if she is unable to make those decisions on her own). This is important. If you do not have this in place for yourself, or if your parents do not have this in place, please make it a priority. We will talk more about this in a future column.

HIPAA? Health Insurance Portability and Accountability Act. In the context of the scenario above, HIPAA refers to the HIPAA Privacy Rule, which regulates the use and disclosure of protected health information. Put very simply, a health-care provider is not able to share information about your loved one’s condition without your loved one’s permission.

D/C is a shortcut for discharge. Your mom is being discharged.

SNF (pronounced “sniff”) stands for skilled nursing facility. If someone in health care tells you that your mom needs a sniff, they don’t mean that she smells bad. They are informing you that she likely needs a skilled level of nursing home care, maybe just for a short time for therapy, until she can transition back home.

Back home with DME (that’s durable medical equipment), better known as walkers, wheelchairs, bedside commodes, shower chairs, and so on. If your mom fractured her hip she will need to use a walker to steady herself until she can regain full mobility and strength. You get the picture.

Why does she need that DME? Because she is having difficulty with her ADLs. Her what? ADLs (activities of daily living) are known in the real world as bathing, dressing, eating, walking, and caring for your personal hygiene. ADLs are the things most of us do every day without a second thought. They are the things that make us independent as we go about our day. However, one fall for an older person can mean the difference between independence and dependence. A fractured hip means you need assistance with your ADLs.

To learn how to use that walker properly and to regain her strength in a safe way, your mom will need PT (physical therapy), which is familiar to most of us. But what about OT? That is occupational therapy, promoting skill development and independence in daily activities. For example, if your mom fractured her hip she will need to learn a different way to bathe herself while her hip heals, since getting in and out of the tub won’t be safe for awhile.

Now, what the heck is a DNR? DNR stands for Do No Resuscitate. A Do Not Resuscitate order is generated by a physician and is very different from a living will. If you choose to have a DNR in place it means you do not wish to be brought back to life if your heart stops or if you stop breathing. Put differently, it means you wish to allow natural death if your heart stops or your breathing stops. There are several junctures as you transition through care when you will be asked if you have a DNR. One is in the emergency room. Another is when you are admitted to the hospital. You will be asked again when you are admitted to the nursing home. The decision for a DNR order is a very personal one and should be discussed with a doctor you feel comfortable with and who knows you well. The most important thing is to have that talk, sooner rather than later.

So, your mom is going from the hospital to the nursing home and then back to her/your home when she has healed and finished her physical therapy. Her fall has led you on another detour in the caregiving journey. There will be many detours along the way, and they will challenge your strength and test your patience. Always remember that knowledge is power. If someone spills a bowl of alphabet soup on you, do not hesitate to slow them down and ask for a translation. Take notes so you can remember later what was said and what the expected time frame is. You are in a stressful situation and not at your very best. It’s OK to need help with your ABC’s.

Barbara Garwood is director of community services for Lutheran Services Carolinas. You can contact her at bgarwood@trinityathome.net