Navigating Hospitalizations with Dr. Monique Nugent

What do you need to know about navigating a hospitalization?

Join Kelly and her guest, Dr. Monique Nugent, practicing hospitalist, associate director for the Division of Hospital Medicine at South Shore Hospital in Massachusetts, and author. 

In this episode:

🔹 Tips on how to make the healthcare hospital system work for you

🔹 Biggest mistakes people make when facing a hospitalization entry and release

🔹 How caregivers can be an advocate for aging loved ones’ health and have a hospital plan

🔹 How people can best advocate for themselves and build a team to lean on if they don’t currently have a support system?

➡Watch this episode on YouTube: https://youtu.be/upeLYRQUDUg

For additional information about Kelly, check her out on Linkedin or www.SteadfastAgents.com.

To explore your options for long-term care insurance, click here.

Steadfast Care Planning podcast is made possible by AMADA Senior Care and Steadfast Insurance LLC.

Come back next time for more helpful guidance!

Transcript

Kelly Augspurger [00:00:02]:

Hey, everyone. Welcome to Steadfast Care Planning, where we plan for care to live well. I'm your guide, Kelly Augspurger. With me today is Dr. Monique Nugent. She is a practicing hospitalist and associate director for the Division of Hospital Medicine at South Shore Hospital in Massachusetts. Monique is also the author of her latest book, "Prescription for Admission: A Doctor's Guide for Navigating the Hospital, Advocating for Yourself, and Having a Better Hospitalization", which is a complete guide to providing the critical info that you need to navigate the hospital. So, Monique, thank you so much for being with me today.

Dr. Monique Nugent [00:00:40]:

Thank you for having me, Kelly. I really appreciate your time and your audience's this time, as well.

Kelly Augspurger [00:00:44]:

Today we are going to talk about navigating the confusing world of hospitalization and healthcare. So, Monique, can we jump right in?

Dr. Monique Nugent [00:00:53]:

Yeah, let's do it.

Kelly Augspurger [00:00:54]:

Okay. Can you give us a behind the curtain peek into the healthcare system and give us tips on how to make it work for us?

Dr. Monique Nugent [00:01:02]:

That's a big question. So I'm a hospitalist. That means that I only see acutely hospitalized patients. I don't have patients in a clinic, and I don't keep office hours. And so my realm of the hospital is a place that A) people a don't like to think about, but B) most of us are going to end up in a hospital at some point in time. Be it something happy like the birth of a child, or something that you have chosen, like a knee replacement, or an unforeseen accident or illness. And so the hospital tends to be this black box. Right? Even doctors who practice in the clinics, they'll say, like, I don't really know what happens to my patients once they go in the hospital. And I think it's really just, unfortunately, the fragmented nature of healthcare in this country, everything kind of works in silos, and hospitals are no different. And so the thing that's going to be really helpful for patients or their people who are advocating for them right, because not everybody is able to make their own health care decisions or speak for themselves when they come in the hospital.

Kelly Augspurger [00:02:00]:

Right.

Dr. Monique Nugent [00:02:01]:

The thing that makes a big difference, I always tell people, be number one, the owner of your own information. If you can give us clear, consistent information or at least where to get that information, you're going to be helping make a big plan and make a safe plan for you. And the second thing is, advocating for yourself means being involved. And I think a lot of the times, unfortunately, people come into the hospital and there's an idea that this should work. I think if you've ever interfaced with hospital, you understand that it doesn't always work. It doesn't always work the way you want it to. And so if you're engaged and you are participating, that's going to be the biggest thing that's going to help you drive your hospitalization forward and help you advocate for yourself.

Kelly Augspurger [00:02:44]:

Good tips. What do you think are the biggest mistakes when facing a hospitalization entry and a hospitalization release?

Dr. Monique Nugent [00:02:52]:

So there's actually a name for those two points in time in healthcare, and we call those transitions of care when someone is moving from one phase of care, home or wherever they call home, right. Some people live in facilities into the hospital and then from the hospital back out, right. And you're right. Those points, those transitions of care are places where lots of mistakes can happen. And like I said, the number one thing you can do is be the owner of your information, right. There's going to be a process called a medication reconciliation process.

Kelly Augspurger [00:03:22]:

Okay.

Dr. Monique Nugent [00:03:22]:

If you've worked in healthcare, in hospitals, you know this process is to be a really high point of safety, something that hospital systems are very invested in. And what that is, is when you come in, we take a list of all the medicines that you're taking. We look at them and we say, this, this, and this are safe to take. This, this, and this are not safe to take right now. And then I'm going to add this, this, and that.

Kelly Augspurger [00:03:44]:

Okay.

Dr. Monique Nugent [00:03:45]:

And then during your hospitalization, your medications may change. We may go up on something that you were taking. We may stop something totally. We may say, you can't take an aspirin while you're taking this other medicine, right? There's all these things that are happening to medications. And then when you leave now, you have to get all that information and you have to get it right. And the medication reconciliation process is done, again. We say, okay, so today in the hospital, they're taking A, B and C. They can resume taking D, E, F at home. They should not take G and H. And I'm going to add I and J, right. And so this is where I say being the owner of your information is really important because these transitions of care is where errors happen. And if you can give us clear, consistent information, not only the medications that you take, do you have any special limitations? Right? Some people have dietary limitations. Do you use a CPAP machine at night?

Kelly Augspurger [00:04:40]:

Right.

Dr. Monique Nugent [00:04:40]:

Who is your primary care doctor? Who is your specialist? Give as much information as possible. Be the owner. Know that information, and if you can't know it, know where to get it. Right? Medicines are really complicated. So if you can say, I don't know the name of everything, but I use CVS on Main Street in my town, right? We can get that information.

Kelly Augspurger [00:05:02]:

Okay.

Dr. Monique Nugent [00:05:02]:

And this is where you're going to bolster the safety. So that's coming into the hospital. Now, leaving the hospital again, knowing your information is really important, but this is where I'm going to ask for you to really lean into your honesty. What are your capabilities at home? Everybody wants to go home.

Kelly Augspurger [00:05:18]:

Sure.

Dr. Monique Nugent [00:05:18]:

But not everybody can. Right. And for those who do go home, from the hospital home may look different. So lean into your honesty and say, what is it that I need from you? What is in the community? What does my insurance provide? How can I be successful at home? And what I see oftentimes is when people may not understand their needs or may not communicate their needs, they get home and all of a sudden, something becomes really obvious. They can't get up the stairs. They can't use the toilet safely. They're still in pain. Right. And now to readdress those away from the hospital, where you have a system of social workers and case managers, speech therapists, pharmacists who can get you things, navigating that away from the hospital becomes extremely difficult because now you're trying to piece together, can my primary care get me something? Do I need to talk to the specialist? How do I get a walker? Do they sell them at Walmart or do I need a prescription? All of those things are really complicated. And what I say is, when it comes time for discharge, lay it on the table. What can I do at home? What can't I do at home? Or if I have to go to a rehab, what is the rehab going to be? Where is it going to be? Is it close to a place that I like, oh, my dad was there. I hated that place. Oh, that's on the way to my daughter's work. She can stop off and visit me. What are you looking for that's going to help you get the most out of your stay there and be successful? Because the truth of a hospitalization is your discharge planning. That's what we call when we think about what you need to leave the hospital. It starts when you get admitted. And I know people don't like hearing that. They're like, you're thinking about me being discharged. I just got here. No, I'm thinking about what you're going to need to be successful. And sometimes those pieces take a long time to put together on the endpoint and the transition coming in. Know your information, know your stuff, and then you're going to participate through your hospitalization. You're still going to know your information. But when they're talking about discharge, be open and honest. Tell them everything that you need, everything that you're capable of, what your fears are. We may uncover things. There are oftentimes I end up uncovering food insecurity for our elder patients. Right.

Kelly Augspurger [00:07:27]:

Yeah.

Dr. Monique Nugent [00:07:28]:

And we can plug them into Meals on Wheels.

Kelly Augspurger [00:07:30]:

Right.

Dr. Monique Nugent [00:07:31]:

Or whatever other program is in the community.

Kelly Augspurger [00:07:33]:

Yeah. Recommend resources. Yeah.

Dr. Monique Nugent [00:07:35]:

Recommend resources. Be open and honest when it comes time for discharge, because you want to be set up for success. I know it's time to go. And people are like, I just want to get out of here. I had a patient this week. It was the same thing every day. I just want to leave. I just want to leave. But we got to get paperwork done because I don't want you to fail. And when you're out there and come back and feel bad, we're starting at a different point or sometimes starting over.

Kelly Augspurger [00:07:58]:

Yeah. Oh, those are such wonderful tips. I think what I really took away there is you want to be the owner of your information, and we want to be honest, and when going home, we want to be successful. And part of that is I think the last thing most people want is to go home and then have to go back into the hospital because you weren't ready to go home. That's not successful. And so being realistic and honest about, okay, is it safe for me to go home? Is my home ready for me? Because if I need a wheelchair, am I able to get around my home in a wheelchair? If not, we need to figure something out so that I can go home, maybe make some home modifications in order to be able to go home and stay at home and be safe. And for me, that is really key, Monique, is we all and we want our family members to be as safe as possible wherever they're aging. A lot of times that is in home, but maybe it's not. Maybe it's in a family member's home, an assisted living community somewhere else. But, yeah, aging successfully and safely are key. And now for a brief message from our show's sponsor. The Steadfast Care Planning podcast is sponsored by Amada Senior Care, Columbus Amada is your one stop shop for in home caregivers, senior housing advice, and long term care insurance claim assistance. Visit www.amadaseniorcare.com/columbus-senior-care to learn more. Next. Monique how can caregivers be an advocate for aging loved ones' health and have a hospital plan? What's important for them to do and ask?

Dr. Monique Nugent [00:09:32]:

So for this, I'm going to go back to our elders, the people that we're advocating for and caring for. One of the best things that they can do to set up their caretakers for success is to plan ahead and really list their wishes. There are going to be times where you come into the hospital and it's really not that complicated. You may have fallen and a wound got a little bit more infected than usual, and you go in, you get some wound care of some antibiotics, you can go home. But there are other times where hospitalizations get really complicated. And at the end of a hospitalization, there can be life changing diagnoses, there can be life changing need for equipments, or someone may not be able to return home, or they may not be able to make decisions for themselves. What I always tell people is, have conversations that you need to have before you're in an emergency.

Kelly Augspurger [00:10:19]:

Yes.

Dr. Monique Nugent [00:10:20]:

If you can sit down with the people who are going to be your caretakers and outline what your wishes for your health care are, what your goals of care are talk about things like your MOLST and your POLST, which are depending on your state. They're either called MOLST or POLST, but they are portable orders of life sustaining treatment around CPR, electric shocks, intubation, which is a tube down the throat. If you can't breathe for yourself when you don't need to have those conversations. I know they're hard and I know they're awkward, right? But when you're not in an emergency, sit down, fill out a MOLST or a POLST, let their caretakers know your wishes, complete an advanced directive. An advanced directive is a piece of paper that's going to be able to list who you want to make decisions for you if you can't make decisions for yourself and then you get to say everything about your value system and what type of interventions and care you will accept, you wouldn't accept, what your limits are. The more information you can give is, the more you're setting the person who's going to be advocating for you and helping you navigate healthcare up for success. Because you're giving them your voice. And when they have your voice, then advocating for you means that they know exactly what you would want and they can drive that boat. And it's a big gift that you're giving to the people who you're listening to, your medical decision makers, because some of those decisions can be hard. And if somebody feels like they're making that decision from scratch, it's a lot of emotions that go into it. If you can give someone your decisions and your voice beforehand, you're relieving them of some pressures or guilt that they may have. Instead, what you're giving them is you're bolstering them in their confidence to do the thing you want to help you get through hospitalization. And I know you said, how can we advocate for our elders and the people we're caring for? And I kind of put it back on them. But I think really setting that set of information up is going to be what sets people up to know what they're going to do and how they're going to advocate for others.

Kelly Augspurger [00:12:21]:

So what you're saying here is proactive. We need to be proactive and as caregivers, if you want to advocate for your aging loved ones, you need to bring this up. If your loved ones have not already told you their wishes and we don't have it written down, you need to be proactive about it. Ask them. Mom, dad, if you are admitted into a hospital, how do you see that playing out? What do you want in XYZ situation to happen? We need to know these things to be able to make decisions for you. And hopefully you already have an estate plan and you have like a medical healthcare POA and all of these other important documents and if not, okay, now's the time to do it. Get this done. But being proactive in bringing these, like you said, kind of awkward. Can be difficult conversations up so that we are setting everyone up for as much success as we can.

Dr. Monique Nugent [00:13:10]:

Oh, yeah, I think you put it much better than I did. No, thank you for recapping that. I'm going to steal that. Yeah, no, that's exactly what it is. Get that information. I'm going to fall back on my other things. Be organized. If you're caring for someone, make sure you know what their medications are, what their dietary needs are. I know that sounds kind of silly, but not everyone can eat and chew normally. And so sometimes you're like, oh, dad actually uses a thickener, or mom eats puree diet, those type of things. They may seem small, but they're really big when it comes to safety. And that's the big word when it comes to hospitalization, is like, you want to give as much information, you want to participate, you want to make sure that safety is the number one thing that's going on.

Kelly Augspurger [00:13:53]:

From my experiences with loved ones and being the hospital, it's really nerve wracking, right? You're going in, you're like, how long are we going to be here? What's it going to look like? When are they going to get out? What's going to happen after they get released? All these things with family members that have been young and older, and so the unknown is just so scary. So if we can be prepared as much as possible to minimize, really the consequences that come from not having a plan is going to be, I think, really, really important and having these conversations upfront with our loved ones and, hey, do we have all of our documents? I mean, I've even taken our whole estate plan binder to the hospital before. When we had a loved one in the hospital, it was like, okay, we've got everything with me. I'm prepared. I'm ready. And you just never know. And I've seen and I'm sure you've seen this, too, Monique. Many mistakes can be made in a hospital because it's so complicated, right? There's so many things going on. There's so many different people, too, coming in and out of the room and then different shifts. And I know that nurses and doctors, they talk to each other as they switch and rotate, but sometimes things slip through the cracks. So as an advocate for your loved one, be sure to speak up and say, hey, just FYI, I want to make sure that you understand whatever the situation is, right? If you're feeling a little uncomfortable about it and not sure that you're on the same page, just talk about it with that nurse or that doctor, whoever it is, to make sure we can minimize those mistakes as much as possible.

Dr. Monique Nugent [00:15:21]:

That comes up with me a lot. When people say, like, "Oh, how do I say if I feel like something's going wrong or advocate for someone?" I say, do it in real time, right? When you notice something, bring it up then because you don't want the event to have passed. And maybe, like you said, a mistake has been made, an unforeseen consequence occur. But also, if you bring it up, you can rectify it, then you can clarify it, then. One of the big questions I get a lot is, "Oh, I didn't get my medicine from this morning. I take this and this and that at home, and I didn't get that." I love it. Address it immediately, because then we're able to have the conversation of, like, "You're right, you didn't get the medicine, and this is why." Or, "You were taking that medicine? It wasn't on your medication list. Let's review your medication list again and make sure that we have it right", because somebody will give you their medication list, and then their daughter will come in the next day and say, like, actually, this is the correct medication list. There's no shame in readdressing those issues. Address those things in real time. And that way you're, like I said, participating, but like you said, you're catching those errors. I myself had a situation where my daughter was hospitalized and my husband caught an error in real time on rounds. He was listening to them because children's medications are dosed by weight, and they listed her weight, and he said, "Whoa, no, that is not this child's weight." And they were able to go back. And some things that we were concerned about, we saw like, oh, well, this is actually because she was getting too much fluid. And so he was addressing things in real time and picked up on an error that to us as parents was really big. And we were able to say, "Okay, now hospital, this error was made, we picked up on it. What is your process for addressing it?" And they said, "Okay, we'll file an event report." So participating in that, say like, "Oh, you found this error, how are we going to fix it?" And those things make a big difference, right?

Kelly Augspurger [00:17:16]:

So as an advocate for your loved one, if you're in the hospital with them, don't be afraid to speak up and listen well. Pay attention to what's going on around you and to your loved one, so that you can pick up on those potential errors that might happen, because, yeah, for instance, with your daughter, that potentially could be a really big deal. If you're given the wrong dosage, what could the consequence be to that? So we want to pay attention and stay on our toes to be able to best protect our loved ones. And now for a brief message from our show's sponsor. The Steadfast Care Planning Podcast is sponsored by the CLTC Certified in Long Term Care Training program, which gives financial advisors tools to discuss extended care planning with their clients. Look for the CLTC designation when choosing an advisor. Monique, I know we've touched on how can we best advocate for ourselves and our loved ones. What if we have someone that doesn't have loved ones that can advocate for them, and they need to build a team to lean on if they currently don't have a support system. So how can people do that? How can people best build a team for a support system?

Dr. Monique Nugent [00:18:22]:

In my book, I refer to your care partner. And your care partner is the person who in life helps you navigate the world and helps you make medical decisions, right? No medical decision is made in a vacuum. Even your decision to take Tylenol in the morning for a headache is really kind of driven by, like, I got to get the kids to work, I'm in school, and I got this. Nothing's made in a vacuum. We do things for lots of reasons. Your care partner doesn't have to be a blood relative. It doesn't have to be somebody who people would traditionally think of, right? Chosen family is family. Find the person who you trust and who is your support system and build that support system out. Because being hospitalized can be very isolating. The first day you get in the hospital, everyone knows you're in the hospital. And kind of everyone's world slows down a little bit because they want to know what's going on and you're okay. But day two, three, four, people got to go to work, people got to go to school, you're still in the hospital, right? Whatever that support system looks like for you socially, bring that support system into the hospital. If you have spiritual, religious advisors, feel free to reach out to them and ask them to come and visit. I always joke everybody has a cousin, sister, neighbor who's a nurse, whoever it is who, you know, knows how to navigate the system a little bit better because the system is so cumbersome. There's no hack or secret trick to healthcare. You have to go through it little by little. Reach out to that person and say, hey, I'm sick. I'm in the hospital. I'm hurt. I'm in the hospital. I just need someone to lean on. And I think, unfortunately, there are people in our world who just kind of don't really have many people or are alone. For those people, building out your documents to support you are really going to be key because you don't want something to happen that you didn't wish to happen.

Kelly Augspurger [00:20:05]:

Right.

Dr. Monique Nugent [00:20:06]:

And the hospital, when they have your documents, they know that there's something they can fall back on to help make decisions for you that are in line with your value system. But keep your cell phone charged. Call, text your best friend. Keep sending those instagram reels. Participate in the world that's going on outside. Let people know when you need some help. I've had a lot of patients FaceTime their loved ones when I'm in the room with them. I'm okay with that. I would suggest asking your providers if they're okay with that.

Kelly Augspurger [00:20:36]:

Yeah, great idea.

Dr. Monique Nugent [00:20:36]:

That brings people in. Don't do it alone. There's very few hospitalizations that are just kind of cut and dry. There's lots of many moving pieces that go on being successful after a hospital stay.

Kelly Augspurger [00:20:49]:

Stay connected and don't be afraid to reach out to people. Even if it's not family. Right. It might be a close friend.

Dr. Monique Nugent [00:20:56]:

Chosen family is chosen family.

Kelly Augspurger [00:20:58]:

Reach out to people, stay connected and don't be isolated. You don't have to do it alone. Yeah. Great advice. Monique, any final advice on how people can plan for care to live?

Dr. Monique Nugent [00:21:07]:

Well, wow, that's a big question.

Kelly Augspurger [00:21:09]:

It is. No pressure.

Dr. Monique Nugent [00:21:11]:

Yeah, well, you know, I'm actually, like, in a strange place in my life where I have littles, I have parents that are starting to get older and I'm seeing growth kind of in both of those ways. And the thing that I think I have noticed is when you're engaged and participating in your environment and your social circle, that's really going to be the thing that helps you thrive. Nobody does this life alone. My daughters, I watched the first one really glam on to us as parents. The second one, I've never seen someone love a sister the way she loves her big sister. The third one is just obsessed with the other two and they're their own little world and support system. And so I just see them growing in the world together. And it's the same thing as my older patients in the hospital. Those who are still volunteering, going to church, pick up their grandkids, doing whatever, who are involved in their community. They're the ones who are really sharp as a whip and thriving. They have people who are with them in this journey. The NHS, the National Health System in England actually declared loneliness to be a health care issue that was plaguing them. And I don't think that our country is any different. I think that we need to lean into supporting each other and building the community. What I would say is, as we get older, in order to plan a beautiful life, is participate in that beautiful life and be a part of the world. And people love you, you love them and it's all a circle.

Kelly Augspurger [00:22:48]:

That's so beautifully said. Yes. Don't isolate yourself. Stay connected. Engage with people around you. Social health is extremely important and should not be forgotten. People need to make sure they take care of themselves in that way, too. Physically, mentally, emotionally, spiritually, socially. Right. We are people and we need all of these things in our lives.

Dr. Monique Nugent [00:23:08]:

No man's an island.

Kelly Augspurger [00:23:09]:

Right. Right. Yeah. We really need to address all of those things. Well, Monique, thank you so much for your time today. Where can people find out more information about you, your new book, and any resources that you offer?

Dr. Monique Nugent [00:23:20]:

Yeah, you can check out my website. It's drmoniquenugent.com. DR. D. R. Monique. M-O-N-I-Q-U-E. Nugent N-U-G-E-N-T.com. And you can find the book anywhere that you buy books online: Amazon.com, barnesandnoble.com, my website has a couple of really great downloads. I always tell people to go check it out. I've got some things you can practice, filling out your medication list.

Kelly Augspurger [00:23:45]:

Oh, okay, good.

Dr. Monique Nugent [00:23:47]:

And I also have a guide to how to plan for a successful family meeting during a hospital stay. And I'm flushing it out. We'll start putting up articles and blogs and stuff, so it'll be a place I want people to go to get information on hospitals. So check it out. DrMoniqueNugent.com and prescription for admission. Anywhere that you buy books online, you can find it.

Kelly Augspurger [00:24:08]:

Terrific. Well, Monique, thank you so much your time today and sharing your expertise and knowledge. We really appreciate it. Have a wonderful day.

Dr. Monique Nugent [00:24:15]:

Thank you. Thank you again.