When a loved one is hospitalized, family caregivers often find themselves overwhelmed, worried, and unsure of what to do next. In this episode, host Karen Summey, ACAPcommunity is joined by Dr. Bibhusan Basnet, MD, MS, FACP, Board-Certified Internal Medicine Physician and Hospitalist; Chief Executive Officer and Co-Founder, eHealthyInfo talk with an internal medicine physician about the critical role of caregivers during a hospital stay. Learn how to communicate effectively with the healthcare team, understand medications, prepare for discharge, recognize potential problems, and take care of yourself while caring for someone else.
[00:00:02] What You Want, When You Want It, Where You Want It. This is The MESH. When a loved one is hospitalized, family caregivers often find themselves overwhelmed, worried, and unsure of what to do next. In this episode, we talk with an internal medicine physician about the critical role of caregivers during a hospital stay.
[00:00:30] Learn how to communicate effectively with the health care team, understand medications, prepare for discharge, recognize potential problems, and take care of yourself while caring for someone else. Stay with us. We'll be right back. I used to think health care was all the same until I discovered PACE at Senior TLC. Now I can come to a place to stay active, see the doctor, or just enjoy a meal with my friends.
[00:00:56] Plus, having a team of people that help me make sense of my options gives me the support I need to stay in charge of my own health. It's been life-changing. With PACE at Senior TLC, we offer a unique lineup of personalized care and a caring staff that feels like family all under one roof. Call today and find out how you can experience a different kind of care. Welcome. I'm your host, Karen Summey, with ACAP Community and an active family caregiver.
[00:01:26] We're delighted you've joined us today. If you've ever had a parent, spouse, or loved one admitted to the hospital, you know how stressful and confusing that experience can be. Suddenly, you're faced with medical terms, medications, test results, and important decisions, all while trying to support someone you care about.
[00:01:45] Today, we're talking with Dr. Bibasan Basnet, an internal medicine physician, about what family caregivers should know during a hospital stay and the importance of their role in helping their loved one receive the best possible care. Dr. Bibhusan Basnet is a board-certified internal medicine physician and hospitalist with more than a decade of experience caring for hospitalized patients.
[00:02:09] Hospitalists are physicians who specialize in treating patients during their hospital stay, coordinating care with specialists, communicating with families, and helping ensure safe transitions home or to rehabilitation and nursing facilities after discharge. Dr. Bibasan Basnet practices at Frye Regional Medical Center in Hickory, North Carolina, and serves as clinical faculty at Wake Forest University School of Medicine in Winston-Salem, North Carolina.
[00:02:36] He also is the co-founder of eHealthy, a health education platform dedicated to making medical information simple, trustworthy, and accessible to patients and families. And finally, he serves as deputy editor of the American Journal of Patient Health Info and holds a master's degree in health informatics from the University of North Carolina at Chapel Hill. Dr. Bibhusan Basnet, welcome to the ACAP Community Podcast.
[00:03:05] We so appreciate you being with us today. Thank you, Karen, for having me. It's a pleasure. Great. So, I want to start our discussion with a big-picture question. Why are caregivers so important during a hospital stay? Caregivers are really important because they know who the patient is. They are the ones who can fill in the gaps.
[00:03:33] As doctors, I can talk to a patient. I can look through the charts, some labs, some x-rays. But exactly what happened at home, if there was a change in a recent medication a week ago, or something has gone wrong at home, they are the ones who fill in the gaps, the real clinical picture.
[00:03:58] And that's so much important in someone's medical treatment plan. So, yeah, they are just not caregivers, caregivers per se. I think they are part of the whole clinical team, I say, because that's how we generate a picture. So, yeah, I mean, they're very important. Wonderful. Well, I have experienced that personally,
[00:04:25] and I've noted that always when we're in a hospital setting, there's always some little something that has been left out of the records or something that's changed, and I understand how important that can be. So, when a loved one is first admitted to the hospital, things can move very quickly. What should caregivers know on day one?
[00:04:50] Very important question, and I think an amazing one. The reason why is when someone comes in to a hospital, and what we really want from caregivers is the medication list. What are they taking? Because that gives me an idea what has been going for a long time, and that gives me an idea of what has changed. Allergies, medication list,
[00:05:20] and also what has happened in the last few years. And advanced directives, like I think if I was working yesterday, and I had like 20 patients, among them 15 were 75 plus. So, I need to know the advanced directives. I need to know what I shall do if things go wrong, because I need to respect what they desire, and for that I need to ask.
[00:05:47] And if there's a family member or a caregiver or a friend who knows them in person, my life is so easy, and overall, that's what we want for everyone. We want to make sure we respect people. So, advanced directives are so important. So, yeah, first thing is, if someone introduces to the clinical team, like if a patient is there, and if there's a daughter or a son, if we know that they have a family, it's so easy,
[00:06:16] because the next day we're going to plan something, we can always ask, hey, do you want me to talk to your daughter? Do you want me to talk to your son? So, we can make a plan easier. So, we can make the hospital stay more proactive. No one wants to stay in a hospital. I don't want to go to a hospital if I don't have to. Exactly. It's not a very fun place. It's not a fun place. That's why I tell people, my kind of job, I wish I did a different job, otherwise I see people only when they're sick.
[00:06:46] I tell them, I wish we met under better circumstances. Say me hi if you see me in public. Say me hi if you see me in Sam's Club. I could be there, but yeah, especially those things, medication list, allergies, advanced directives, and making a plan with the family. I think if we start, and we want to start it from day one, so that we can provide the best care. Perfect. Okay.
[00:07:15] So, what if day one is on a weekend or a holiday? How does that change the timing of provider visits, tests, and treatments in the hospital? Well, weekends and holidays does matter, and that does bring a slight change in some non-emergency tests and planning, like going to rehab or a nursing facility
[00:07:45] or getting some kind of diagnostic test or a specialty visit. But all the active care that we need in a hospital, like getting CAT scans, getting a surgery, getting cardio CATS, or getting the antibiotics, putting you on a machine to help breathe, all those treatments that we need, that goes 24 by 7, no matter what. I've worked in places where we do MRIs
[00:08:14] 24 by 7. Like, you could be having an MRI of the brain at like midnight because we are so much staffed. That's how things go on. But yeah, weekends or holidays, we do see that the non-emergency things don't carry out on weekends. But on those scenarios, this is what we say is we got to make sure we talk to the family
[00:08:42] and the case managers and figure out a plan in advance. Okay, we have a long weekend coming because we all have families. We want to be around there. What's next? Did we start the pre-aught? So starting from day one, because we know we are ready for a weekend. So if someone's family is there on a Friday, Saturday, oh, definitely. And we know we will have a, we might have a stress test on Saturday. Sometimes we might not have stressors on Sundays. Many places
[00:09:11] these tests are our place in the hold because they don't have the staffing or the resources. But we can always plan in advance to see, hey, can we do that first thing Saturday morning? Right. So if needed, family, they can be out of the hospital by Saturday evening. Or if we have to wait, yes, we know we'll have to wait. It's good to know what to expect for everyone. So I think planning in advance
[00:09:42] really helps, especially on the weekends and the holidays. Right. Thank you. Okay. You know, many caregivers are afraid of being a bother or asking too many questions. So what would you have to say to them? Well, keep on doing it. I mean, you got to ask. Sometimes I've been on the shoes of caregivers and I have called doctors saying, hey,
[00:10:12] he or she is my, he's my dad, he's my mom. I never tell them I'm a doctor first. But I have asked questions myself because I want to know. And that's very important because this, we got, because you got to ask, hey, what's the plan? What's my uncle getting treatment for? What are you treating him for? Or when will he come back home? So I think asking questions don't hurt.
[00:10:42] If you think you're asking a lot of questions, I mean, sometimes we could, we have come across those scenarios and where people might be, might think, okay, hey, maybe I'm asking a lot of questions. I'm really sorry. But I think it's good to ask because unless you ask, you don't know. And I think everyone there in the clinical team is there to make sure your family member, your friend is getting
[00:11:12] the right care. And if by asking you, like for example, there are so many things that could help. Like if you know that your family was confused at home even a few days ago and asking, hey, is this confusion going to be lasting forever? If you never ask, the doctor will never know. So it's good to ask. Sorry, it's good to ask. I think number one thing
[00:11:41] in medicine is communication. And there's no running away from communication. Not clinical providers, not family. I think one goal we want to make sure everyone is happy, everyone is safe. If we want our family member to go home, if I want my patient to go home early, if I'm enjoying a weekend with my family, I want to make sure they get on Friday there too. So yeah,
[00:12:11] communication is very, very important. And that's not running away from that. All right. Very good. Okay. Let's switch gears and talk a little bit about medication management. Okay. You know, that's a common challenge for families. So why is it so important for caregivers to pay attention to all of the medications in the hospital beforehand, afterwards, all of that time? You're so right. It's so important. And sometimes I've realized that families
[00:12:41] and I mean, even patients don't know about it. When I ask patients, hey, do you have a list of medication you've taken home? I am told multiple times, check my records. And I trust everyone. I trust computers. I even trust a lot with AI. But medications, I want to look at those myself. Right. At least my clinical team should look at those myself. So yeah, we got to keep a really good track of this
[00:13:11] medication because a single change in medication could have caused this hospital stay. Right. And we need to know what changed the last few weeks or a month or is there a side effect of this new medication. So that's really helpful. And then there have been new apps these days. I think whichever health systems has this epic. We have MyChart. Yes. MyChart is very handy. You can just go log into MyChart and check what medications
[00:13:41] someone needs to be on. or I've seen some very diligent families write it down, even laminate. Some people put it like a card and put it in the wallet. So yeah, medication list. We've done some of all of those. Yes. And it's so much helpful. Yes. Especially the dosing because that matters so much to us. Right. I'm very fortunate to have a neighbor who is a pharmacist. Wow. And so
[00:14:11] I ask her many times, okay, what goes with this? What will interact? Is it okay to do this or that? And I've heard from various pharmacists that sometimes people can be on four medications, all of which have Tylenol in them. And there are prescription drugs and they're over the counter and you just have to be very careful about what goes with what. Exactly. And one of the more difficult things I find is when to take medications
[00:14:41] like nighttime or daytime which is going to be most effective. And I've asked the pharmacist that many times to make sure that I'm getting it right. So I know how complex it can be for everyone. I had a patient the other day, he was on two different calcium channel blockers for blood pressure. Apparently he got it at one facility. He came back, he brought in the pills, he got sick, he was there almost a few weeks after that, he didn't take the same list. He had no list. So boom,
[00:15:11] the doctor prescribed him a similar medication but he's now taking two calcium channel blockers. And he knows the name but he doesn't know that they both do the same thing. Right. And how would most people know that? You don't. I mean there's a lot of loopholes in this lack of communication. You're not having a list with you. Maybe apps could help, maybe electronic medical records could help, or maybe a caregiver. Yes. could help. Right.
[00:15:41] Okay, good. What are some of the most common mistakes that happen after a patient is discharged from the hospital? Number one, medications. It's just not me or my clinical practice, it's just data all over the world. Medication errors, I think, bad, wrong dosing, wrong timing, or not picking up the scripts. And not finding out before you leave the
[00:16:11] hospital the last time that medication was given? Exactly. And then you don't know about the side effects. You have not talked to the provider or the nurse or the pharmacist before leaving. So that's number one. Number two we see more often is missing the follow-ups. a cardiology follow-up after a hospitalization for heart failure is very important. And then it might just fall to the crack. You might feel better
[00:16:40] and say, hey, I'm good, I'll see the doctor maybe next week or like maybe in a month. What matters? But missing those follow-ups and then a lot of times you do not know where to go. So lack of coordination in this. There's a follow-up order in place but you forget it or like it does not go through the system and there's no consult made, follow-up made, there's no referrals made. So lack of communication is one more thing. So those are the major things I have seen.
[00:17:11] Yeah, but you see, there could be a lot, there could be a lot, but my clinical practice, mostly follow-ups, communication and missing medication errors, I think those are the major things I would pick. Okay, good. Well, sometimes families have a gut feeling and that's it, just a gut feeling that something isn't quite right. So what
[00:17:41] should they do if they feel there's something that's being missed? Just talk to the provider, be polite and say, hey, this is what I think. A lot of times when we are with the clinical team, I'm talking to the nursing staff, I would say, hey, I see this, this, this, and I see this. What do you think? They might have seen something different. They might have expressed something different to the nurse.
[00:18:11] So overnight, or maybe the patient was not comfortable with me, they are with the nurses, 24 by 7, rather than me. I'm there like 10, 15 minutes. So there could have been more, the nurses could have known more. So when I talk to them, I know more. So you just talk to the clinical team. And sometimes if you think that you have not been heard, then it's always very reasonable to talk to the nursing manager.
[00:18:41] Hey, can I speak to the nursing manager? Some concerns you have, I think in case of any hospitals, any health system, you go to a local health care, and that's your own. Like fire reason next door, or it could be atrium next door. We got to think like that's your own hospital. If the food's not good, we do have a system for CMS, write a few lines, like hey, maybe the food could
[00:19:10] be good, so that they give feedback. We all run on feedback. So those things could really help. Right. Okay, great. Let's end with a topic that doesn't get enough attention, and that's caregiver burnout. Who takes care of the caregiver? Very important topic, and we started with a conversation about caregivers and
[00:19:39] how it has evolved. I mean, five years ago, I didn't know about caregiver support that much, you know, because you see patients, you send them home, and you don't understand the value of a coordination. Caregivers, that journey is more of a marathon, not a sprint. Absolutely. Because I think you've got to know your
[00:20:08] limitations, you've got to know what you can do, and the main thing I always say to people is, ask for help. help. You know, ask for help if you think that has been a lot. I had a very interesting patient almost a few years ago, and his wife used to play tennis in the morning and come to the hospital. And some people were
[00:20:38] questioning, oh, he's here sick, and she is coming back. But, point taken now, she's taking care of himself. She's taking care of herself there. That was a long run. He was sick for a while. She got to be sharp. She got to be up to date and having a life so that she can take care of him. Yes. That's so much important. People took it a different way, but
[00:21:07] when we looked at that thing, that helped us so much because she knew everything. She was on top of all of his appointments. Everything was set up in the house. She was on top of everything. But, overall, maybe that tennis was helping a lot because that was keeping her on the toes. She was being fit with that. She had crossed her 60s, but that was really helping her. So, you got to know when you got to take a
[00:21:37] break, figure out what you want to do. And, enjoy the marathon. It's a long run. Yes, it is. We hope it is. I mean, we don't want our people to be sick. Sick. But, we want to keep them with us for as long as we can as well. And then, you keep on enjoying the life. Yes. Because, if it was a pneumonia, it would be better in a week. But, when you have chronic disease in the family, you get
[00:22:07] to live with it. Like, my dad has diabetes almost 25 plus years. We live with diabetes. When I grew up, I knew what a diabetic diet looks like. And, but slowly, slowly, you adjust. And, you enjoy the, you know what food you can enjoy in diabetes. You enjoy what, and you know what the kids should not be eating or should not be brought to the kitchen because dad won't have it. Right? Right. Exactly. So, you'll bring those adjustments in
[00:22:36] the kitchen table too. So, I think it's overall a journey. Good point. You know, I think sometimes we think that one of our loved ones needs to eat a special diet and need to eat a special way. But, we ought to be paying attention to that ourselves because what they used to eat helped bring them to where they are now. So, if you've been eating what they've been eating, things may have a little bit of a different outlook for you as well. Exactly. So, you really need to pay attention to what
[00:23:06] is being suggested for dietary guidelines. Exactly. Absolutely. Okay. Well, thank you for that. You know, all of this is wonderful advice. And, I hope caregivers remember that they're valued members of the healthcare team and that their voice matters. Dr. Bibhusan Basnet, thank you so much for volunteering your time to be with us today. We deeply appreciate you being with us. And, I want to thank you, our viewers and listeners as well. We hope today's
[00:23:35] conversation gives you greater confidence if a loved one is facing a hospital stay. If you found this episode helpful, please be sure to share it with a friend or fellow caregiver and visit ACAP community.org for more free programs, resources and supports. We have new ACAP chapters opening up this summer and fall in communities from coast to coast. So, please be sure to check those out on our website to see if there's a chapter near you. If you haven't already done so, please be sure to
[00:24:05] click the like button to let us know this episode was helpful. If you'd like to hear more of our broadcasts, click the subscribe button as well. We also want to say thank you once again to Senior TLC, formerly known as Pace at Home in Newton, North Carolina, for sponsoring our monthly podcasts, available in both video and audio versions, and to every age our sustaining partner. You can access the video version on our YouTube channel at ACAP Community and our audio version through the Mesh Caregiver
[00:24:35] Community on any platform where you listen to podcasts. Please join us again in the coming weeks for our next episode. Until next time, remember you don't have to navigate caregiving alone. Until next time, be well. Thank you, Karen.
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