Care transitions help you move from hospital to home

Let’s face it: When you’re sick and in the hospital, there’s nothing more annoying than a hospital full of sick people.

Oh, sure, you probably get good care (especially locally!) by genuinely decent people who honestly do care, and you get to lie around a lot and most of the time (despite all the old jokes) the food is even pretty decent, but the fact is, you’re in the hospital.

…and that’s usually not good.

It’s not good because you’re sick: You feel anywhere from lousy-to-dreadful, you’re scared, you don’t know exactly what’s going to happen next or who’s going to make it happen to you or if it will hurt, you can’t account for all the weird sounds you hear (or don’t), you’re getting pretty tired of telling everybody your date of birth and maybe you’re worrying about how all this is going to get paid for and how the dog/cat/iguana are doing without you and just getting to the bathroom (or not!) is a major undertaking (OK, we won’t use the word “undertaking”) and you just want to go home.


Another funny thing about sick people in hospitals is that there’s a reason we’re in the hospital, and that’s scary! We’re sick! We’re…scared.

And if we have a spouse/family member/buddy/significant other who’s trying to take care of us, they’re feeling a lot of the same things PLUS listening to us casually whisper, every 11 seconds, “Get me out of here.”

So, do you know what happens? Right: By the time it’s getting close to actually getting out of here, we’re all so myopically focused on getting out of here that we don’t hear what we’re being told to do once we finally do get out of here because we just want to get out of here. So, somebody gives us a handful of “discharge instructions” written in Martian and we smile and nod and thank everybody and then whisper sweetly and discreetly, to whoever it is that is trying to help us:


Do you know what happens then? Right. We go home, breathe a huge sigh of relief, inquire after the iguana, and go to sleep; then, what often happens, is that we get sick all over again (or sicker) because we don’t know what-the-heck to do to take care of ourselves because all these papers are written in Martian and we didn’t really hear much of anything because all we could hear was the sound of our own minds (or voices!) saying, “Get me out of here.”

And what often happens then is…Right. We end up back in a hospital full of sick people. Oops.

And this is particularly likely to happen to those of us who have a chronic disease or condition, like heart failure or diabetes or COPD or pneumonia, etc. Oops.

So, what if you had somebody whose job it was to actually coach you through what to do when you got home? Who could actually understand those Martian instructions? Who could (and would!) help you figure out the difference between the prescriptions you were taking when you went in and the ones they sent you home with and the ones you’re supposed to be taking now? In other words, walk you through it? Yeah? And what if it didn’t cost you anything? Yeah?

This coach could (and would!) help you figure out who you need to make an appointment with, and when, how to get there, what to say (and ask!) when you get there and how to keep track of what’s happening to you, the goal being to not end up back in the hospital, worrying about an iguana with abandonment issues. Really.

It’s called “Care Transitions,” if you care, but the idea is simply to help you, the patient, transition from this care setting (hospital) to that care setting (home) so you can stay where you want to stay, which probably isn’t in the hospital.

Is this about money and healthcare costs and all that jazz? Sure! If you’re not bouncing in-and-out of said hospital every other day, it’ll save everybody money, so…OK. But that really isn’t the point if you’re you, is it? The point is to make it at home and have your life, right? So, you wouldn’t do this…why?

Right, so here’s what you (or your “person”) needs to do if you’re in the hospital or about to be or just got home and don’t read Martian: Call 532-0520 (1-800-801-0060, which is Information & Assistance, or any of the numbers at the end of this column) and say, “Care transitions,” or something close to that, or just tell whoever answers the phone what’s going on – They’ll figure it out; or, tell the folks who are caring for you in the hospital that you want to know about “Care transitions.” They’ll figure it out, too.

That’s all – The rest will happen to you. What you’ll have to do is try to pay attention and tell the truth and be the best “patient” you can be, so you won’t have to keep being a “patient,” but don’t worry about that too much. These folks understand that you’re sick.

This works – I’ve seen it – and it doesn’t hurt or cost us anything, so why not?

The iguana will thank you.

Still on the “wrong side” of Medicare’s “open enrollment?” Don’t panic, because there will be good, free, we-won’t-try-to-sell-you-anything help at the Aberdeen library this Tuesday at 2 p.m. and at the Hoquiam library (420 7th Street) at 2 p.m. on Nov. 28.

And you can always call any of the numbers at the end of this column for help from good people who won’t make you feel like an idiot. Just don’t put the iguana on the phone.

Mark Harvey is the director of Senior Information and Assistance for Olympic Area Agency on Aging. He can be reached at or 532-0520 in Aberdeen, (360) 942-2177 in Raymond or (360) 642-3634. FACEBOOK: Olympic Area Agency on Aging-Information & Assistance.