Many seniors have chronic medical conditions that must be closely monitored and for which they take any number of prescription medications. Family caregivers tend to get a crash course in nursing and managing medical care once they begin helping an aging loved one, and the biggest lesson many learn initially is that organization is key. This is especially true when a senior develops a need for urgent medical care.
Carlos Paisan, M.D., is no stranger to the complex medical issues that seniors navigate on a daily basis. As the medical director of MyCareClinic at The Carlisle Naples, a senior community offering both independent living and assisted living in southwest Florida, and an urgent care physician at ER QuickCare, Dr. Paisan sees countless patients and families who struggle to convey important medical details to health care staff.
In addition to openly communicating with primary care physicians (PCPs) and knowing where the nearest walk-in clinics and hospitals are located, Dr. Paisan recommends that caregivers and seniors create an emergency “packet” of medical information that can be given to paramedics, emergency room staff, and urgent care clinicians.
“At The Carlisle, there is an envelope on the back of each resident’s front door containing an exact list of their medications and dosages, a copy of their power of attorney, contact information for their doctors, and information relevant to any chronic conditions,” Dr. Paisan explains. “Paramedics know this information is there, so they can pick up this packet with everything they need and go. I think this is a great practice to adopt in any home, especially if you’re responsible for the care of an elderly person.”
Such a medical folder is actually quite simple to put together, since it contains copies of information that caregivers should already have on file. Dr. Paisan’s suggestions for assembling your own emergency file are detailed below.
Build Your Own Medical Emergency Packet
Include a list of all a senior’s prescription and over-the-counter medications, their exact dosages, and how frequently they are taken. In a 2019 Kaiser Family Foundation Health Tracking Poll, more than half of adults 65 and older reported taking four or more prescription drugs. It can be difficult to remember all the details of a complicated medication regimen, and the more drugs a senior is taking, the greater the risk of mistakes and interactions.
“One of the biggest problems I see in the urgent care clinic is that patients don’t know or remember exactly what medications they’re taking,” explains Dr. Paisan. “They’ll say they take a ‘water pill’ or ‘blood pressure pill.’ There are a lot of medications that interact with each other, so detailed information can be a lifesaver.”
If your loved one is allergic to any medications, additives, preservatives or materials like latex or adhesives, be sure to include a list of these things and the severity of their reaction to each.
Include the name and contact information for the patient’s primary care physician. If your loved one regularly sees any specialists for chronic conditions, such as a cardiologist or a neurologist, provide their contact information as well.
- Medical Conditions
Provide general information about a senior’s more serious physical and mental conditions and medical history. For example, diabetes, a pacemaker, dementia, falls, and past cardiovascular and cerebrovascular events (e.g. heart attack, stroke) are all important to include. Don’t forget to list pertinent dates as well so health care professionals can differentiate between long-standing medical issues and newer changes in an elder’s health.
- Do Not Resuscitate (DNR) Order
If a senior does not wish to receive cardiopulmonary resuscitation (CPR) or intubation in the event of cardiac or respiratory arrest, be sure to include a copy of their state-sponsored and physician-signed DNR order or Physician Orders for Life-Sustaining Treatment (POLST) form. (POLST forms are more comprehensive than a basic DNR but are only available in some states.)
- Medical POA
If your loved one has appointed you or someone else as their medical power of attorney (POA), make sure a copy of this legal document is included in their packet. This is crucial for communicating with medical staff and making health care decisions. Ensure your contact information is included on or with the form as well.
- Most Recent Labs
Including copies of a senior’s most recent laboratory tests can be very helpful for physicians who are trying to make a diagnosis and decide on a course of treatment without a complete medical history to reference. “Pertinent labs, like most recent EKGs, complete blood counts, and kidney function and liver function tests can set benchmarks that help physicians a lot,” Dr. Paisan points out. “These are basic tests, but they take time when you’re in the emergency room feeling badly and waiting for answers.”
- Insurance Information
Provide copies of all current insurance cards (both sides), including Medicare Supplement Insurance (Medigap) and Medicare Prescription Drug Plan (Part D) cards if applicable. This information can help ensure your loved one’s medical care is billed correctly from the start, even if their original cards are left behind in the rush to the hospital or clinic.
- Photo Identification
While emergency rooms must treat patients regardless of whether they have identification or insurance information, many urgent care centers typically require a picture ID to see patients. Include a copy of the senior’s driver’s license (or ID card if they do not drive) in the folder to avoid any problems.
Using the Emergency Medical Folder
Once you have gathered the records listed above, copied them and assembled the folder, put it in an easily accessible place. If you share caregiving responsibilities with other family members, friends or professional in-home caregivers, inform them of this file’s existence and location. “Put that collection of information where everybody can find it,” Dr. Paisan urges.
This packet should be given to paramedics responding to 911 calls, and it should be brought along to walk-ins at the emergency room or urgent care clinic. In the latter cases, Dr. Paisan recommends giving the information to a staff member who is going to have direct contact with the senior instead of a receptionist whose only job is to check patients in. “This could be a triage nurse, the actual nurse on duty once the patient is put into a room, or the physician who is in charge of their care,” explains Dr. Paisan.
For seniors who attend adult day programs or spend ample time in their family members’ homes, having one of these folders available in each location isn’t a bad idea either. Remember to update the contents of each folder as needed, though. Speak with administrators at the adult day care center or senior center to see if they can keep the packet on file in case of emergencies. Dr. Paisan notes that, “When this detailed information is handy, it makes life easier and safer for everybody involved.”
Sources: KFF Health Tracking Poll – February 2019: Prescription Drugs (https://www.kff.org/health-costs/poll-finding/kff-health-tracking-poll-february-2019-prescription-drugs/)