Navigating the Hospital System

Michael Hughes 00:07
Hello and welcome to The Art of aging, which is part of the abundant aging podcast series from United Church homes. On this show, we look at what it means to age in America and in other places around the world with positive and empowering conversations that challenge, encourage and inspire everyone everywhere to age with abundance. Today, we’re gonna be talking about the world of the hospital and how to navigate the world of the hospital. And it’s something that more likely than not you’re going to face in your future, at least with a loved one. And we’ve got an expert to talk about that today. Dr. Monique Nugent, we’re pleased to welcome her to the show. And just to tell you a little bit about Monique, she is a practicing hospitalist and a physician leader at a large independent health system in the Boston suburbs. She completed both medical school and residency in internal medicine at Loma Linda University Medical Center, and after completing her medical training, Monique obtained her master’s degree in public health while fellow in the Commonwealth Fund fellowship in Minority Health Policy at Harvard University. Dr. News Mnuchin has shaped her career to include leadership and efficacy alongside her clinical practice. As a physician she advocates for every patient we’re working to make healthcare equitable, safe, and high quality. As a parent of three children, Dr. Nugent and her husband live in the Boston area, and she enjoys exploring New England and collecting cookbooks. She also loves to travel and visit art museums mainly when she can tuck her daughters into a company R and I have the same issue on my Docker Monique, welcome.

Monique Nugent 01:32
Thank you so much for having me. I really am looking forward to our conversation.

Michael Hughes 01:36
I am too. And just a reminder that this podcast series is sponsored by United Church homes, Ruth frost Parker center for Abundant Aging. To learn more about the center, including our annual symposium October visit UnitedChurchhomes.org/parker-center. So, Monique, I gotta ask you, this is a neat area of study. You know, as a doctor, you can be doing a lot of different things getting into a lot of different specialties. What got you so passionate about the world of hospitalization and how patients should be navigating it? Yeah.

Monique Nugent 02:05
So when you finish residency, you can specialize further and you know, around your third year, second, third year, everyone’s kind of figuring out what they want to do. And I just really enjoyed hospital based care. So for a while, I thought about going into critical care. But I had a really great mentor who said to me, you know, when you pick your career medicine, pick something you can aid you forever and feel like you could have the biggest impact. And this is where I fell into hospital medicine, really focusing on making sure that the people who come into hospitals have a better experience, a safer experience, and a more equitable experience. And as I’ve gone through my career, I’ve been doing this for about 15 years now, in hospital based care. As I’ve gone through my career, I’ve noticed the same patterns over and over. What is the saying there’s like everything old is new, or as something new is old, something like that? Yeah. You know, I trained on the West Coast, I currently practice on the East Coast. I’ve been in the VA hospitals, academic centers, community, hospitals, private hospitals. And it’s the same exact experience, because our system really is kind of built the same across the country. And people are coming into a hospital not realizing that it’s a system within a system. And oftentimes, their frustrations are not new. Several people have had those same frustrations. And there’s a whole science and study around improving the experience and safety in hospitals. And I jokingly say the hospital is the health care of DMV, like everybody’s going to show up there at some point in time, right? You’re like everyone’s gonna come by whether you’re excited to have a child excited because you decided to replace a joint, or you didn’t have a choice because you had an illness or injury that was unexpected. We’re all going to somehow come through the doors of a hospital. And I want to prepare people for that experience, describing

Michael Hughes 04:14
it as the DMV and God plus the people that do work at the DMV, but that’s not it’s not a very, you know, the trope is it’s not a very well designed experience. People don’t look forward to going into the DMV. And so is that the job of a hospitalist as a hospitalist is really to look at all the different systems that are present in the ins and outs in the operations of a hospital and see if they can improve it. Is that the idea?

Monique Nugent 04:39
So a hospitalist is either like an internist or a family practice physician who just sees acutely hospitalized patients. So I don’t have a clinic that I go to. You can’t make an appointment to see me. When you come into the hospital through the emergency department, if you’re too sick to leave, you don’t need the ICU you’re going to see somebody like me. Oh hospitalist, granted if you’re over the age of 18. Right? But this form of practice of realizing that the things that go on in a hospital and the care for acutely sick patients is really kind of unique, has spread across a lot of specialties. So you’ll find pediatric hospitalists, right pediatricians who care for patients who are only in the hospital, you have labor rest, or who are obstetricians who just helped women delivering and you have acute care surgeons who are surgeons who see the things that come in through the emergency department or the things that are happening on the floor, and they’re caring for their patients in the hospital, rather than some other surgeons who make an appointment and say like, oh, okay, I would like to talk about having this removed, I was sent by my oncologist, things like that, because you know, the things that go on in hospitals are constantly changing, fast paced. People with acute illness are very different from your chronic type illness, or an acute exacerbation of a chronic illness is a different experience in presentation and a different way that we treat it. So a hospitalist is really a physician who’s going to take care of adults who are acutely hospitalized who are not in the ICU, during the ICU be seen by an intensivist. I’ve gone and done a little bit more study, you mentioned getting my MPH, and kind of focusing my career on the improvement of the experience for both the physicians and for other providers who care for patients, and also the patients in the hospital.

Michael Hughes 06:31
Yeah, I mean, it strikes me that the role of the hospital and the health care system, it just seems to be just this centralized hub. I mean, when I look at it, I mean, look at Medicare spending, the biggest proportion of Medicare spending outside of the transfers of money to Medicare Advantage plans, is hospitalization. You know, when we think about all the incentives in the healthcare system right now, everyone just keeps pointing at the hospital. And the most effective measure at least in managed care programs that I’ve seen is lowered hospitalization and lowered rehospitalization rates, right? Why do you think I mean, what hospitals just seem to consume so much money?

Monique Nugent 07:14
hospital based care is very expensive, because like people jokingly say, like, if you take a Tylenol in the hospital, right, that’s an $18. Tylenol versus you buy a bottle for like 499 at CVS, right. But let’s break down. Why is this an $18 Tylenol? Well, the hospital has to pay for the building, pay for the energy to run that building the water, they have to pay the nurse, they are paying the provider who prescribed it and their insurance to you know, and then the hospital has their own insurance. And when you are at home, you can put some Tylenol in your hand. I want to take three, not two and you take them back . You can’t do that in the hospital, right? So it has to be either individualized or the nurse is going to use gloves and she’s going to put them in a cup, like the care for them in the hospital is a lot more cumbersome than what goes on at home. And so it really is very much an apples or oranges thing when people compare the two. But also, you know, like they’re unfortunately beholden to businesses. They’re a business, they have contracts, right? Like you can buy a CVS if it’s on sale. But if the Tylenol is on BOGO two for one, you decide to do that. No hospitals have contracts with insurers, they have contracts with pharmacies, they’ve got contracts with different people who come in and supply medical equipment. And so and then also like at home, you’re caring for yourself. So you know, the things that you need. A hospital has to be ready to care for everybody who walks in the door. Yeah, right. Right. And so there’s a lot of things that, you know, are available for everybody that may not be used all the time. And then remember, like, again, cooking for 400 300 hospitalized patients who require, you know, an additional like 200 different types of diets. And then different types of textures. So just the level of care and the acuity that goes on in a hospital is part of the reason why it’s expensive. The other part of the reason why it’s expensive is because healthcare is expensive in this country, we have unfortunately built a health care system, where pharmaceuticals are expensive. And procedures are, you know, more reimbursed than not getting a procedure. So it’s a combination of the reality of what a hospital has to do to deliver care for a patient and the reality of the healthcare system that we have built in this nation.

Michael Hughes 09:55
Yeah, yeah. Yeah. And I just think about, I mean, you talked about planning for hospitalizations. and those are predictable. But it really just I never heard it explained that way. They don’t know what’s happening on any given day, right? Anybody could be walking through that door. And I guess for people, there’s such a story. I can represent the hospital that I guess in everyone’s mind is the place that’s always open. It’s the place where you can always go for health care, right? I mean, it’s always when you have an emergency, the instinct is to go to the hospital, which adds to that. And but there’s more of a trend towards, I mean, it was urgent care evolved. As a part of that. Do you see more hospitals buying urgent care clinics having those relationships so that they can steer some of that traffic to places that may deserve more of that lower acuity setting? Or can

Monique Nugent 10:45
I circle back to the earlier statement that you made about the hospital always being open in the place that we go when we need help? I think the other thing to really think about is the hospitals become a big safety net socially. It is also socially, always a place that is open, it is also socially, always a place that can solve problems. You know, social workers are always available in the hospital, people who may lack housing may lack food. And then, you know, with older people, sometimes you get into a situation where being at home isn’t safe. But there’s no setup for you to go to a place yet. So the hospital becomes this interim, where you and your family are actively seeking medical care, but also trying to figure out the next social steps. Right? And so there is a cost to the social support that the hospital service provides for society as well. Well, it becomes

Michael Hughes 11:38
a habit, doesn’t it? You know, if you go to the hospital once, because you know, you know, just, it’s an instinct to go to the hospital. And navigating the hospital can be challenging maybe the first time you go in. But then the next time and the time after that the time after that is I know this, I know what’s going to happen, I can assist them.

Monique Nugent 11:56
Right? Yeah, the system is getting to know you. And I tell people that if you do have to go to a hospital, again, try to go to a place that knows you. Because the system builds a story about you. And that story adds to your safety, right. So it has all of the meds you’ve taken and things like that. And it is a point, excuse me, there sometimes does get to a point in people’s medical illnesses, where you will see this repeated hospital stays over and over. Oftentimes, those people are referred to in the system as high utilizers. And there’s a ton of attempts to try and break those cycles, they sometimes get assigned to specific case managers or social workers, hospitals have ways of tagging them. ACOs are accountable care organizations that have ways of tagging those patients and trying to get them more resources into the home. And the truth is like, a lot of the times when you look at these situations, it may boil down to like one of a few things. One, it may be that an illness is very actively changing and progressing. And they do need that active support. Right? There are times in an illness, particularly as maybe someone is progressing and getting worse, where things change a little bit more rapidly, or they change more than someone would expect, right? So they need that little bit of extra assistance. But then there’s a lot of times there’s some kind of social issue that’s going on, that doesn’t allow the person to really thrive outside of the hospital, and they’re coming to the hospital looking for that support. And so how do we intervene? And that’s really the question I think that this country hasn’t solved is, where do we say we’re going to put more resources into social things to prevent medical need, versus the fact that we know if we put it into the medical need box, it creates a bill and somebody gets paid. And we know who’s responsible for X, Y, and Z. But in the social box, it’s really a lot more nebulous. And I don’t think we’ve had that conversation as a nation yet.

Michael Hughes 14:08
Yeah, it’s an i, this isn’t. I don’t necessarily think these are things that are taught in medical medical school, right. I mean, you’ve got, you know, people coming again, again, to the hospital. I mean, I know, you know, you know, one of our team, terrific person, you know, has a story about, you know, a gentleman that went into the hospital, again and again, for exhaustion, and it turns out, his wife had, has dementia, and he didn’t want anybody to know, because they knew that maybe they would take her away from him. You know, that’s the these are crazy things to unpack, but I just get the impression that hospitals just don’t have the time to be that advocate, to be that social worker, you know, the stereotype is you’re in and then you have to make a decision about how to transition someone in care and then sort of you know, dump the person on to the next site of care they send the person home. I mean, you know, the Get into the hospital, you stay but you get stabilized. And then okay, the problem follows on to the next. Yeah, fight and care. I mean, is that a terrible way to think about things? So

Monique Nugent 15:10
So you’re right. In medical schools, I think medical schools are better about it now about talking about the social determinants of health. But I still think we need to remember that they are medical schools, like in the end, you’re trying to train a medical professional, you’re trying to train someone who’s going to have a certain amount of medical knowledge, to be able to create safe medical plans that are effective for people. Medicine is not practice in a silo, I tell my teams and my patients all the time, it is impossible for me and so your physician to keep up with everything that goes on, I do not know all the changes in Medicare, and Medicaid, there’s no way I know, which like assisted livings shut down in which one built a new one, it isn’t, it’s impossible for me to know, what I need to be knowing as cell counts, and the new antibiotics that are coming out and the things that are safe, so I can create that medical plan. House hospitals are supported by social workers, case managers, the community, and those are professionals themselves who have a ton of training and have the ability to get out there and do this work. But do we as a nation value that work? Right? Is that what our insurance agencies will remove to rate the hospital for? Or will they pay the hospital for a hip replacement? Like we have not yet decided what is more valuable, keeping somebody out of the hospital or paying for that person every time they come into the hospital to solve a problem, right? We do not have a health care system in this country, we have a sick maintenance system in this country. Right? If we truly had a health care system, all the things you and I are talking about would be the toppest. Like highest priority, making sure people are safe in their home, that they’re fed, that they’re not lonely. Loneliness is a big problem, particularly for our elders, you know, and then when somebody needs help getting the resources to make these transitions smooth and quickly, because you’re 100%, right, like in the back of the 70s 80s, and 90s, used to go to the hospital and get better. And I say it and I’ve said it in my book, the hospital is no longer a place to get better. It’s a place where you get your care, and you move on to the next stage so that you can recuperate, and you can get the things you need to get better. insurers do not pay for you to be in the hospital, like I will get a phone call from an insurance agency, if they feel the patient’s been in the hospital for a prolonged amount of time. And I have to justify to them as to like, what am I doing? And why does this require hospitalization? Also, when someone comes into the hospital, I often have to ask, Am I going to make a change for this person’s care if I admit them to the hospital? Or is this care that does not need to happen in the hospital? Right? So shifting where care takes place, helps for lots of reasons, but also can make people feel like you were saying they’re kind of pushed out, dumped, because the problem solving hasn’t really occurred. And a lot of the time the true problem may not be just medical, the true problem may be more of their social support, goals of care, long term plans. And those are not things that I can prescribe. Right? Those are things that are conversations that take time to solve.

Michael Hughes 18:49
Yeah, yeah. No, there’s I mean, there’s so much there. I mean, it’s almost like, you know, unfortunately, if people really only notice things when they go wrong, right? I mean, when things go, right, you know, people don’t notice them at all. But if things go wrong, that’s when people sort of point things out. So you can’t win, right? Yeah,

Monique Nugent 19:06
yeah. Yeah. I mean, I have a friend who is an organizational engineer. And he says, we don’t have a broken healthcare system, our healthcare system produces the results that it is created for and it is created to keep these problems going. Because we have not decided that there are true problems yet.

Michael Hughes 19:25
Oh, goodness. Well, let’s shift and talk about really what patients can do here. Because if you’re facing a planned hospitalization, if you’re in the hospital, what are some best practices for patients to know as they navigate themselves when they’re in the hospital? And how can they be good advocates for themselves in those transitions of care?

Monique Nugent 19:46
Yeah. So people often ask me if you can prepare for a hospital stay outside of pregnant people who pack a bag and their snacks. You know, most of us don’t think of ourselves as being ready for hospital stay Even if you have a plan, like, let’s say you’re going in for chemo, that those types of things, though planned are also not like 100%. Exciting, right. And so it’s all about information, and getting that information to the care team, because more information helps assure safety. Right? If you know your medications, or know where to get a list of medications, this is 2024, you don’t have to memorize things anymore. Like your primary care doctor likely has an app associated with their health system, you don’t see CVS, or Walgreens can, you can call and get the list of medicines that you’re taking, if that’s where you consistently get your prescriptions for, right. But if you can get the information of what medicines you take, that is going to help a great deal, there’s a process in a hospital stay called a medication reconciliation. And that’s when you get all of the medicines that the patient is taking. And you look at them, and you say, and these are the medicines I want them to take. And then you say where they line up. You do that on admission? Why is that important? Because likely I’m going to be prescribing new medicines, you want to make sure things are not interacting, that I’m not duplicating, that I’m not going to cause a pourraient side effect. Because it’s an unexpected thing that you are taking a medicine I didn’t know about. Or you may be on a blood thinner, we need to plan for surgery, right. So all of those things help to create a safe medical plan. And that process goes on throughout your hospital, say if you go in and out of the ICU and in the operating room, and then a charge occurs again, when you leave the hospital, the doctors are gonna say, okay, these are alternatives you’re taking in the hospital. These are all the medicines you were taking beforehand. Now, these are the ones I want you to take, right? And again, what is that?

Michael Hughes 21:55
One Foley pharmacy is is a quality pharmacy is all about polypharmacy

Monique Nugent 22:00
is when you’re taking a lot of medicines, and they start interacting with each other. And so going, what

Michael Hughes 22:05
about Nutritionals? Like when I’m taking like, a Nutritionals? We’re kind of crazy in this country too. And I can go on my front lawn and take GraphQL things and sell them as Nutritionals. Right? Yeah.

Monique Nugent 22:15
But you do want to tell all of the things that you’re taking, including nutritional supplements, because some supplements are known to have certain side effects and interactions with prescribed medications, right. And so you don’t want to tell people that and it is all about safety. And then again, also talking about like, if you see a specialist, making sure that the hospitalist is going to know who your specialist is and how to contact that person. Because the last thing that we want to do is to mess up a long term plan that you may have for care that’s going on, right? We don’t want to totally recreate the wheel and then like whatever your cardiologist was doing is now like bunk and has to be done. That’s not what we want to do. We want continuity of care. And we alluded to it earlier about the information that a system has about you. Right, we do not have a nationalized health care system, sorry, medical record in this country, right. The VA has a medical record that is available to all VAs across the nation. But not every hospital’s medical record talks to the other hospitals’ micro even if they use the same vendor like Epic is a big medical record that is used. Not every EPIC system talks to the other EPIC system across the nation, right? We

Michael Hughes 23:42
need interoperability we’ve been hearing at conferences for the last 20 years or

Monique Nugent 23:48
so. And so when you show up at a new hospital, like I understand you may be on vacation, and it’s totally not avoidable. But if you normally go to the hospital on Route nine, and then you’re like today, I’m going to try a hospital on route 31 or 31 may not have any information on you. And now they’re building your story from scratch. And what I said earlier is safe, right? Having more information that the institution can tell your story. Because each time another provider logs in and writes a note prescribing the medicine to a lab, that story becomes more and more flush. Right. And so there is benefit to going to a system that knows you.

Michael Hughes 24:33
Well, I love that phrase information safety because it may seem frustrating to patients to say okay, I do need to bring my medication list. I do need to tell what Nutritionals I do need to have a list of the doctors that I’m taking or what have you. But when you start unpacking the reasons why, you know it’s really just all about protecting yourself. When

Monique Nugent 24:57
I yeah, I’m so sorry when I was writing my book, I reached out to a lot of my friends who are hospital based physicians. I said, What is that? You want patients to know that like I can get across in the book? And almost every emergency medicine physician, a friend of mine, said, Please, can you tell people there’s no such thing as a record? Like? Like, you can’t just look at me and say like, it’s in my record, like, you have to participate in Tell me something, because I may not know you. If you’re here a lot, that’s great. But like, we may not know anything about you. And so I was surprised that when I have these conversations, a lot of people say like, really put, like, yeah, a lot of that information becomes proprietary in a way, you have to sign permission for them to send it. You know,

Michael Hughes 25:51
Everyone saw that episode of Seinfeld where Elaine went to the doctor and was mean to the doctor. And then she tried another doctor, and the doctor looked at something in the charge that Oh, because all the doctors talk to each other. Are you risking it here on the podcast? Sorry, listeners, you know, but yeah, there is this kind of myth of just like that one record to rule them all. But it’s, you know, it’s, it’s just not there. The other thing that’s crossing my mind right now is Oh, and first of all, what is the name of your book? And where can people get it? Oh, yes,

Monique Nugent 26:24
Thank you. So the name of the book is prescription for admission, it’s a doctors guide, to navigating the hospital advocating for yourself and having a better hospitalizations, one of those books with like a semicolon and a lot of words, you can just stick in prescription for admission in Barnes and Nobles, or Amazon or anywhere you buy books online. And you can find it is really meant to be a guide for patients. It’s not written for physicians, it’s written for people to use for them and their loved ones. So it’s got places for you to fill out your thoughts and practice writing your medical record and practice writing your medication list, and all of that stuff. So please check it out. And a lot of this conversation, basically all this conversation will be in there except for the more juicy parts. We talk about health care theory and stuff like that, that you’re doing the

Michael Hughes 27:19
work for people here. I mean, you’re giving them the workbook, you’re giving them things to fill out, you’re giving them a checklist. So I can just see people bringing prescription for admission around the minute everywhere, because it’s got all that person, you know, it’s a place to store all that necessary information. Yeah, I

Monique Nugent 27:32
I really want people to have the information because hospital stays are not easy, like even a good hospital stay. You know, even when people say everything went well. They’re still leaving with new medicines or new providers, you know, they were still sick and in pain, and someone had to come and advocate for them. Like even when things go well, it’s not an easy experience. So I want to give people the tools, because strangely enough, I really love hospitals. I think they do amazing work. And I want to be a part of making sure that we’re delivering what we say we should be, which is good care, that’s safe, that’s equitable, that’s caring, that’s non judgmental. Because I think hospitals have a big role to play in our country’s health care.

Michael Hughes 28:26
Yeah, but I want to get on to something that’s important, you know, around the discharge process. Yeah. And the discharge process just in, you know, my personal observation can be a very frustrating experience for patients, and especially for their family caregivers, you know, somebody may expect to go to nursing care, but they’re sent home, or, and there’s also the language issue there. I mean, there’s a lot of information that kind of gets posted at discharge, and seems, you know, the stories I hear it’s rushed, I can’t understand what people are talking about, you know, I mean, how can you be a good advocate for your loved one or for yourself, you know, during that point of discharge,

Monique Nugent 29:05
so all discharges should start being planned for on admission. And I know some people bristle when they hear that, but you should be thinking about when you or your loved one comes into the hospital, you should be thinking about what do I want to happen and where do I want to go when I leave here? Because it’s a conversation that should occur throughout your hospital stay. If one day before you leave the hospital, suddenly lots of decisions are being made, it’s going to be rushed. You’re going to be unhappy. You may not get the things you need, things will be missed. And no one’s going to be happy. Right? Like case managers and providers don’t like when we feel like we’re pushing people out either. Because then you on our end, everyone is scrambling to get things done, you know. So, start thinking about that, on the day that you’re admitted the day someone says, Okay, you need to come to the hospital, we have to start thinking about where do we want to go, when we leave? What do we need for a successful discharge? The key, in addition to having the conversation throughout, is to have another set of eyes and ears. If you have a care plan, partner, right, who is your cleric care plan, partner, it’s the person in your life who helps you with your medical decision making, someone who maybe takes you to doctor’s appointments, and really helps you navigate your health care, right? The person who’s going to know what is necessary for you to have a successful discharge, that’s your care plan partner. For most people, it’s also like a health care proxy, the person who they would sign to say, like, if I can’t make decisions for myself, This person should be able to do that, or is able to do that for me. But it doesn’t have to be right. If it’s your daughter, if it’s your neighbor, if it’s your spouse, whoever it is. But if you have another set of eyes and ears, because it’s not only are you like you’re leaving, either, like excited to leave or frustrated that you’re leaving, right, so like you’re not fully hearing everything, but someone else also knows what it takes for you to be successful. Like, everything is a team effort for health care, both in the hospital and out the hospital, right. And I hear it and I see it all the time where like, someone will say, particularly some of our elders, I’m ready to go home, I don’t want to go to rehab. You know, I’m like, Okay, can you be safe in your home? Oh, yeah, I’m perfectly safe in the home. I only have like, two, three stairs to get to my, to my front door. Okay. And then their daughter will say, Yeah, but you got like, 18 stairs to get your bedroom. Like, oh,

Michael Hughes 31:43
That’s the thing. You know, we see. I mean, we see these patterns where I think, at least the research I’ve looked at is most hospital readmissions. I think, like, good, none of them happened within just a day or two of getting home, we’ll get out of the car and trip on the front porch. I mean, you know, it may be tough for a lot of patients to say, look, you know, I really want to go home, I don’t want to go to skilled nursing, but they know in the back of their head that they don’t have enough food in the house. They don’t have they don’t have a plan.

Monique Nugent 32:14
That’s the hard part. You’ve been hospitalized for however many days, you’re right, is there food in the house again, who’s going to take me to pick up all the new medications that I had, who’s gonna do a medication reconciliation with me in my house, because the visiting nurse is going to come the next day or a day after and you still want to

Michael Hughes 32:33
or home health could be days before home health comes right, you know.

Monique Nugent 32:37
And so it does take a team effort to be successful for discharges, because it’s not just our people medically ready to go, right? It’s our people safe to go. And this is the conversation I have with people all the time. Because there is unfortunately going to be a feeling that I am not ready a lot of the time, right? Like, like I said earlier, the hospital is not a place where people get better anymore, right? Rehabilitation getting better, feeling like yourself will occur outside of the hospital. Even if you were excited to go to hospital and have a baby, you’re walking out with this new baby that’s crying and you have to figure out life and you’re still in pain. And now you’re gonna start breastfeed like you’re not like those people are not excitedly perfectly comfortable either. Right. But are you safe? And that’s the question I asked my patients when they get discharged when I’m talking about discharge. So do you have everything in your home to feel safe? When

Michael Hughes 33:36
people feel embarrassed about that, though? I mean, people tend to feel I mean, I’ve seen you know, people getting phone calls, you know, from the hospital, and they’re just checking up on you do you have everything you need, you know, I have what I need, they have none of those things, and I’ve had people feel people there, there seems to be this relationship with doctors when doctors are so well respected. And you guys have your own language and sort of admitting to your doctor that, you know, that I’m not. I’m embarrassed because I don’t have these things. I’m embarrassed as I’m not ready. Or maybe I feel like I’m in the hospital to begin with because I did something stupid, or whatever that mental, you know, world that people live in. But that’s a barrier unto itself. I mean, how do you overcome something like that? Yeah.

Monique Nugent 34:20
The fierce independence some people have as well, like really wanting to be in their home. And really being like, I’ve seen it really work for people. And I’ve seen it really not work for people. And your physician is not the only person their physician is not the one calling you saying like do you eat food in the house? That’s likely the social worker, case manager, a discharge specialist, whatever they call them, every hospital has a special name for those people who are responsible for that. And this is somebody who tends to either To be a nurse or social worker who’s well versed in healthcare, case managers, I call them kind of, like, super souped up nurse, nurses and social workers or nurses who have been at the bedside for years. So they know what is necessary for patient care. But they spend a lot of their time planning and working with insurance, setting up the things you need to be successful outside. These are the people who if you feel like you can’t speak to me, these are the people you should be more comfortable to, you know, share your true needs with. You have to say, and I don’t know how to say it, you have to ask, you have to tell us the truth. Like medically, there’s very few things you can hide, those things will come out in the lab or an x-ray. Right. But I will never know what goes on in your home. I will never know if you need Meals on Wheels. But I’m also not the person who’s going to set that up case manager a social worker a discharge planning, those people will be the ones to set them up and they want to do it and the community wants people to be successful the commute you will be surprised at the programs different communities have different councils on Aging’s have different, you know, elder support services throughout the nations have. I’ve seen everything from like a walker library, which I thought was just the coolest thing and right yeah, we’re like, oh, you may need a walker for a certain amount of time you check it out and, and like, or, you know, give it back when Stan or people who donate their walkers keep their canes and things like that. I think those are things that are only going to be community based so that the communities get together and say things like, how can we support each other and your case manager, your social workers are going to know how to get you those things. I have seen unfortunate things happen where people don’t tell us what their true needs are. And the best case scenario is a repeated hospitalization. The worst case scenario is somebody gets hurt. Yeah. Or worse.

Michael Hughes 37:09
I just want to I just want to go back and say, you know, they’re, you know, social workers have the role in the hospital, I want to tell listeners as well that, in addition to United Church Homes has our navigator program, you can look to navigate.org and use that as a resource with your local area agency on aging, has these resources available, you should connect with them? And when can you just talk a little bit about the role of a patient advocate in the hospital? Is every horse in every hospital required to have a patient advocate? Or do I only seldom do? What do they

Monique Nugent 37:41
do? So patient advocacy offices. They may go by different names in different hospitals, it may be called something like patient experience, patient outreach, different things, right. But the role of that role, the role of the patient advocate in the hospital, and yes, every hospital is supposed to have a patient advocacy office or something in that equivalent is to be that intermediary where you feel like something is not right here. I need help. I need help advocating for myself, I need help navigating the system. And yes, they are employed by the hospital. Right. So people sometimes feel like, well, you’re not really here for me, you’re here for the hospital. Right? Yeah, that’s something that I hear. But their job. And one of the benefits of them being employed by the hospital is they know how to navigate the system. They know who’s the director of watch and watch, they know which, like, where the lost and found for pediatrics is on the second floor, they know those things, and they know what can be done to help resolve the problem? Is everything going to work out 100% The way that people want? Probably not right, I cannot guarantee that you’re gonna get the exact thing that you want. But if you feel like I’m not being heard, I feel like I need someone and a lot of the time they are lay people. So that helps a lot too, because you’re speaking to somebody who doesn’t have that medical background, but they have that experience background. And they know what it feels like when I’m pushing the button and nobody is coming to change me. And you know, that’s something that we hear over and over again is, you know, being toileted is a big experience issue. Yeah, and nothing improves without feedback. I encourage people to write letters to reach out to the patient advocacy offices to give even the negative feedback. Because nothing improves when we don’t know that the system isn’t working for people. And the things that we’ve seen improve over time have only been from repeated episodes of feedback and trying and doing things over and over again until we start seeing things being safer and being more pleasant for patients. Wow.

Michael Hughes 40:05
This could be, we could go for hours and hours on this topic Monique, I am just so thankful that you’ve made the time to be part of this podcast today. And I also want to thank you for putting out a terrific resource for patients and their families. And that’s the prescription for admission. The book offers a comprehensive guide to navigating the hospital system as well as worksheets and other resources to help plan for your hospital visit. And I encourage everyone to check that out. But we can’t let you go just yet. We always ask our guests three questions about their own personal experience in aging. We always ask permission to say is it okay if I ask these questions?

Monique Nugent 40:47
Yes, go for it.

Michael Hughes 40:49
Okay, all right. So the very first question I want to ask you is when you think about how you’ve aged, what do you think has changed about you or grown with you that you really like about yourself?

Monique Nugent 41:02
I have become a lot more confident as I’ve gotten older. And I actually really enjoy that about myself. I think when I was younger, you’re trying to find your way in the world. And you’re figuring things out. And I like now that I know what I like. And I know where I stand. And little one off comments. Don’t send me into that like 20 year old 22 year old spiral of being like, what did he really say? Does he like me? That type of stuff. And it makes me feel that it’s a different way of being now that I feel like I have something to say so I’m going to say it because I know that I have the understanding and the experience to back the thing that I’m saying. And so I think I’ve become funnier, because I’m more confident. Because I don’t take things as seriously, because I’m not second guessing myself anymore.

Michael Hughes 42:04
That’s very cool. That’s very cool. And that actually leads into the second question is, which is what has surprised you the most about you, as you’ve aged, I actually

Monique Nugent 42:14
I understand my parents a lot more than I thought I would. I understand their journey, why they did things and do things. And it’s allowed me to be a lot more patient with them as they get older, because I see where they’re coming from. And I understand that. And so I think we all go through a phase where like, you know, you’re nothing your parents say is right, and everybody sees the exact opposite. And so I think I’ve really surprised myself by just very naturally coming out of that and into, Oh, I see where you’re coming from, and being able to have conversations with much more understanding.

Michael Hughes 43:05
Very cool. Very cool. And our last question, is there someone that you’ve met or been in your life that has set a good, good example for you and aging, someone that’s inspired you to do as we say, in our church age with abundance?

Monique Nugent 43:17
Yeah, I, you know, I actually look at older athletes. And I see that, like, aging doesn’t truly have to be. I think we have this narrative that aging means you become this passive thing over time. And you see a lot of very active older athletes nowadays. And it’s like, no, a body at rest stays at rest, but a body in motion stays in motion. And I think of that phrase over and over again. And I’m like, wow, that’s how I want age. Like I am not a runner. Like if you know me know that. Like, I hate it. It is an unpleasant experience for even those watching me run. But I keep doing it. Because I know that it’s gonna pay off and I see it like down the road that investing in myself and this age, continuing to be active and not just giving up the ghost and saying like, Oh, yeah, my knees hurt because I’m getting older, like, No, keep moving. Keep doing the things that you love boiling your joy, oily and joints because, you know, like I said, a body in motion will stay in motion and and I want to stay in motion. Yeah,

Michael Hughes 44:42
and as you know, I was actually thinking of this exact thing when I was taking a long walk this morning. It’s like yeah, you just need to keep doing it. I just need to remind myself to stretch

Monique Nugent 44:52
mobility framing of big mobility training Israel back. Yeah,

Michael Hughes 44:55
absolutely. Oh man. It’s been such a pleasure talking with you on the show today and for Our listeners, we’ve been pleased to have Dr. Monique Nugent on the show today. Her book, prescription for admission, is available right now. Please check it out at Barnes and Noble anywhere you get books, including through I guess Apple books and

Monique Nugent 45:12
all those places, Amazon, all those places. I have a website, you can check it out. It’s just my name Dr. Monique nugent.com. And I’ve got some free downloads for people to check out. You know, if you could think about purchasing the book, you can download some of the sheets that I’ve created to do things like learn how to do a family meeting and some of the skills that I teach in the fun. I really want people to have these resources. So please check it out.

Michael Hughes 45:40
That’s Dr. Mooney, nugent.com. And the book again Prescription for Admission. But most things of all to you, our listeners. Thank you for joining us again for this episode of The Art of Aging which is part of the abundant aging podcast series from United Church Homes and we want to hear from you. What has been your experience in the hospital? What has been the most difficult part of navigating hospitalizations, what tricks do you know, for successful navigation of the hospital? Or what topics do you want to see on the show? Please tell us about it at abundantagingpodcast.com You can also give us feedback when you visit the Ruth Ross Parker Center at UnitedChurchhomes.org/parker-center. Thank you so much for listening. We’ll see you next time.