You don’t choose the hospital trip. The hospital trip chooses you. A fall, a fever, a chest pain that turns out to be more, a routine surgery that becomes complicated. Suddenly you’re in a hallway you didn’t expect to be in, your parent is in a bed you don’t recognize, and you have to advocate for them in a system that wasn’t built for the person inside it.
Hospitals aren’t bad. They’re fast, complex, and built for throughput — and the people in them are doing their best inside constraints most patients never see. But none of that means your parent automatically gets what they need. A hospitalized senior whose family is present and engaged gets meaningfully better care than one whose family is calling once a day. That’s not a moral statement — it’s how the system actually works.
Seven things that move the needle, drawn from fifteen years of being in those hallways myself.
1. Be there. As often as you can.
Physical presence is the single most powerful advocacy tool. Hospital staff make different decisions, ask different questions, and watch for different things when a family member is in the room. It’s not bias — it’s just reality. A patient with someone present is a patient whose situation is more visible to the team.
If you can’t be there yourself, someone you trust should be. A spouse, a sibling, a friend, a paid companion. Especially in the first 48 hours. Especially overnight. Especially at shift change.
2. Watch for delirium. Aggressively.
This is the one most adult children miss. Hospital-induced delirium affects up to 50% of hospitalized older adults (American Geriatrics Society / NIDUS) — and it’s one of the most reversible complications when caught early. It looks like sudden confusion, agitation, hallucinations, withdrawal, or a personality change you’ve never seen before.
Families often see it and assume it’s “Mom getting worse.” It usually isn’t. It’s the hospital — disrupted sleep, IV medications, anesthesia, unfamiliar environment, sometimes a urinary tract infection nobody caught yet. It’s reversible. But only if it’s identified.
If your parent seems “off” — say so. Out loud. To the nurse, to the attending. “This isn’t her baseline. Something’s changed in the last 12 hours.” Push for it to be evaluated. Ask whether a delirium screen has been done.
3. Bring the medication list. And the medical history file.
Bring it in writing. Print two copies — one for the chart, one for your own reference.
Include:
- Every medication, with dosage, frequency, and the prescribing doctor
- Every supplement and OTC they take regularly
- Every allergy — drug, food, latex, anesthesia complications
- Existing conditions, with rough timeline
- Recent procedures in the last six months
- Their primary doctor’s name and phone number
Hospital med-rec — reconciling the medications they should be on with the medications the hospital actually gives them — is a leading source of error. Your accurate list is the safest input the hospital has.
The toolkit’s Documents module covers exactly which records to keep and how — but for now, even a hand-typed sheet is better than relying on memory.
4. Get your name on the chart.
Every hospital admission needs three pieces of information about you, written into the chart:
- You are the emergency contact.
- You are an authorized recipient of medical information under HIPAA.
- You are (or aren’t) the healthcare decision-maker under your parent’s existing healthcare proxy.
If your parent has a healthcare proxy already, bring a copy. Hand it to admissions. Hand a second copy to the floor nurse. Don’t trust it to be in the system from a previous visit — hospitals lose documents constantly.
If your parent doesn’t have a healthcare proxy yet, the hospital will offer one on admission. This isn’t an ideal moment to be filling that out for the first time — but it’s better than not having one. Don’t skip it.
5. Ask “what’s the plan?” Every shift.
Three times a day, ideally — once at morning rounds, once mid-shift, once at the night nurse’s start. The question is the same: “What’s the plan today?”
What you’re listening for:
- What problem are we treating? Get specific. “Pneumonia” or “post-op infection” beats “she’s not feeling well.”
- What’s the goal of this admission? Discharge? Stabilize? Diagnose?
- What’s the expected timeline?
- What’s scheduled today? Tests, procedures, consults.
- What changed since yesterday?
If the answer is vague, ask again with different words. If it’s still vague, ask the attending physician directly. A vague answer means the team itself isn’t aligned on the plan — which is itself a problem you need to surface.
6. Know who’s who. And know how to escalate.
The hospital has a chain of command that adult children almost never know. Memorize it before you need it:
- Bedside nurse — your first point of contact for almost everything
- Charge nurse — supervises the bedside nurse; escalation point for nursing concerns
- Resident or hospitalist — making the day-to-day medical decisions on the floor
- Attending physician — the doctor with ultimate authority on the case
- Case manager or social worker — handles discharge, insurance, post-discharge planning
- Patient advocate or patient representative — formal complaint and resolution channel
- Hospital ombudsman or chief medical officer — when nothing else works
If you raise a concern with the bedside nurse and nothing happens, ask politely for the charge nurse. If that doesn’t work, ask for the patient advocate. You don’t need permission to escalate. You just need to know the escalation path.
7. Own the discharge plan.
Discharge is the single highest-risk moment in a hospital stay. About 1 in 5 Medicare patients is readmitted within 30 days of discharge (CMS Hospital Readmissions Reduction Program) — and most of that preventable harm happens because the discharge plan was rushed, incomplete, or unrealistic.
Before your parent leaves the hospital:
- Get the discharge summary in writing. Read it before you leave the building.
- Confirm every medication change. What’s new, what’s stopped, what’s the same.
- Get the follow-up appointments scheduled. Don’t leave with “you’ll get a call to schedule” — push for actual dates and times.
- Understand what “watch for” symptoms mean. Specifically what would mean “go back to the ER.”
- Know who to call at 2 AM with a question. The discharging hospitalist? The primary doctor? An on-call nurse line?
- Match the discharge destination to actual capacity. “Home with family support” isn’t realistic if the family support is one exhausted daughter who works full-time. Push back if the plan doesn’t match reality.
Discharge day is when the hospital is ready to let go of your parent. It’s also the day your parent is most fragile and least equipped to advocate for themselves. This is the day you advocate hardest.
“A hospitalized senior whose family is present and engaged gets meaningfully better care than one whose family is calling once a day. That’s not a moral statement — it’s how the system actually works.”
FROM THE NIGHT WE THOUGHT WE’D LOST HER:
A few years into Mom’s Alzheimer’s, she was hospitalized for a separate problem. Three days in, she went from her usual confused-but-recognizable to someone we didn’t recognize. She didn’t know who we were. She was agitated in a way she’d never been. She’d be calm one minute and, um, unpleasant the next. We thought she’d crossed a threshold and wasn’t coming back.
A nurse who’d seen this before pulled me aside and said: “I think this is hospital delirium. Has anyone screened her for it?” No one had. They did. She had a UTI nobody had caught yet. We treated the infection, kept her on a more consistent sleep schedule, got her familiar things into the room.
Within four days she came back. Not all the way to where she’d been before — Alzheimer’s doesn’t give you that — but back from the cliff we thought she’d fallen off. Without that nurse, we’d have taken her home in that state and accepted that decline as permanent.
The one thing I learned from that week, that I tell every adult child I work with now: if your parent is in a hospital and they suddenly seem like a different person, ask out loud whether it’s delirium. Don’t wait for someone else to bring it up. Most of the time, you’re going to be the one who notices first.
The hospital is the moment your parent needs you most.
Aging parents in a hospital bed are physically and cognitively at their most vulnerable. The system around them is moving fast. The decisions being made will affect not just this admission but everything that comes after.
You don’t have to be a doctor. You don’t have to be confrontational. You don’t even have to be there 24/7.
You have to be present, prepared, and persistent. Bring the list. Ask the questions. Watch for what nobody else is watching for. Catch what nobody else has caught.
You are the one who knows them. The hospital staff is doing their best with the patient in the bed. You’re the one who knows the person. That’s the entire job description for advocacy.
You’ve got this.
Hospital advocacy is one part of a much bigger picture. The toolkit’s 7-Day Care Plan Sprint and the Documents module give you the records, lists, and conversations to have ready before the hospital trip happens — so when it does, you walk in prepared instead of scrambling.
Back to the Caregiver Library. Read more on Conversations & advocacy.
