Hospital stays and emergency rooms

A trip to the emergency room or a stay in the hospital is hard for anyone. For a person living with dementia, it can be frightening and confusing. The place is loud and strange, the faces keep changing, and the routine is gone. People living with dementia have about twice as many hospital stays each year as other older adults.¹ Many families will face this at some point.

You cannot control everything in a hospital, but you can make a real difference. This page covers delirium, what to pack, how to speak up, observation status, and a safe trip home.

When to go to the emergency room

For milder problems, ask the doctor whether a same-day visit or urgent care would work. Before a planned procedure, ask whether it can be done as an outpatient.^2,3

Delirium: the biggest hidden risk

Delirium is a sudden change in the brain that causes confusion. It can come on in hours or days. The person may be restless and agitated, or very sleepy and quiet. The quiet kind is easy to miss. Symptoms often get worse at night.⁵

Common triggers include infections such as a bladder infection or pneumonia, dehydration, some medicines (especially sedatives and some pain medicines), surgery and anesthesia, and lack of sleep.⁵

People with dementia are at high risk. In one U.S. study of older adults with dementia, about 1 in 3 (32%) developed new delirium during their stay. Those who did stayed in the hospital longer (about 9 days instead of about 6). They were also more likely to lose daily skills and to die within a month.⁴ Delirium often clears in about a week, but it can take several weeks for thinking to return to normal.⁵

Why you matter so much. Staff do not know how the person usually acts. You do. Delirium on top of dementia is hard to spot.⁴ Telling staff "this is not how my mother usually is" can lead to tests that find the cause.²

Steps that help prevent delirium

A Cochrane review looked at hospital programs that use several simple steps together. These programs cut new cases of delirium by about 4 in 10, from about 18 in 100 patients to about 11 in 100.⁶ Moderate evidence Few studies included people with dementia, so the effect for them is less certain.⁶ Still, the steps are safe and comforting.

Ask the team whether the person really needs a urinary catheter, bed alarms, or medicines for sleep or behavior. Ask staff to avoid physical restraints and drugs used only to calm behavior whenever possible.² Never stop or change a medicine on your own; ask the doctor or pharmacist.

Get ready before you need it

The hospital bag

Keep a packed bag by the door, with copies of papers in a folder or on your phone.^2,3

• Insurance cards (Medicare, Medicaid, supplement or plan cards)
• A list of medical conditions, all medicines and supplements, and allergies
• Doctors' names and phone numbers
• Copies of the advance directive and health care agent papers, and any DNR (do not resuscitate) order
• Glasses, hearing aids with spare batteries, and dentures
• Clothes, toiletries, and briefs and wipes if used
• Comfort items, such as a photo or music with headphones, plus snacks and water
• For you: your own medicines, a phone charger, a notebook and pen

The "about me" sheet

Write one page about the person. Give copies to the nurse and ask that one go in the chart.²

• The name they like to be called and the language they speak best
• How they show pain, fear, hunger or a need for the toilet
• What usually calms them and what upsets them
• Their normal daily routine and sleep times
• How much they can do on a usual day: walking, eating, dressing, talking
• History of wandering, falls, or seeing or believing things that are not real

That last item about the usual day is very important. It lets staff see when something has changed.² A memory notebook can hold this information. If English is not the person's first language, ask the hospital for a free medical interpreter.

Legal papers

Make sure someone can legally make health decisions if the person cannot, usually a health care agent named in an advance directive. A release that lets doctors share information with family also helps.³ See advance directives.

In the emergency room

Expect long waits and repeated questions. These steps help:²

1. Tell staff right away that the person has dementia, what happened, and what is different from usual.
2. Hand over the medicine list and the "about me" sheet.
3. Stay with the person, or ask a friend or relative to take a turn.
4. Do not assume the person will be admitted. Before leaving the ER, make sure you understand the plan and follow-up steps.

During the hospital stay: be the advocate

You are the person's voice. Be polite, but be clear and direct.²

• Make sure everyone knows. Check that the dementia diagnosis, allergies and behavior concerns are in the chart. Ask that each new shift be told.³
• Stay close. Try to have a family member or trusted person with them as much as possible, including during tests. Ask about longer visiting hours or overnight stays.^2,3
• Talk to doctors away from the bedside about hard topics, so the person does not get upset.²
• Ask to be included in big decisions. Share what the person would likely want.³
• Ask about surgery and anesthesia. Ask how it might affect thinking and memory, and whether there are other options.³
• Ask for help. A hospital social worker, case manager, or patient advocate can help with problems and planning.⁷

If behavior becomes hard to manage, see our page on agitation and aggression and our tips for talking with someone who has dementia.

Take care of yourself too. Take breaks, eat, and sleep. Share bedside time with others so you do not wear out.² If you feel overwhelmed or hopeless, call or text 988 any time. See caregiver stress and burnout.

Inpatient or observation? Why it matters

Observation means the person gets hospital care as an outpatient while the doctor decides whether to admit them. A person can sleep in a hospital bed for one or more nights and still be an outpatient. They become an inpatient only when a doctor writes an order to admit them.⁷

Why it changes your costs:^7,10

• As an outpatient, Medicare Part B covers the care. You pay Part B copays for each service, and they can add up.
• Medicare covers rehab in a skilled nursing facility only after at least 3 days in a row as an inpatient. The day of admission counts. The day you leave does not. Time in observation or the ER does not count, even overnight.
• In 2026, if you qualify, Medicare pays all costs for days 1–20 in a skilled nursing facility after the $1,736 deductible for the benefit period. For days 21–100, you pay $217 per day.¹⁰

Some Medicare Advantage plans, and doctors in some approved groups, may waive the 3-day rule.¹⁰ If you have a Medicare Advantage plan, call the plan to check your costs.⁷

What to do:

• Ask every day: "Is my father an inpatient or an outpatient?" Ask the doctor, nurse, social worker or case manager.⁷
• The MOON. If the person is in observation for more than 24 hours, the hospital must give you a form called the Medicare Outpatient Observation Notice. It must come within 36 hours, and staff must explain it to you.⁸
• If the hospital changes the person from inpatient to observation. Since February 14, 2025, people with Original Medicare may get a form called the Medicare Change of Status Notice. It applies if the person has no Part B, or has Part B and has been in the hospital at least 3 days. The hospital must give it at least 4 hours before discharge.⁹ You can ask an independent reviewer, called the BFCC-QIO (Beneficiary and Family Centered Care Quality Improvement Organization), to decide whether the person should have stayed an inpatient. If you appeal before leaving the hospital, the reviewer decides within about one day after getting the records.¹³

These rules are current as of October 2026. See what Medicare covers in dementia.

Discharge planning: start on day one

Discharge planning should start soon after admission, not on the last day.²

Your rights at discharge

• Virginia caregiver law. Virginia hospitals must offer each inpatient the chance to name a caregiver who will help at home. The hospital must record this person and tell them before discharge. It must give them a copy of the discharge plan, ask whether they can provide the care, and offer to show them how to do the care tasks they will handle. The teaching must be in the caregiver's own language. Being named does not force anyone to give care.¹²
• The Important Message from Medicare. Medicare patients should get this notice within 2 days of admission and again before discharge. If you think the person is being sent home too soon, you can ask the BFCC-QIO for a fast appeal. Do it no later than the planned discharge day. While you wait, the person can stay without paying extra, except normal deductibles and coinsurance.¹¹
• A place that fits. A hospital cannot force a move to a care place that does not meet the person's needs. If you disagree with a plan, ask to talk with the patient advocate or nurse supervisor.³

Questions to ask before leaving

Where will the person go next?

• Is it safe to go home? Will they need home health, physical therapy, or equipment?
• Do they need short-term rehab in a skilled nursing facility first? Will Medicare cover it?
• Is it time to think about more help, such as in-home care, adult day care, memory care or a nursing home?

What changed with medicines?

• Which medicines are new, stopped, or changed? Why?
• Were any sleep or calming medicines started in the hospital? Should they continue at home?
• Who will check that the home list matches the hospital list? See managing medicines at home.

What care tasks will I need to do?

• Can you show me how, and watch me do it once?
• What warning signs mean I should call the doctor, and what means I should call 911?
• Who do I call with questions at night or on a weekend?

What follow-up is needed?

• When is the follow-up visit? Which test results are still pending?

The Alzheimer's Association and AARP Community Resource Finder can help you find local services after discharge.³ The Alzheimer's Association 24/7 Helpline is 800-272-3900.

Coming home

The person may be more confused, weaker or more tired for a while. If delirium happened, recovery can take weeks.⁵ Keep the routine simple and calm. See building a good daily routine and preventing falls. Call the doctor if confusion gets worse instead of better, or if there is fever, pain, or not eating or drinking.

A hospital stay is also a good time to talk about the future. In later stages, some families decide hospital care brings more burden than benefit. Ask the doctor about care goals, palliative care and hospice. See late-stage dementia and the caregiving hub.

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.