Why Communication And Planning Keep Seniors Out Of The Hospital- Sid Gerber, Houston, TX

A quiet fever, a missed noon dose, a confusing discharge packet—small cracks that can send an elder into a chaotic ER spiral. We bring together two seasoned pros, Sid Gerber and nurse case manager Maddie Bunch, to show how thoughtful planning, trained caregivers, and fast communication keep loved ones safe at home and out of the hospital. Their stories span ICU nights, VA leadership, dementia care, and the hard lessons that come from watching systems strain under the weight of too many patients and too little continuity.

We dig into what’s really happening inside hospitals today: marathon ER holds, overworked teams, and hospitalists who don’t know the patient’s history. Then we move to the fix—actionable steps any family can take. Learn when to call urgent care versus 911, what a complete discharge plan looks like, and why having a sitter or caregiver at the bedside is no luxury. Hear how shift‑by‑shift reporting, early detection of UTIs and delirium, and a direct line between case manager and home care team can stop problems before they explode.

Preparation changes everything. We walk through advance directives, medical power of attorney, and out‑of‑hospital DNR orders, plus how to organize a next‑of‑kin kit so every sibling and caregiver has instant access. The goal isn’t to avoid hospitals at all costs—it’s to avoid preventable admissions, protect dignity, and ensure calm, informed choices when seconds count. If you’re caring for a parent with dementia, managing chronic illness, or just getting your family’s plan in order, this conversation gives you a clear, compassionate roadmap.

If this helped you feel more prepared, follow the show, share it with someone who needs it, and leave a review with the one takeaway you’re putting into action.

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Episode Transcript

SPEAKER_00 (00:09):
My name is Sid Gerber.
I'm president and owner ofPersonal Caregiving Services.
We are licensed as a non-medicalhome health agency in the
Houston, Texas market.
I've been in long-term care for33 years now.
I started out as a nursing homeadministrator for eight years.

(00:30):
Before that, I was in a totallydifferent business, but really
wanted to get into the healthcare administration focus.
So I had sold my business thatwas a family business in 1989.
Went to the University of TexasHealth Science Center.
Was actually, because I couldn'tget into hospital

(00:51):
administration, I asked alongtime high school friend of
mine who is a long-term careadministrator himself what there
was, what opportunities therewere for me.
He suggested that I get mylong-term care administrator
license.
And I did that through theUniversity of Texas Health
Science Center here in Houston.

(01:11):
I was thrown into a class of 35graduate nurses who were also
taking the long-term careadministrative curriculum.
Completed that in 1992, and myfirst building was after two
weeks, the current administratorof that building, which is a

(01:32):
200-bed Medicaid facility herein Houston, said, I'm leaving
for another job in Dallas, andyou can have this if you want
it.
So I went ahead and stayed withthat building for about four
years and then left to go to twoother facilities.

(01:52):
My last facility was in 1996.
I was at the groundbreakingceremony for a exclusively an
Alzheimer's and dementiafacility, skilled nursing
facility, and took it out of theground and stayed with them for
another basically three and ahalf years and left in 2000 to

(02:15):
really it was at that point intime.
I of course worked in for-profitcorporations.
And the key for them was fillingthe building and census.
I had a weekly census meetingevery week.
And the first question was,What's your census today?
And what are you going to doabout increasing it?
And so it's not what I signed upfor.

(02:37):
I decided to leave and go out onmy own and became a geriatric
care manager, consulting withfamily members, adult family
members, and spouses who hadmostly elderly that needed some
guidance and education andcoordination of care.
So I did that, oh gosh, from2000 to about 2009.

(03:01):
I had my own business inconsulting and doing that.
And then some of my privateclients would ask me to help
manage their private caregivers.
And I suddenly realized thatbecause they were not my
employees, they weren't going todo what I asked them to do and
trying to improve the quality ofcare and life of the clients I

(03:24):
was consulting with.
So I realized at that time Imight as well jump into it and
become licensed with the TexasDepartment of Health and Human
Services.
In 2009, I started my ownnon-medical agency, and that's
where I am today.
I have approximately oh 80caregivers in my pool.
Most of my caregivers aretrained in Alzheimer's and

(03:46):
dementia care because thepredominant focus on my services
or dealing with clients who haveAlzheimer's and dementia.
And that's my story.

SPEAKER_03 (03:58):
That's a great story.
All right.
Let's talk to Maddie.
Maddie, tell us about yourhistory.

SPEAKER_01 (04:04):
My name is Maddie Bunch.
I'm a nurse case manager, theBSN.
I went to college at theUniversity of Bridgeport in
Connecticut and did my clinicalsat Yale, New Haven and
Bridgeport Hospital.
I decided after meeting anorthopedic surgeon in New York
one day, after he said to me, ifI was interested in a job, call

(04:26):
him and go to Texas.
I packed up and moved to Texasand went to work at the
Institute for Rehabilitation andResearch.
I found I my first role was the11 to 7 shift in the ICU of PEDs
and adults.
And there I was, the only RN,and it was my first night at

(04:48):
work.
I went, oh, this went well.
This will go well.
But anyway, it turned out great.
I had a long career with Tierand moved from Tier to the VA
hospital in Houston, where Iworked in the brain injury and
spinal cord injury as a nursemanager and returned to Tier
under a federal grant toestablish case management in the

(05:12):
community.
And then was moved up to nursemanager of their outpatient
clinic.
And when I was in the outpatientclinic, I would see the nurses
come in at that time.
Insurance companies had nurses,registered nurses for workers'
comp.
And I was watching and Ithought, there's more to this

(05:32):
service than just the workers'comp market.
And in 1984, I left here andstarted a company with another
woman.
She was an occupationaltherapist.
And we had the company for 13years.
Our focus was catastrophicinjuries.
And we subsequently sold it.

(05:54):
And when I left that company, Istarted M Bunching Company,
which is my existing companynow.
That was in 1996.
And retirement is this is myretirement, is what I tell
people.
I'm retired now, I'm having fun.
I focus on medical casemanagement mostly.

(06:15):
I do receive many dementiapatients or Alzheimer's
patients, but people come to meoften because of the medical
side of the need for theirelderly or their loved one.

SPEAKER_02 (06:28):
And so, Sid, how do you guys, you two of you, work
together?

SPEAKER_00 (06:34):
We complement each other because I, of course, have
the caregiving staff, and wehave worked really very closely
together with some of the casesthat that Maddie has presented.
And like she said a minute ago,some of these clients are cases
have or more complex medically.

(06:54):
And so she brings that forte tothe table.
And I bring, like I said, thecaregiving forte.
And we've worked very well.
The important thing iscommunication.
We found that out is essential.
And we even have our caregiversreporting to Maddie directly on
a shift-by-shift basis so thatshe has a very clear because

(07:18):
things can change.
Some of our clients can changeon an hourly or even a
minute-to-minute basis.
And again, this kind of gets usinto the issues that we're going
to be talking about, which ishow to minimize the admission to
hospitals.
Because if you have that quickof response and communication,

(07:40):
we can try to prevent thehospitalization at all costs.
And that's basically why we havecreated this accommodation for
both of us and the client offamily members.

SPEAKER_03 (07:53):
It sounds to me like you guys are a powerhouse team
together because I and I knowthat a lot of families don't
realize this, but especiallywhen it comes to the medically
complex, um, the care managementor case management, whatever,
whichever way you want to swingit, is so important in all of
this.
Even down to a missed medicationcan be the difference between

(08:16):
say a Parkinson's patient reallyhaving a good day or a bad day,
or there's just so many littlethings.
So for the not complex and thefact that you both have care
management and case managementexperience is so nice for
families.
I feel that like as a nurse,I've done that whole care
management thing in the past,and I that is a lifeline for

(08:39):
families, having somebody tomanage that care and to be
available to talk to and toreally have somebody, especially
if they're not, even if they'redown the street, it really
there's so much interpretationof medical language that people
don't understand.
If they don't have a healthcareperson in their life that a

(09:01):
nurse in their life or a doctor,somebody who can explain things,
it becomes overwhelming reallyfast.

SPEAKER_01 (09:07):
Yes, it does.

SPEAKER_00 (09:08):
It truly does, excuse me.
It's also a first time foreverybody.
And of course, the the educationis essential, and that's what
Maddie and I do provide is thatwe're always making
recommendations, we're alwayseducating our family members and
our clients because they don'tknow.

(09:29):
They absolutely have no idea,and we try to avoid the
pitfalls.
And the healthcare system isbroken, and I think the three
elements that my business modelis based on is the fact that
there's very littletransparency, there's very
little communication, andthere's very little family
support, if at all.

(09:50):
So I pass that on, and myexpectations are very high with
my own caregivers.
I need them to promote thosethree elements that are missing.
And that's, I think, that'shelped my reputation in the in
the industry is that withoutthose three elements bridging

(10:10):
those the gaps in healthcare,nobody else is going to be an
advocate for them because theyjust don't know how to be an
advocate.

SPEAKER_03 (10:17):
They don't know what they don't know.

SPEAKER_01 (10:18):
Yes, they don't remember what they don't know.
Even at this stage of ourcareers, there is never, if the
family needs us, we are the fewthat the two of us, whether it's
Sunday afternoon, we may notwant to do it, we're tired, but
we will go out and make a homevisit, or we will meet a patient
who's being discharged from thehospital because nobody else is

(10:42):
able to be there.
And that makes a big difference,especially with the older folks
whose family may be out of town,especially.

SPEAKER_00 (10:52):
Yeah.
That's a very good point,Maddie, because I tell clients
that look, I'm available 24-7.
I have a staff coordinator andsupervisor who's also available
24-7.
We have a weekend scheduler onthe weekends.
And I want to be responsivebecause that's what most of our
clients are.

(11:14):
I have to say this, they getoverwhelmed, they get very
emotional at the least littlething, but we are understanding
of that, we appreciate that, andwe are responsive.
So we basically operate as aconcierge practice.

SPEAKER_03 (11:29):
Yes, that's lovely.
That is great.
It's good for people to knowthat because they're not gonna
get that level of service andindividual attention from most
generic home care agencies.
It's just not that's notavailable to not possible.

SPEAKER_01 (11:44):
Yes.
And now, I'm sorry.
No, go ahead.
I was gonna say the hospitalsare so inundated with patients
that even their dischargepackets are not intentionally
incomplete, but they'reincomplete.
So I open it and I call back thenurse, whether it's a CID
patient or another patient, andI say, I need more information.

(12:05):
I have caregivers in the house.
I need to know when he last ate.
Did he get his medicine at noontoday?
Or are we starting all overagain?
I need a med list.
And we've been able, both of ushave been able to create a huge
resource of people we know inthe medical community.
And we take, we use acts, wemake act, we access that.

(12:26):
We because it's critical.

SPEAKER_03 (12:29):
Isn't that funny how people go home and there's there
like from a nurse perspective,there's no one to report off to.
There's no one to give report toto say, from if you work in the
hospital, you from one shift toanother, nurse to nurse, we give
report to the next shift and wesay, here's what's happened,
here's what's going to happen,here's what needs to happen.

(12:49):
And then, but when you go home,it's like you're they tell the
family members if there is anywho are not gonna remember all
of this, probably.
But they get this folder andthey go home and they are just
kind of hoping that everything'sgonna go okay.
And there's no one to givereport to to say this is what
you need to do now.

(13:11):
And they're just too overwhelmedto absorb it anyway.
So having folks like you to beable to call back and ask those
questions is so nice.
So very nice.
I know that we want to talk alittle bit about the current
condition or status of hospitalstays.
So I'm gonna ask you guys thisquestion, and you either one of
you can answer it.

SPEAKER_02 (13:30):
Sure.

SPEAKER_03 (13:31):
So, what is the current condition or status of
hospital stays today in terms ofcare, treatment, and have and
hazards for the health andwell-being of patients or
clients being admitted anddischarged from the hospital?
What's going on there?
What do you guys see?

SPEAKER_01 (13:44):
What I see is most patients who are over 75 are
admitted because they'reconcerned if they cannot find
anything with the patient,they're worried they're missing
something.
The patient's 75 or older, theywill be admitted regardless of
what they think the diagnosisis.

(14:04):
That's number one.
Number two, they could be in anemergency room for 12 to 48
hours, depending on the day, thenight, the day, whatever's going
on in the ERs.
Number three, they I telleveryone, you cannot leave an
elder person in the hospitalwithout a sitter, a caregiver,

(14:26):
or somebody from the family.
It's not that they don't want totake care of him.
The nurses, too, are veryoverwhelmed and very
short-staffed.

SPEAKER_03 (14:35):
You can't leave a 40-year-old in the hospital
cells at this point, even ifthey can talk.

SPEAKER_01 (14:41):
There's I would go, what did the doctor say?
I don't know.

SPEAKER_02 (14:46):
Yeah, exactly.

SPEAKER_01 (14:48):
Something I don't remember.
So it's it's a very stressfultime in the health care in the
hospitals.

SPEAKER_02 (14:55):
Yes.

SPEAKER_00 (14:55):
The other thing I might mention is the health risk
of being in the hospital for anyperiod of time.
And COVID was a good example ofthat, but even some of the other
diseases or illnesses that canbe contracted in the hospital.
I've seen people who've goneinto the hospital with without
pneumonia come back out withpneumonia or some other

(15:17):
contagious illness or disease.
So it's very important to try tominimize that exposure as best
as you can.
And again, Maddie mentioned theunderstaffing, which is true not
just in the hospitals, really,but basically in every corner of
the country and really justabout every facility that's

(15:39):
providing care assistance.
Very true.
Yeah, even in assisted livingcommunities, we're seeing that.
Yeah.
But yeah, the and the otherthing, too, is I gotta say this
because Houston is probably themedical capital of the world.
Yeah, I don't know how manyhospitals we have, and just in
our medical center alone, Ithink there are 10 to 12

(16:01):
hospitals.
But one of the things that Ifound out in the nursing home
industry is that you're doingyou're doing tasks.
There's no time, literally notime, I know in the nursing home
to have one-on-one caregiving,not even close to one-on-one

(16:23):
caregiving, where the staffingratios in a typical nursing home
today, even on a day shift,could be in an eight-hour shift,
could be one to twelve or one tofifteen.
That means that you may have atthe most 10 minutes for each
patient.
So the same is true in thehospital setting.

(16:43):
And that's what Maddie was wasdiscussing earlier.
But they're just doing tasks,and there's no understanding of
what the history of the patientis, other than looking at the
chart.
They don't have any knowledge ofthe family and other conditions
or circumstances that led themto the hospital.

(17:05):
And the other problem is thatthere's the family practitioner
doesn't usually go into thehospital because hospitalists
are now managing the wholeadmission and during the time of
admission.
And occasionally a consult willbe called on, but it's very

(17:25):
rare.
So that's where some of thebreakdown in communication is.

SPEAKER_03 (17:31):
Yeah, you don't see the primary care physician
making rounds the way they usedto.
There's no it's a hospitalistsystem that sees somebody you've
never met that doesn't know you,doesn't know making rounds and
hoping for the best.

SPEAKER_01 (17:45):
And they may have 27 patients on their care.
Yeah.

SPEAKER_03 (17:49):
Yeah, they have it's so many people to see and to
round on.
And what's the best way?
I know the next thing we want totalk about is what is the best
way to keep people from going tothe hospital in the first place?
What can we put in place to helpavoid hospitalizations?

SPEAKER_01 (18:04):
Education with excellent communication is to me
is one of the keys.
Teaching a family member or helphaving them understand the
importance before you call 911.
Yeah, make sure it's a 911 call.
If your mom has a temperature,maybe call urgent care first.

(18:26):
But don't just call 911 and goto the main hospital down in the
medical center.
You you could be there for threedays in the ER at times.
Education with the caregivers.
I like working with SIDS folksbecause they want to learn, they
want to hear what I have to say,and they follow through with it.

(18:48):
Occasionally there's a littlebit of pushback, they don't know
me or whatever, but nottremendously.
Takes one time explaining, hey,I'm teaching you skills you're
going to use for the rest ofyour life.
And that is critical with thecaregivers.
But the families are a big partof why people end up in the
emergency room, in my opinion.

(19:09):
They react, they don't think itthrough, and they just head on
in.

SPEAKER_00 (19:16):
They get emotional.
That's right.
No matter how significant orinsignificant it might be,
they're going to be veryemotional, and they just make a
knee-jerk re have a knee-jerkreaction to taking somebody to
the hospital.
And like you said, particularlyfor people who are chronically

(19:41):
ill, and if there's asignificant change, of course,
then it would be important tocall their physician and let
them know.
And again, it's theresponsiveness of the physicians
to uh because usually and I hateto say this, but a lot of
doctors on the weekends inparticular.
Particular, they're notavailable, or somebody's on

(20:02):
call.
And the first answer is if thisis an emergent, if they don't
get anybody on the phone, thenthe first message that you hear
is we'll call 911.
So we're encouraging people tocall 911 when it may not even be
necessary.
Yeah.

SPEAKER_03 (20:18):
It's I a simple urinary tract infection that
could be treated at an urgentcare can make somebody act kind
of wild.
They can really have some mentalissues, especially as we get
older when for something thatcould be easily treated, but it
looks scary in the moment.
If you're not aware, you don'thave the skill to assess what

(20:38):
this could be.
You don't know, then it thefirst thought is let's just take
them to the emergency room, ortake them, or you're right.
You call the doctor and theysay, if you really think that
you're not sure, or they'll giveit back to the family member,
then you maybe need to take themto the emergency room.

SPEAKER_01 (20:55):
And the facilities, the facilities tend to do that.
They they, I mean, they'reemployees as well, the facility,
and somebody calls and said, Idon't feel good, or I'm short of
breath, they may not know thepatient has oxygen right there
in the apartment or haspulmonary disease chronically.
The excuse they're going toreact, call 911, the person is

(21:19):
over 75, and they're going towhism off to the emergency room.

SPEAKER_03 (21:25):
And do you I it's funny that you say for folks
over 75, I wonder, I guess Idoctors today, or the ER
physicians or the hospitalistsare covering all the bases so
they don't get accused ofmissing anything.
That's right.

SPEAKER_01 (21:40):
So it's easier just to admit and make sure, and then
I had a patient who the firstwords out of her mouth when she
didn't feel well was, I'm goingto the ER.
This was inadvertently herpattern.
She'd go to the ER, they wouldadmit her, and then the next day
she'd call me and say, Get meout of here.

(22:05):
But she didn't have any childrenclose by.
And so she would just call theconcierge at her apartment
building, say, I need to go tothe hospital.
And they would call 911 and thenshe'd say, Get me out of here.

SPEAKER_03 (22:21):
Yeah.

SPEAKER_00 (22:22):
She got some attention and had some fun, but
one other thing that I thinkneeds to be addressed is the
fact that many people stilldon't have an advanced
directive.
Yes.
They haven't made a short or andor a long-term health care plan

(22:42):
in the event that somethingoccurs medically and or don't
even have a medical power ofattorney.
And they have to react to it'sit's they have to react to a
situation instead of beingproactive.
And I think it's absolutelyessential that people have those

(23:07):
documents available and ready.
A lot of people don't even knowwhat an out-of-hospital do not
resuscitate is because in somesituations, which I've seen both
in the nursing home and at home,is that if the family they may
have an in an in-hospital do notresuscitate, but they don't even

(23:30):
know what an out-of-hospital donot resuscitate is.
And if once they call anambulance, and if they do, if
their wish is not to beresuscitated, as soon as the
ambulance arrives and loads thatpatient on the way to the
hospital, if they code, they'regoing to do everything they can
to save that patient.
So that's an important documentto have in some cases.

SPEAKER_03 (23:53):
And having 10,000 copies of that document
available to every adult child.
You got it.
And the person in the house, inthe car, I can recall from
having family members that wemanage to care for.
You constantly have to bere-giving that those documents
to the hospital with everyadmission, with every change.

(24:15):
The doctor doesn't have a copy,or even if the doctor has a
copy, if it's eight o'clock on aSunday night, that's not
available.
So you have to have another copyin your hands of all those
things.

SPEAKER_00 (24:27):
So that's the worst the worst case situation I had
in the nursing home was we knewthat somebody had an out of
hospital an in a DNR, butcouldn't locate it.
And if you call 911 and they'recoming into the facility,
they're going to do again,they're going to try to

(24:48):
resuscitate, even though thefamily knows that there's there
should be an out-of-hospital, anin-hospital, in-facility DNR.
So that can be very problematic,especially if you're trying to
resuscitate a 95-year-old womanwho's frail and elderly, and you
know, you're going to cause moreharm trying to resuscitate that

(25:11):
individual.
So it's very important that youlocate the documents and they're
readily available.
And you, like you said, Valerie,that you've got a number of
copies available and accessible.

SPEAKER_03 (25:24):
Yes, everybody.
I sent my family members a box,and there's a I can't remember
the name of it right now, butthey sell packets and binders
online and all kinds of stufffor organization of this stuff.
So I it's called a knock box,and it's got next, it's called
next next of kin, is what thatwhat knock stands for.
And it's this file folder boxfull, and you don't have to buy

(25:47):
one to do this, but it's got aslot for their insurance papers,
a slot for their DNR, a slot fortheir power of attorney.
It's got all the things it andlets you organize that
information, which I'm sureyou've done a lot of, both of
you, for making sure everybodyknows where all those documents
are, and and that can save somuch time and heartache knowing

(26:10):
where those documents are,knowing that person's wishes,
and all the kids knowing thesame thing at the same time.

SPEAKER_01 (26:17):
Yes, that's really critical is knowing the person's
wishes at the same time.
All children should hear it, alladults.

SPEAKER_03 (26:24):
Yes, yes, for from the person, the adult, the from
the mom and or the or dad, ifpossible, from their mouths.
This is what I want, this iswhat I don't want.
And yeah, talking to you two,this is great.
I wish every family had theopportunity to talk to some
well-versed veterans in thisarea because there's so many

(26:46):
things that can be avoided, andwe hate having these
conversations with our parents,but everybody's gonna get older,
hopefully, if you're lucky, andeverybody's gonna pass away.

SPEAKER_00 (26:56):
You can't put you can't put aging off.

SPEAKER_01 (26:58):
No, you cannot run.
That's exactly right.
I have even I have gone as faras had to arrange funerals for
families that they didn't haveany, and they had no plan.

SPEAKER_03 (27:10):
Yeah.

SPEAKER_01 (27:11):
And it was that's rough, it's hard on them and
it's expensive, it's sad andit's expensive, but more
important, they feel so trash,they feel sad because they
didn't recognize to do it.
They not only do they have thegrief of the loss of a parent,
they're grieving that how couldthey let this slip by?

SPEAKER_03 (27:31):
It is it's rough.
And if you've ever had someonepass away suddenly in your life
at a young age or middle-aged,even who didn't they're young
enough that they didn't realizereally quickly how important it
is to put a plan in placebecause having to have people
who never thought they wouldhave to make these decisions go

(27:51):
and choose all these differentthings and how much to spend.
It I think funerals are reallyway more expensive than people
realize.

SPEAKER_02 (27:59):
Yeah, that's true.

SPEAKER_03 (28:00):
And uh it's really hard, even if your parent was
older, it's hard, it's a hardmoment.
So, yeah, having everythingarranged in advance is such a
good thing to do.
Yeah, I want to thank both ofyou for thank you, sharing your
wisdom with us and lettingeverybody know what the
important things are.
And Houston is very lucky tohave you both.

(28:21):
So thank you so much.
Thank you for being on CareAcross America.
Thank you.