For those sending kids to college in the fall, this summer brings the delicate dance of relinquishing key responsibilities to our children, including caring for their health. A properly stocked first aid kit is a must, but there is also some planning that can be done ahead of time to smooth the medical bumps your teen will inevitably need to navigate on her own. From one mom who just weathered freshman year with her daughter six hours away, here is a primer on some of the relevant health care issues to think through NOW so you can sleep a little better at night this fall.
5 Things About Health Care to Discuss With Your College-Bound Kid
1. First Things First – Get Hip to HIPPA:
Before getting into the nitty-gritty of healthcare planning, an examination of the Health Insurance Portability and Accountability Act of 1996 (HIPPA) is necessary. Most associate HIPPA with the clipboard of paperwork filled out at medical appointments, but it is important to understand what these five letters mean for you and your college student before she rides off into the quad.
HIPPA is a federal law that establishes rules for healthcare providers regarding who can look at and receive an individual’s health information. Although your pediatrician’s office may have winked/nodded around this for a newly minted 18-year-old, the college your child attends will not. Unless she has signed a release authorizing disclosure expressly to you, your call to the campus health center or local urgent care will be met with the following: “I’m sorry, but due to HIPPA rules, I cannot give you any information.” You may be the one paying tuition and covering her under your insurance plan, but she is legally an adult and thus entitled to HIPPA’s privacy protections. Here’s a HIPPA form you can use with your college student.
This unwelcome realization can rattle even the steeliest of parents, particularly in the heat of a medical crisis. One option to consider before your child leaves, is to have him sign a HIPPA release authorizing medical professionals to share diagnoses and treatment options with you. If a blanket release makes your child skittish, try a “happy medium” version that specifies that information about sex, drugs, and/or mental health is excluded and to remain private.
A Durable Power of Attorney and Medical Power of Attorney, which would authorize you to make medical and financial decisions should your college student become incapacitated, are also options.
[More on THE most comprehensive list you have ever seen for a college first aid and medicine kit here.]
2. Introduce the Left Hand to the Right Hand:
Once your child jets off to college, his medical issues are no longer managed by one practice. This creates the possibility that relevant medical information will fall between the cracks and necessitates coordination among medical professionals in different geographical areas. Without sending him scurrying off to bury his head in his Instagram feed, explain to your beloved the concept of the left hand keeping the right apprised in the context of his medical care.
In short, if you the parent is removed from the informational loop via HIPPA, it is now his responsibility to call the doctor’s office at home to keep the staff apprised of medical developments that occur while he is away. Explain how ensuring that the right hand (home doctor) knows what the left hand (campus doctor) is doing minimizes the chance that prescriptions conflict or that important medical trends will be overlooked in the crossover. Cheat sheet alert: While your pediatrician’s office cannot disclose information to you, nothing precludes you alerting them to developments and requesting they reach out to your child to coordinate follow-up.
3. Have the “You Don’t Know What You Don’t Know” Talk
Chances are, you’re already painfully aware your teen believes turning 18 has magically transformed her into a full-functioning adult, not just a legal adult. Sorry to be the bearer of bad news, but this will only be exacerbated once the freedom of college life kicks in. This is annoying in the normal course, but downright ulcer-inducing when you feel your child is cavalierly approaching her health care.
Your mission here is to temper the know-it-all mentality with some recognition on his part that “you don’t know what you don’t know.” Try to sandwich in among the binge drinking, alcohol, and sex talks you have scheduled for the summer, some discussion of the following:
- Mixing medications – whether prescription or over-the-counter – can be dangerous.
- Discuss the danger of combining medication with alcohol.
- With respect to prescriptions, there is a need to ensure they do not conflict (see above).
- Just because medications are available over the counter, doesn’t mean they present no risks. Kids need to read dosage instructions and contra-indications.
- For our daughters, a reminder that antibiotics that lessen the effectiveness of birth control pills and/or cause other side effects for women require appropriate arrangements.
- Beware excessive caffeine – the freedom to set their own hours and engage in all-nighters to cram often results in college students sloshing down Five Hour Energy, Red Bull, or crazy amounts of coffee like they are water. They are not. Per the Mayo Clinic, heavy caffeine use – described as more than 100 mg per day for adolescents and more than 400 for adults –can cause insomnia, nervousness, fast heartbeat, muscle tremors, and stomach upset (think gastritis), and can also clash with medications.
- Assessing when it’s necessary to see a medical professional – review basics such as, a “cold” that lasts a certain number of days without relief of symptoms, and the difference between viral and bacterial infection (and how fever is often indicative of the latter). The Mayo Clinic site has a handy symptom tracker tool, that provides guidelines per symptoms as to “when to see a doctor.”
4. Summer To-Do List
Here are some administrative tasks that can be done this summer to make future health care situations more manageable:
1. Key information to store by phone: Let’s face it, your kid’s “wallet” is digital. Keeping key information in picture form on both of your phones increases the likelihood your child will be able to produce it if needed, and eases what will already be a stressful situation for you when you have to re-send it! These screenshots will make life easier:
- Insurance card
- A list of current medication names and dosages – a single picture of the various pharmacy tear sheets lined up with name, medication, dosage, and Rx number for ease of reference works well
- A list of any known medical or other allergies
- Bookmark the campus health center’s hours, contact information, and walk-in policies
- An urgent care name, number, and directions link
- The signed HIPPA release and/or Durable Powers of Attorney, should your child consent to any of these
2. Get a game plan for handling prescriptions — some options:
- Send a full semester’s worth of medication – this is not recommended as the medication can end up lost or damaged; also with so many teens in the dorms, consider whether it is wise to have excessive amounts of medication in the room.
- Send one month initially, and fill/mail refills from home.
- Have prescription filled at a pharmacy near campus for student to coordinate himself.
3. Try to tap into a local “mom network” – after asking around, I learned a friend’s sister lived near my daughter’s school. We became text acquaintances and she has been invaluable for good references. She recommended a preferred urgent care (which came in quite handy) as well as an emergency room.
4. Consider an emergency contact friend – if possible, get to know a couple of your student’s friends at college and exchange cell phone numbers. In an emergency, that friend may just reach out to you. I got this call one night after my daughter had been battling an upper-respiratory bug for several days: “D is wheezing and having trouble breathing. The clinic is not open this late. Is it OK if I take her to an urgent care?”
Aside from the momentary panic at seeing the friend’s name light up my cell phone screen, I was so grateful she reached out, apprised me of a medical situation I was unaware of, and that I had handy a screen shot of a recommended urgent care to immediately provide her with.
[More on what parents of college kids need to remind themselves of here.]
5. Prepare Yourself – Bracing for “the Kimono” Effect:
Lastly, a friendly heads-up as to the angst you will experience when you are out of the loop and unable to ladle out chicken noodle soup. Back when I was negotiating case settlements as an attorney, my mentor gave me advise that sticks with me today – “open the kimono, but only partly.” In other words, we were to show our adversary enough to scare them about the strength of our case, but close it quickly to leave them guessing as to the full picture.
Don’t be surprised to find your child-turned-adult using this technique. After several days of debilitating stomach cramps fall of freshman year, my daughter finally agreed to get checked out at the campus health center. She happily reported that the doctor was pretty certain he knew what the problem was and prescribed medication. The text exchange went something like this: Me, with bated breath, “Oh great! What is the diagnosis and what was prescribed?” Her, “Well, I’m 18 now so I don’t really need to share that. But don’t worry.” Later that day, the kimono flashed open via a subsequent text: “Haven’t pooped for 3 days; pray for me.” Honestly, you can’t make this shit up (pardon the pun).
I can laugh about it now, but at the time – my daughter six hours away, sick, and selective with the information she was providing – it was incredibly upsetting. She was willing to open the kimono enough to describe the pain she was in, but declined to share diagnosis or treatment. On my part, I needed to take a breath and accept that I had no control or access to information when my daughter was sick. This was hard.
Once the crisis passed, however, it was also important for me to calmly go over some of the issues set out above that I had not thought of until we were in the thick of it, as well as some ground rules going forward. Namely, while I understood I needed to respect her right as an adult to privacy about her medical affairs, the kimono treatment would need to stop as that was not fair to me. As the year progressed, we learned to meet in the middle, which made life better for both of us.
This has entailed coming to terms with something I wrote to my daughter when I dropped her off at college: “One of the hardest things for me today is that I have treasured, nurtured, and loved my firstborn baby for the past 18 years and 40 days, and now I’m being asked to turn over the keys . . . to you!”
For many of us it is a struggle to do this willingly. Hell, I’m not sure I’m comfortable turning over a blouse to her care given the current state of her room, let alone the most precious thing in my life. But perhaps legal status at 18 and HIPPA are the universe’s way of chuckling at me and gently prying the keys from my reluctant grip.
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Christine Bachman is an attorney and mother of three, who serves as a court-appointed advocate for abused and neglected children, advises high school students and their families on college admissions, and enjoys writing in her spare time. Although not actively practicing law at this time, she credits her children with finding ways on a daily basis to help keep her litigation skills sharp. She can be reached on Twitter (@cdbachy) or Facebook (Christine DiBacco Bachman)