In September 2020 I had to move my 93 year old mother from her house in VA to my house in NC because she could no longer walk or get up from her chair or bed. I am the only daughter. I have two brothers one of whom is living with my Dad in VA. They could not care for her. I am married and this has been a big adjustment but the alternative- a nursing home - was out of the question due to COVID. I have also witnessed the neglect both my parents experienced in rehab nursing home facilities and feel it is not the best for them. I thought I had a good team set up which included getting her set up with my family doctor. Since she is bedridden he has had to use televisits to see her. That has worked fine. She has Medicare A and B. She arrived at my house from rehab with a small bedsore that I have managed to heal with prescriptions from the doctor. I have aides helping me 6 days a week and the doctor ordered home health care to come for out for wound care and a UTI. My mother is on very little medicine and really has no major health issues aside from her age and physical deterioration. We use a Hoyer lift to get her in a chair almost every day and she assists with changes of diapers in the bed by rolling herself on herside.
She does not have dementia and is oriented except when a UTI is brewing. Most days she can tell you what day it is, what is going on in the news and she . remembers birthdays and the aides names She has been here about 9 months and while hard at times, I am making it work. During televisits, the doctor has sometimes seemed irritated even though we have not had frequent appointments and try not to ask stupid questions. In June, shortly after getting her 2nd COVID vaccine, my mother developed pain under her arm on the same side as the shot. She also had extreme swelling and itching at the site. That went away but the side pain did not. I also noticed she stopped eating and drinking as much. Long story longer, on a Friday evening I finally sent her to the ER. That was the first and only time she has gone to the ER since she has been with me. She was diagnosed with a pulmonary embolism and a UTI. Both were treated and she was released in three days in good condition. She has continued to do well at home. I was told to follow up with her Primary to determine any changes of dosage of the blood thinner. His first words were to tell me I can’t keep sending her to the ER and that she is costing Medicare a lot. He suggested a nursing home “would be better for her”. I informed him that in the past 6 years she has been to the ER exactly 3 times (including thus trip) and one trip in 2015 was because she was knocked down by an automatic door. This was her first ER trip since being with me. Anyone with pain that doesn’t go away can legitimately visit the ER. He failed to address the dosage issue so I had to call back. Today he informed me that Medicare rules prevent him from keeping my mother as a patient because she needs to be seen in the office to certify her as bedridden! What?! He told me to sign her up with Doctors Making House Calls. I tried. The merged with Eventus Home Healthcare and they do not have any providers in my area at this time. My doctor’s response was there is nothing he can do. He has given me 30 days to find a new doctor and then he will discharge her either way. We do not owe him money and he is being paid by insurance- can he do this???? He is leaving my mother with no primary care doctor. What am I supposed to do if she needs a prescription or home health for a condition?
Can Dr No make a referral for Geriatrician instead?
Someone who specialises in elder issues may be better for Mom? In my limited experience, they can be more maintenance orientated, rather than curative: more holistic & big picture, less pills, less scans/tests, less 'must fix'.
Depends if this is the direction you want.
The doctors were also refusing to refill prescriptions if the clients couldn't "come into the office".
Your mother will have to go to the doctor's office by ambulance.
This is what I had to do with all of my homecare clients who were either homebound or bedbound. The paramedics come and they bring the person to the doctor's office. Depending on the ambulance company, some of them will stay too and make sure the person gets into the exam room. They will not however, put a person on the exam table or help them get undressed. All of them said no to that. Pretty much all the doctor did when the paramedics got the clients to the office was listen to their heart/lungs, the blood pressure, temperature, and put the blood ox on their finger. Nothing a visiting nurse service couldn't do at home. Of course these clients were completely out of it with dementia and didn't know what day it was, let alone be able to answer any questions the doctors had.
They have to see them or can't bill it as an office visit. This is why they insist. Any doctor can drop a patient from their service and not give any reason at all. They do it all the time.
As for the UTI's. Well, every time you suspect one you will probably have to call an ambulance and send mom to the ER in order to get antibiotics.
I had one client with an old-school MD who still possessed common sense which is all but extinct in the medical profession.
Anyway, I would call him and explain that the client's urine had a certain smell and was darker than usual. He understood that I'm an expert on every kind of piss and sh*t there is because I've been in elder care for so long. Every time this happened it was a UTI. The client was bedbound and in diapers so he'd prescribe an antibiotic before the next stage of bloody urine showed up with this client. He retired though. With all the others it was a ten or twelve hour visit to the ER. Family would always have to come down and wait with their loved one in the ER when my work hours ended and that was hard on them. Many lived out of town. Or hard on the finances because any hours that ran over my working hours I charged double-time pay.
All you can do is find mom a new doctor and take her by ambulance to appointments unless there's one who will make a house call.
"Let me stop you there, please, Doctor, I'd just like to clarify - can you tell me how a bedridden patient should attend your office in order to be certified as bedridden, please? How about you explain the process, and I won't call my insurers to make a formal complaint."
Has anything else happened that would have made this doctor so anxious to get rid of not only your mother but presumably also you and your entire family as patients? Is he having a nervous breakdown or something? (I'm not being rude, there genuinely is a lot of it about among primary care providers).
To make a long story short ....
I wound up calling a Medical Transport Company and hiring a stretcher and ambulance for her and paid out of pocket.
Her new Doctor set her up with 60 days of Medicare approved Home Health Care visits by a Nurse and PT. And also ordered a Hoyer lift for her which the PT will train me on how to use after it arrives. I'm disabled myself, so this will be a bit more complicated.
For anyone reading further - here's what we tried:
1. Specialized Doctor's office that made home visits. Did not work, as the Doctor was almost a two hour drive - they tried twice and opted out.
2. Called her insurance company and asked for help with this. None given. Called the county transport about their bus, they don't help people out of bed. 3. Called every Home Care Agency in the county. None would lift without a Gait Belt, Hoyer Lift or Slide Board.
3. Finally found a local doctor that agreed to see her once to establish a patient relationship. After that - phone visits are okay.
ALL because her previous Doctor decided that she didn't want to bother anymore with televisits!! I feel your pain!
You can use a wheel chair van service or a stretcher service for her to be seen by a new Dr,, just as you could do now. Most insurances cover this service.
If it is a Medicare requirement that she been seen in his/her office, then Medicare will cover it.
We did this with my mom once when her dermatologist insisted that he could only do a biopsy in his office, not at the NH. I belive we discovered that Medicare (not Medicaid) would cover a trip like this for some limited number of times per year.
https://www.medicareinteractive.org/get-answers/medicare-covered-services/ambulance-services/scheduled-non-emergency-ambulance-transportation#:~:text=Depending%20on%20your%20circumstances%2C%20Medicare%20may%20cover%20scheduled%2Fregular,no%20earlier%20than%2060%20days%20before%20the%20trip.
IMO those "televisits" were allowed because of COVID. They would not have been allowed by Medicare forever. I think that you were lucky a new doctor would not have wanted to see her personally the first visit. She is not an existing patient. He is correct that he must see a patient face to face. In my State, to refill medications, you must see a doctor every 6 months.
Doctors are hiring more and more Nurse Practitioners. You may want to find a doctor who has NPs and sends them out to homebound patients. Thats what the Visiting doctor does in my area.
DhAunt had a primary several years ago who was always coming up with things he blamed on Medicare. I knew they weren’t correct as my mom had original Medicare and was on HH for years with an annual visit and no problem. This guy wanted her in every 60 days I think it was and then when we were there he gave very poor service. I found her a geriatrician who understood how Medicare worked and got rid of that primary. It’s easy to blame it on the gov when your office staff doesn’t understand it and neither does the doctor. It puts you in a bind but you are better off without him. I’m sorry he was rude to you and how dare he spout off about you wasting Medicare’s money. Your mom has been paying insurance premiums for many years and she didn’t write the programs.
Here is a Medicare link where you can look for providers.
https://www.medicare.gov/care-compare/