Appointments outside of memory care are becoming more challenging. How would you handle this?
My 91-year-old mom lives in memory care, and from time-to-time it's necessary to check her out from MC to take her to doctor appointments, etc. Months ago I'd call her the night before, tell her I'd pick her up at 9 AM for a 9:30 appointment, and when I arrived on time the next day, she'd be ready to go. It's amazed me that despite her deficits Mom's been organized enough to manage this; but still, in the back of my mind I knew the day would come when she couldn't. Sure enough, I began to notice that when I'd arrive, she'd know we were going somewhere but still not be dressed, and I'd have to prompt her to get ready. Entirely understandable. However, more recently, I've found her ready to go but furious, insisting I'd told her I'd pick her up at 6 AM for a 9:30 AM appointment, saying "Where have you been? I called and called and you didn't answer!"; essentially a catastrophic reaction with anger, hand-wringing, pouting, refusal to leave, etc. Reasoning, of course, does no good. In both cases it took a "time out" followed by a great deal of wheedling to get her out the door. Fortunately, we weren't late for her appointment. Obviously, I need a strategy to avoid more of the same. I've contemplated arriving early and unannounced to assist Mom in getting ready, but I can hear it already: "Why didn't you call me??? Nobody tells me anything!!!!" with another scene of anger and confusion. I've tried to limit outings with Mom as much as possible for my own sake (there's a long history of verbal and emotional abuse; thank you, Mom), and my sister shares in my care-giving duties; nevertheless I'm anticipating a number of future outings, and without going into detail, they are necessary, non-optional followup appointments and social engagements. So far Mom's social conduct is okay, sometimes inappropriate (but not combative) and so far I've been able to manage her okay. The staff at Mom's MC love her and are wonderful; however, they don't have time to coach residents about when to get ready, etc., and they don't prepare residents for or take residents to appointments; just a once-weekly group pleasure jaunt on the community bus. Has anyone encountered similar situations and how did you manage them? Thanks!
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Dad was the opposite, he would think he was ready but the search began for his cane... then his eye glasses... ok Dad you have your wallet?.... time for a bathroom run.... then the struggle to get into his favorite jacket... now, what baseball cap to wear. Then getting them into the car was no easy feat. I use to tell my parents their appointment was 30 minutes earlier than it was.
Eventually no matter what you do, with memory issues, it just becomes more complex. Lot of trial and error until you find one certain way that works. I had used what MAC above had mentioned, pick a time that works well, when Mom is the easiest to work with.
Mom is up half the night and has all night to fret about a morning appointment. I'll make sure to ask for afternoon appointments right after lunch, inasmuch as I can.
The message board is a good idea; unfortunately I live 4 hours away so there's no opportunity to get reminders up on Mom's board in time.
But yes! I always take responsibility when things "go wrong," like yesterday: "Mom, I don't remember you giving me your pajama tops to let out the seams; I must have forgotten! I'm so sorry! How forgetful of me! Blah, blah." It's just easier. Let her have the day. Take the blame and the trouble generally diffuses. (I'll go out and buy new pajamas.) She reminds me often that SHE doesn't have dementia, only a "little memory problem," but she "knows SOMEONE that's got a serious problem (her emphasis, not mine) and looks glaringly at me! LOL
Wish I could take her out for ice cream or some other goodie; but she's diabetic! (Sigh) And as for sugar-free alternatives, I'm learning now that artificial sweeteners raise glucose levels much like sugar.... Maybe a cup of Starbucks with cream will have to do!
Thank you guys, you're the best!
If this facility does not have a house doctor perhaps a private caregiver, or a geriatric care manager would be able to transport.
So I guess my suggestion would be, little advance warning, few trips, distraction with others in attendance and remind her that it is her decision. You need to mean that by the way. They can tell.
It's been upgraded to accommodate newer technology, and it's easier now than before. A handheld device is held over the pacemaker; transmissions are wireless. Only caveat is that there has to be adequate wireless coverage in the area.
If someone's in a rural area, that could be a problem. But in my father's area, he's one of the few who doesn't have a cell phone growing out of his ear.
The other idea I had is could you call the morning of either to "remind" her or verify something about the arrangements so she could cover up that she didn't know or forgot easily enough? I had been thinking your usual evening call about it and then again in the morning so she is gently reminded of what time you are coming to pick her up. My brother often gives my mom a call when he is on the road to either see her or take her somewhere, he lives about 40 min away, (I stay with her when I'm in town for appointments and things so while I update her from the road on my arrival time it's not the same thing) this way it's a habit so she doesn't take it as she can't be trusted to remember.
My LO's MC provides transportation to all of her doctor appointments. We have recently switched to a doctor who comes to the MC facility for weekly visits. This means that she doesn't have to travel, unless it's for some particular issue. They also transport her to her dental appointments.
I would expect the MC to be more cooperative and helpful. How do other residents handle it at the facility your mom is located? Do they have a protocol?
I usually don't say anything ahead of time.. schedule afternoon appointments like others have mentioned. I might call in that morning and tell the facility to let them know an hour or so before I get there. They should be ready and dressed unless you go early in the am... or they had some accident that need to be cleaned up for.
Last time I took my mom to the Dr., when I came back she didn't recognize the memory care from the outside... wanted to know what we were going to be doing at this place and just take her home! If I can at all avoid taking them out.. I will .... Its sad because I would like to be able to take them out at times but am nervous about how they will react when we return... or if they will even go back in.
When I took my Dad to the Dr last.. the electricity went out at the Dr.'s office.. and we were on the 3rd floor in total darkness.. with my Dad.. with dementia! What an experience. The staff had to help us down 3 flights of stairs..
Needless to say. ... I do not look forward to their Dr appointments!
It hasn't always been going this smoothly. Took lots of trial and error and once even having to cancel the appointment because she refused to move. So just when I finally have a "system" down I've pooped out. I admitted to the facility director when I was leaving this afternoon that I did not think
I could do it again. It's all too much for me. My mom weighs over 200 lbs and just pushing her around the clinic in the chair is exhausting. Not to mention the transfer from walker to chair to car to chair to exam table to chair to car to chair to walker. She has to be prompted for every movement. The director reminded me that the facility provides a transport van that I can ride in with her and it would cut out at least four transfers in and out of her chair. Duh!! Sometimes we forget the obvious because we get locked into the way we've been doing things. Next appt we'll be taking the van! Hopefully the driver won't mind going thru the drive thru at the local burger chain so I can still treat mom to lunch out when we get back to Memory Care.
Also mom checked out fine from the fall.
MC does not provide transportation for anything except aforementioned weekly group outing. If friends or family cannot take her out of MC for whatever reason, there remains the option of hiring an agency caregiver, who at $22/hr at a 6-hour minimum, which is pretty expensive. There is a house MD that comes to MC to check on residents for issues. She can arrange to have a mobile testing unit come to MC to draw blood, urinalysis, and some imaging, which is a Godsend. Now that Mom's long-neglected medical issues have been addressed (prior to Dad's passing she refused to go the doctor for years), the house MD can pretty much manage all but the most specialized medical issues, so in the future, doctors appointments will be few and far between.
So I think I can expect to be taking Mom out less and less.
For what it's worth, for those who have loved ones in wheelchairs, there are medical shuttles that can easily accommodate wheelchairs who will take your LO to a Dr. appointment. Here in California it's about $100 round trip (5 miles or less one way); quite expensive indeed but may be worth a consideration if transferring your LO in and out of a private vehicle is a challenge. These shuttles are wonderful; driver places wheelchair with LO on a lift that places wheelchair in and out of the shuttle. No pain or strain for you and less stress for your loved one; a possibility if it's affordable.
Again, thanks to all. Your suggestions have really helped!
My moms pacemaker was not one that could be checked on the phone. Wireless nonexistent in her neck of the woods. I had to drive about 10 mi in a specific direction to get cell reception. We made sure to get the pacemaker checked each time we made the trip. Pacemaker rep would come to wherever we were seeing another dr in the medical complex to do the check. It's good to know they have made improvements.
The memory facility has a schedule I worked around so I knew she'd be dressed and fed
I didn't tell her about appointments anymore because she'd stay up all night worrying about them. Thanks be to God
I found a doctor who makes house calls. What a blessing
I don't have to make appointments get her in the car or to the bathroom 10 times
See what you can do to make that happen!
Currently she has appointment cards with the dates on them. She typically rifles through her purse and wallet, especially in the car and waiting rooms, but still goes through it all in her room. I'm hoping the calendar can work - especially if I tear off the months that have passed. I also tend to make afternoon appointments, more so because it is easier for me, but as noted by others she is more likely to be up and dressed.
Although there might be "in-house" doctors, many elders have specialists. Our mom still goes for macular degeneration treatments, which could not be done at the MC. I do not know if there is a more local place that could do this, but she has been with these doctors for a long time and my preference is to continue with them. Keeping her eyesight is important at this point. I changed her to a local PCP, and for a couple of falls, they used ambulance/transport vans to have her checked at a local ER and return. The dermatologist is a little hike as well, because I thought it was another office for the place she had used, but we had to have a basal cell on her face checked/treated and since we had this place and I like them, we'll stick with them for now. At least that will not be often. I still need to find a local dentist, but thankfully she does not have any other conditions requiring treatments and appointments!
I recently ordered a transport chair, hopefully delivered soon, as some places have a long walk to get in/out and she tires easily. She does not yet use a walker. She did tell my brother she wanted one like another woman had - I moved the ones my dad had used to my place, both a regular walker and the one with a seat and basket, so I brought the latter one up, which is what she asked for. Then it was 15 minutes of my brothers trying to explain to her that there was no cost, we did not buy it, it was dad's on and on and on... They don't get it! I taped a paper with her name on it, but that has disappeared since.
Anyway, try any and all methods. Setting afternoon appointments and just arriving early enough to ensure she is bathed and dressed might be the only thing you can do. If he/she is balking at going, insisting they don't have an appointment, just make up something, like we are going for ice cream, or lunch or something, just to get them going!