My 90-year-old mother has dementia and can barely walk. She does fairly well at home in her familiar environment and our desire is to keep her happy and as comfortable as possible for as long as possible.
Last week she had a follow-up with her cardiologist. Although I transported her as carefully as possible, the whole episode left her disoriented and unable to even walk the next day. I decided I could not do this to her again, especially for a checkup where they just listen to her heart and send her home again.
Unfortunately, the doctors require checkups to refill her prescriptions so I'm trying to figure out what people do in this situation. She's on Medicare and TRS insurance, so I'm currently checking into the home visits but no one can tell me about the specialists.
If anyone has any experience or information that I can begin my search with, I would be more than grateful.
Blessed Be
When I was signing papers for my mother's admission into MC, one of the papers I could have signed, was to turn over medical responsibility to another medical practice. The practice was full-time "go to where the patient is" and they had both geriatric doctors and specialists. I never even heard of the group before, however, they are apparently well known in the Assisted Living community.
When my friend in another state moved her father who is bedridden into a highly regarded MC with palliative care, the facility wouldn't accept him unless he signed up with their doctors so that he could have quicker, easier access to medical treatment. The doctors were 24 hour on call with automatic monthly visits with their patients and more often if needed. This was not hospice and the doctors were not dedicated to this facility.
My niece had the opportunity to intern with a company who are in the process of getting government approval for a mobile MRI unit. The company is not unique in this area.
So I believe there are doctor's practices that specialize in bringing their care and equipment, to where the patient is, rather than the patient coming to them. However, I believe you might have to change doctors so that the doctors can visit the patient, rather than go to the doctor's office. How to find these people? First, talk to your Mom's current doctors and see if they have any ideas. Additionally, since you are already searching for doctor's that do home visits, if you find one that you like, he probably already has a list of specialists that also do home visits. Another possibility would be to contact your Mom's medical insurance company or representative and see if their database can filter on the request. Another option might be to see if your state's Office on Aging, might have an agency that could help you locate this type of medical professional.
Good luck! And thank you for being her advocate during this period of her life.
P.S. Telehealth does not work for my Mom. First, she cannot concentrate or stay on task long enough to do tele-health. In addition, since she is hard of hearing, understanding the doctor is very difficult, which does not give her the confidence to do what the doctor recommends.
Hugs 🤗
The doctor has to physically see the patient. They can't bill the patient for a doctor's visit if a visiting nurse comes to their house.
There had to be an office visit. She had to go by ambulance and I'd follow in my car. She couldn't even get on the exam table because there was no one to transfer her from the stretcher to the exam table. All they did was listen to her heart, take her blood pressure and temperature, and put the PulseOx on her finger. All of this could have been done in the home. The doctor also asked her questions that she couldn't answer because she was out-of-it. The doctor visits were always a nightmare. She would get upset, agitated, and scared. She'd always crap through everything the minute she got in the ambulance too. So everyone in the doctor's waiting room had to suffer. The whole place stank something terrible because a stretcher with an incontinent, screaming invalid was parked in the middle of the room. The paramedics don't always offer to stay. When I had to figure out how to get a stretcher with a sh*t and piss covered hysterical invalid into an elevator, that was it. After that I made her doctor's appointments on my day off.
Your mother will have to go to the doctor by ambulance. The doctor might allow you to do a tele-visit because of Covid restrictions and I would definitely inquire about that. If you do have to take her by ambulance, make sure the paramedics are willing to stay.
She also is enrolled in palliative care and was eligible due to her dementia. This offers another layer of support.
Check your mom's insurance and see what is available. You may not need to change her insurance.
Her primary can probably prescribe her cardiac meds like BP meds & lasix.
Consider getting a consultation for hospice. Contrary to what many think, they won't take her off her medications and "let her die," but you'll have the weekly services of a visiting hospice nurse and a hospice doctor who'll prescribe her meds.
The nice thing with hospice is the nurse will really get to know Mom and will be able to tell you if the meds are no longer doing their job or need adjusting. My mom was on hospice for seven months and all her heart meds were refilled every month.
Blessings to you and yours.
Truth told, in this condition it may be time to stop with specialists. Palliative care may be the answer if you want merely the medications to prevent complications of such things as weakening pump/heart and CHF, blood pressure control (which monitoring can be easily done at home and is a more accurate measurement than a confused senior in pain and distress, and etc.
In the palliative care community the doctors are familiar with seniors who can no longer make it in.
In lieu of going that far, speak with the professional about learning to do in home BP and heart rates, about zoom calls, and let them know the problem.
Best to you. Were your Mom in an ALF facility many of them are connected with MD groups and advantage programs in which they are visited in the facility itself. This was the case when my brother was in ALF.
Her GP is affiliated with the hospice company that we use. He also comes to see HER.
She used home health services through Medicare for the homebound. Your mom would qualify if she has original Medicare. They did blood work, X-rays, UTI tests, etc from home. She had pt, ot and cna for bathing as well.
With my dh aunt, we found a geriatric primary and worked with the same HHA. She has transferred to their hospice group with the reason for hospice being dementia. She has a dr through hospice and still has her geriatric doc for everything else. We do Telemed when needed.
The last time I took my aunt to a specialist for an eye problem I decided I would never take her by myself again. Wheelchairs are available at offices and she had all the mobility equipment but it was too difficult for me alone. So I understand the feeling of it is all too much. Since being on hospice we don’t see specialist.
My mom did not have dementia and I took her where and when she asked but I believe she would have stopped going long before we did If I hadn’t been so burned to a crisp that I didn’t realize how hard it was for both of us.
I would never see a specialist or any doctor that wouldn’t work with me on an alternate plan of care for a senior such as your mom.
I hope you find someone to work with you soon.
Your local Area Agency on Aging should be able to help with finding one.
If there was an urgent need, the ambulance would take mom to the ER for a few tests, but she got shoddy treatment there too, I found. If it wasn't "Covid" related, they gave her the bum's rush & out the door she went after a blood test for CHEST PAIN!
You can always hire a wheelchair accessible taxi service to take your mom to the doctor, but be forewarned that it's very expensive (in my experience) and you'll need to hire the van roundtrip.
Leave mother alone to get the minimal PCP care and medication; let nature take it's course while you allow your mom to stay comfy and relaxed at home. That's my suggestion. Otherwise, you may wind up extending her life by a few months or a year and what kind of 'life' is it that you're extending ANYWAY, with dementia at play? IDK about your mother, but mine was in a lot of pain and plagued with Sundowner's and ready to leave this life for the next one anyway.
Wishing you the best of luck.