I think I made a big mistake switching my mother’s primary care provider over to a provider that comes directly to the ALF where she lives. Before signing the contract, I added a stipulation that I was to be involved in any appointment and treatment my mother received. My mother has early dementia and her memory is awful, but she is still pretty sharp. Otherwise, she is in very good health and I didn’t feel that this move would be difficult. I made sure I was there for her initial appointment and was surprised at the end when the nurse said to my mother “I’ll see you next week - your daughter doesn’t have to be here every time, right?” I let it go because I didn’t want to cause a problem out of the gate. I wondered why she needed a second visit, but the nurse said she didn’t get to finish her exam. If she saw her again, I didn’t hear of it. Yesterday I called my mother to take her out and she told me the nurse was in her room. I told her I was coming immediately. I’m only a few minutes away, so I was there quickly. I walked into the room and the nurse jumped up and said “Oh we’re doing a test and there can only be two people in the room. I’m almost finished.” I was fuming at this point but trying to remain objective. However, I have NEVER been asked to step out of the room for any of my mother’s appointments. When I came back in I reminded her that I expected to be at every and any appointment my mother had, and that I was her POA and HCP. I asked what the test was, and she said it was a memory test. I did not request this. Furthermore, my mother had had a memory test in the past and I was physically in the room, so her assertion that no one else could be in the room was a lie. I asked what the results were and she said she hadn’t calculated it yet (my recollection was this was a simple calculation of quantity answered correctly out of 20 questions). After the nurse left, I talked with my mother. While I can’t always trust what she “remembers”, she told me she was very uncomfortable and the nurse asked her a lot of questions that felt invasive and not pertinent to healthcare. She seemed to remember a number of questions were about me and she felt the nurse was trying to find out who was paying the bills, but I can’t fully rely on my mother’s assessment. I’m angry that I’ve told this nurse several times that I am to be involved in everything, and she’s either a slow learner or is intentionally seeing my mother behind my back. I have no written reports about these appointments. I suspect there is another motive here, as my mother is physically one of the physically healthiest people in her facility, and it doesn’t make sense that she’s already had three appointments (that I know of) when there are others there who need more focused care. I’m ready to jump ship and go back to her original provider. I’ve tried to give this provider the benefit of the doubt, but my gut is telling me this whole situation stinks. If this is what is truly happening, I’m wondering why there haven’t been other complaints (maybe there have been).
I’m curious to hear if anyone else has encountered this type of issue, and if you think I’m overreacting to the situation. Maybe this is the way these “traveling” operations work, but I’m just seeing a great lack of transparency and communication and it’s only been a month. I have zero trust in this provider at this point.
The facility practitioners that come do not “ set scheduled appointments “. They come when it is convenient for them . Sometimes it’s the same day of the week sometimes it’s not . They sometimes show up at a facility on short notice . They come and see a group of residents at a time usually . We’ve had some that touched base with us via phone call in the beginning for every visit . After that they only called regarding a change. If we called them to discuss something , they returned our calls . I do recall frequent visits the first couple of months ( getting to know the patient ) and then not as often , until he was more fragile , then the visits were more often again . We did not get written reports either .
The advantage to using an in house provider is that when something does pop up , your parent gets ill etc , The nurse can call that provider and get for example lab work ordered , portable chest X-ray , an antibiotic etc . Otherwise they will be calling you to take Mom to the doctor etc. which could delay treatment .
You can’t go by what Mom says and you have no clue how often the others “ who need more focused care “ are being seen .
Since you would rather have the option of being at a scheduled appt , go back to the regular PCP .
Facility care is the way it is . You can’t dictate a different way . If you aren’t happy stay , with the private physician .
Adding a “ stipulation of being involved for every visit and treatment “ should have gotten you a phone call each visit from the provider but that’s about it . I bet no one told the provider about the stipulation you added . Regardless , They aren’t going to “ schedule “ with you to physically be there for every visit .
What nefarious motivations are you imagining might be afoot here?
Are you fearful that the facility will ask for a move to a more expensive and confine memory care?
This doctor and his nurse would be negligent in just accepting a new patient in memory care without doing their own exams and testing.
Surely you can understand that memory testing should be done in a quiet room with the examiner and the practitioner?
In general, when you accept the facilities caregivers, and sign on with them, they come to the facility on their schedule and check folks, and no, they cannot conceivably call the family of each person to ask if they would like to be present.
You seem not to trust people in caring for your mother. But if she is safe and thriving currently in her facility, there shouldn't be a problem.
I think you should speak now to administration there about your worries and concerns. You may need, as onerous as this will be, to switch back to a care you can trust. You are POA here. This is your decision to make. An adversarial relationship will not do your mother, the caregivers or yourself any favor. If this isn't for you then just take care of it.
I understand the choices you have here. My brother in his ALF had the same and was about to change as it was a bit onerous to get to appointments outside the facility, when he got sepsis, ignored getting it seen to (a small non-healing sore on his shin) and died of it. Would it have been better and quicker seen if he had the visits of the facility nurses? Yes, perhaps. However, my brother had early Lewy's and was HOPING the grim reaper would appear before the Lewy's dementia could rob him of who he was. And he got his wish by simply not going to his doctor.
Your choice here. I can see the benefits to both modes of care. And as you are right there and visit often, you can keep an eye on when you need to get mom to the doc.
Have you had Mom formally diagnoised. If not, I would make an appt with a Neurologist. Is your financial POA immediate, if so thats good. As soon as Mom signed the papers your POA was invoked. Check your Medical POA. That may need a signature of doctor or two to declare Mom incompetent to make her own decisions. I held 2 POAs, the financial was immediate, the medical needed a doctor to sign off the principle was incompetent to make their own decisions. So if your medical needs a doctors signature, then see a Neurologist. When Medical is invoked, then you make sure that the Doctor's office gets copies of the POAs. If your financial needs a doctor signature to invoke, then time to get that done.
The Nurse asking financial questions concerning who is responsible for payment is not unusual. Also, IMO, the NP does not determine who can be in the room, your mother does or POA if in effect. I have never been unwelcome when with Mom. I sat quietly in a corner and made the doctor aware, by my face, that Mom was not answering correctly. I also had notes for him of any changes in Mom.
If you are her HCPOA, you were allowed to be there. That made no sense at all. I’m with my mother at every appointment. She has ALZ dementia. This kind of stuff is why I hesitate putting my mom into a facility right now. I can’t deal with all of the aggravation.
BTW, remember that these are only screening tests. If there clearly is dementia, this may be all the testing needed if the person being tested is probably going to go to a facility. When results are more ambiguous or the person being tested complains of memory/cognition issues even though the screening test results are OK, more extensive testing, lasting a few hours, may be warranted. This testing can show a pattern of strengths and weaknesses that can be very useful. Medicare covers this more extensive testing, also, At this time, Medicare does usually cover the physiologic testing that can help in diagnosis, such as PET scans of the brain, NY guess is that situation will change as these tests become more accepted.
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