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I'm caring for a beloved elder relative to keep her out of a nursing home. I called a visiting nurse agency to line up help and was told they wouldn't come out because she hadn't seen her doctor in ninety days. I explained that she's been too ill to leave the house and they just don't care. I grew up in the era of house calls and this kind of indifference makes me ill. There should be less red tape in senior care. Is this common or is it just my part of the world❓

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I believe it's probably a state regulation. Call your local Area Agency on Aging and ask their help. Nursing care is ordered by an MD.
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Unfortunately we can't order up healthcare like we would a pizza. I don't think it's so much indifference as it is policy--red tape. If your elderly relative is too ill to leave the house I suggest you call a hospice provider. Some people say a Dr. needs to order hospice but that's not been my experience. It's worth a try and with hospice you'll get a visiting nurse, aides, and access to healthcare via the nurse.
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I think Babalou has the answer here. Nursing care is ordered by the doctor. Call that service back and ask for the name of a doctor who makes house calls for home bound people. They're available. They're paid for by Medicare. And have nothing to do with hospice care.

You say you grew up in an era of house calls. Nurses never made house calls. There is plenty of medical help available in one's home. Get crackin'.
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One other suggestion, Elizabeth, and please don't think I'm being nasty. I've found that they key to working with the systems that are in place to help the elderly (and remember that the regulations are there due to past abuses), is not to personalize rejection and "no" when you hear it.

If you call and ask, "I need nursing services for my elder" and you are asked "has she seen her doctor in the last 90 days?", ask them sweetly for a "work around". "We can get her out of the house due to her dementia. Do you have a process where we could get a doctor to come to us? What do you think I should do?". Remember that the person answering the phone is a clerk and not a nurse. Ask for a nurse supervisor to call you back if you run into roadblocks.
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Sadly, it's different in different states. Some states have amazing senior care (Minnesota is one). Others are horrible (too many to mention). Most are in-between.

A call to your Area Agency on Aging may help. Also, the new federal site aging.gov leads you directly to your state services. Get busy with those local links and see if you can find help.

I agree that these people aren't trying to be difficult. They have to follow the rules to remain legal.

We'd love to hear from you about how this goes.
Carol
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A physicians written order must be obtained before any home health care can be provided.
This can be obtained over the phone & the physician can order a R.N.into the home to see the patient & make further assessments. WE do this all the time.
Please remember that the physician is employed by YOU & no magic wand is required....Persistence is required, I am sorry to say...physicians do not go see patients in the home anymore....Sad as it may be. R.N.'s who are qualified do this home health care.
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Moondance, there are doctors where i live who will make a home visit.

The truest thing that can be said is that these things vary widely from area to area. I recall last year, a group of folks told a poster that his mother was lying to him when she said she had an appointment at a lab on a Sunday. Where I live, doctors, dentists and labs are frequently open on Sundays. Never say never!
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I like Babalou's answer. But allow me to add...Before we pick up the phone to speak with any health care organization, we must remember, we are no longer dealing with the same healthcare system and dedicated staff that existed years ago. Today, it's all about them "covering their asses" then "making money" then "taking care of" our loved ones. This is the system we must find a way to work with. Most of the staff is overworked, underpaid, and recite only what is displayed on their computer screen. We must realize that this as our new reality. So, take an Advil- or painkiller of your choice-, be confident in your quest, then proceed to make that call and be as calm and polite as you can possibly be. God Bless you and stay strong.
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I think due to the "abuse" of people suing now-a-days, all agencies are leary on doing certain things. We have a doctor in our area that will visit a person at home BUT only if there is no type of transportation to get them to the doctor and they are seriously bad off. It takes time for doctors now to go visiting people at home, till you figure in the distance they have to travel, the gas it costs them, etc I can understand. And its not like way back when there weren't as many patients as what they see now. Call the Office of Aging to start with, they can get someone lined up to come see your loved one and they can give you some guidance on how to get someone to come to the house, etc. And like someone said, the receptionist is not a nurse, they just answer phones and yes; not all of them are good, they are just there to do their job and get paid. Sometimes things get lost in the translation of what you need so yes ask for a nurse or nurse assistant.
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The comments mentioning how healthcare has changed over the years have made a true statement. Over-burdened healthcare system, CYA questions, and protocols to follow. This is to hold off lawsuits and hold on to one's job.

I'm not in the healthcare system, so I'm not advocating for them. I've just had to make phone calls and inquiries for decades and I do notice the difference. HIPPA rules, red-tape, and handling of elder situations as if they were all "cookie-cutter alike" are current problems for caregiving. There are some good ideas in the comments here. Good luck.
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There are physician's that do visit homes to the elderly. I had my grandmother on one that was called Alliance Care in Tampa Florida. When she got to where she couldn't get out of house as easily and at the time with mine and my sister's work schedule she spoke with her current physician and they recommended them to us. It was about four years latter we had to put her on hospice which she was on for two years and they worked with her doctor that came to the house which he continued to do while under hospice. Speak to her current physician and explain the difficulty of getting her out of the house. They are available
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Elizabeth you will need to update your thinking. A healthcare agency will do nothing until they get approval from a doctor so that they will get paid. If you want to pay out-of-pocket, then you can do so. The agency is covering their liabilities and not being "callous" just practicing good medical practice. I am sure you want the best for your relative. Check to see if a doctor in your location can possibly make a house call, or if she is that ill, take her to the hospital.
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If she needs to see a doc before getting a nurse, try ordering non-emergency medical transit company. They can take her on a gurney or sitting in a wheel chair. Best of luck!
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Some people do not belong in the health care business. Some need to step out of this field forever but others compassionately may just be over worked and stressed, and they should step out for a break. Most likely much needed!
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I am glad to hear you are reaching out for help in the care of your family. Navigating the health care system can be very difficult. I would suggest looking into a visiting physician. Perhaps her primary doctor could recommend one. They really do exist in many places. Besides, if she has been too sick to leave the house, a doctor visit is warranted. If you are hoping insurance will cover any kind of help in the home, you will need a doctor involved. The doctor may have suggestions as far as what kind of help would best suit your family member's needs.
If you are looking for comfort care, not currative care, then the suggestion of hospice was a good one. They can provide some help as well as manage, ie, coordinate with the doctor, on the care needs of your loved one including equipment, medications, and any treatments and most, if not all of it, would be covered by insurance if your loved one meets certain terminal criteria. They will also provide emotional support to you!
If you are looking to pay privately, then involvement of a physician would be less. BUT, I still say that a doctor visit is in order for what you describe.
Blessings to you!
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If insurance is to pay for her care then yes a doctor must perscribe it first. If you pay out of pocket no doctor is needed at least not in Ohio. If your loved one is too sick to leave they do have visiting doctors that come to the house and they should notify the primiary doctor your loved ones condition and they will take over. If your loved one is that bad hospice will come in with their doctor.
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My suggestion would be to get in touch with the Dr. Explain that the loved one is to ill to come to the office and ask for him to write an order for VNA.

VNA can not come out without a Dr. order as Medicare will not pay for it without it. The Dr. May need to see them in order to do this and you can discuss with his office at that time how to get this accomplished.
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The healthcare systems are callous because they do not have a vested interest in the happiness of the patient. When a patient pays monthly care costs, the healthcare system sees it as a business and is uncommitted.
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I read an article years ago regarding CEO's and it was about everything boiling down to 'being raised right'. I believe that about almost every role anyone has. There are a LOT of people being raised wrong with screwed up values and who are lazy. We live in a very entitled society and empathy seems to run low. Many healthcare workers are paid minimally for dirty jobs. So are many daycare providers, so at both ends of the spectrum when human beings are at their most vulnerable and defenseless, they are also subjected to the most lacking, marginal care. OF course, there are exceptions. Some states have good 'systems', but those systems still consist of individual people. You cannot transplant an empathy chip. That's why, again when it comes to our most vulnerable (elderly and children) they need loving advocates, many of whom have to do literally the heavy lifting. I don't know if there are any real answers except to stay deeply 'in' the daily process and be a part of it always. One thing I do know, for example, is that a nursing home 'for profit' and staffed mostly by 'contractors' is not a good deal. The bottom line is accountability. There has to be some skin in the game with one's job, an incentive, if you will, to 'care'. That is the reality. What I heard when the reference was made to 'house calls' was that there used to be an attitude of care that said "I am here for the patient" even by doctors, who would sacrifice of themselves to go to a person's home to take care of the patient. Doctors have not done this in decades; they neither can do it from a practical standpoint not can they afford the liability of not being in a clinical setting, etc. The 'system' is not getting better with socialized medicine, it is getting worse. If we aren't there for our loved ones or to be our OWN advocates, no one will.
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There are docs who make home visits. Check with your own doc perhaps.
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wow...tons of good information on this post!! thanks!
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annettesrose...you are soooo right!!! if you work for the healthcare system and have no verbal, compassion or people skills...they should NOT be working there. any issue addressed in a helpful manner with a caring person...could be worked out with information! makes my blood boil ...
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Because of Medicare guidelines, all governmental regulations are very strict. The person who spoke to you could have been more helpful in terms of suggesting a way for your loved one to be seen by a physician. in the meantime, do gather up all of any needed medical information that will be helpful. Part of the required criteria for home care is for the patient to be home bound. so it sounds like this part has already been met. Hang in there!
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There are many who should not be working in healthcare. Especially nursing, some go into because they have a calling, others just see it as recession proof job. You can tell the difference pretty quickly.
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Just to clarify.... Are you trying to line up in-home care to assist on a regular basis, or trying to get a doctor or nurse to check on a specific health concern?
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Unless you have someone dedicated to your mother, they are all be impersonal. Key is to have the care assistant focus on your mother, not be spread out with all the other patients.
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Those among us who are nurses will enjoy this! A young nursing student, who was not quite up to the required standard was asked by her Nurse Educator, "Why on earth do you want to become a nurse?" Her response (and I kid you not!) "Because it is easy!"
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In many metropolitan areas depersonalization has occured,andregulatoins outweigh common sense. It is not patent centered as yet. The regulation is designed to protect a senior from an unqualified aide. It also serves to protect the aide from over-extending her abilities. Getting a senor to a doctor's office can be a major issue. If you deem it an emergency call 911 and ask for help. They have to help as a first responder,or call a medical transportation company..You did not state what her financial resources are.
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Where I live and work the Dr. can make a referral for VNA but has to do a face to face visit within 30 days. I believe this is a US wide requirement via Medicare. We do have a few docs who will make house calls. Mollydolly please don't be too quick to judge the medical "system" in terms of those of us who work in the field. We certainly don't go into it for the money. Most of us in home care (if not all) put in hours of extras for the patients (everything from getting equipment to food to just staying to listen to a patient or family member who needs an ear) and often we purchase or help fund things that people need but can't afford because we can't stand to see them go without. We do have to meet Medicare guidelines to provide care - not a choice. But those I work with go above and beyond for our patients as a rule. (I'm a physical therapist for a nonprofit VNA in a semi-rural area).
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I agree with all of the above. System, area, etc. I want to add that a lot of times these people are all frustrated as we are. They need their jobs and can only do so much since their hands are tied. They come across non caring because they are frustrated with the system and can't help a lot of people that need it. Like Mollydolly said they are just doing their jobs and hoping to keep them. It's a shame. But keep in mind there are some really good people out there too so keep trying. Good Luck and God Bless
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