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.
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.
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.
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 .
My MIL managed to fall out with the visiting doctor because he wouldn’t prescribe the same medications as her previous doctor at home (understandably in my view). She sacked him, and my DH then had to take her to a local surgery (where I am that just means doctor’s rooms, nothing to do with genuine surgery). It was a 2 hour trip each way for DH. So visiting, if it works, is a whole lot easier.
It’s becoming more common for CRNPs and PAs to act as primary providers here in the states. There is a shortage of primary care physicians .
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.
So, if you can take your mom out to her doctor, do it for as long as you can!
A lot of these facilities have a fast turnover of help. It sounds like this medical personnel employee was trying to find out who the players are in the family.
Usually when there is an appointment, you have the notes in the portal from the House Call Doctor association, etc. If they "the facility" thinks no one is minding the store, don't think that they won't pad the bill or overprescribe.
Oftentimes, the facility will want you use to use "their pharmacy" which the owners usually have stakes in. You tell them. You inform them NOT the other way around. I would get camera too, if allowed. Something doesn't sound right here.
They are snooping around for information. That's little voice inside comes from somewhere. It's known as women's intuition.
I’m guessing the doctor and nurse aren’t getting rich billing Medicare for the check-in visits, whatever they call those. I don’t think it’s reasonable that they need to call you for every little thing, which will make every little thing take at least double the time. Your mom can likely feel your energy when you are asking her questions about the visit. Sensing you are mistrustful may make her also feel that way. My mother is mistrustful and everybody is out to get her … my dad’s dementia is advanced and I watch how his behavior changes dramatically when she’s asking him questions. He goes from easy to please and delightful to he around to not liking anything being offered based entirely on her mood. Ultimately you have to do what you think is right - but pause and consider trusting the process and seeing how it goes. How lucky for you that your mom is physically healthy. That’s huge and rare and tells me an extra doctor visit isn’t going to hurt anything. If anything, she’ll get more familiar with the doctor and how it works by seeing them from time to time.
Plus, the nurse was very disrespectful in saying "Does the daughter always have to be here?" Thats horrible and unprofessional. It's not like it was just an oversight - they are actually being oppositional.
It's okay to not trust anyone in the medical industry.
You have the right as your mother's advocate/POA/daughter to be present for any and all medical inquiries, exams, tests, etc. Especially since she has mild dementia.
No one would kick me out of my mother's room. Ever. You're paying dearly (I'm sure) to have your mother in the facility so they need to respect your wishes.
You are not over reacting to what's going on in your mother's situation.
What I’d be concerned about is….. what precisely does this AL has for dedicated staffing for RNs???…. this is super important as AL in some states DO NOT HAVE TO HAVE an RN in the AL in person at all. The RN can be “on call” 24/7 and all ok for licensing. Some ALs with same corporate ownership have 2 RNs who are the “on call” for numerous AL in the same region. In actuality for this management style of ALs almost all hands on staff is personal aides and CNAs. Aides and CNA are needed but they do not have the licensing and background of a RN, or a NP or a PA. Facilities that do this type of staffing tends to contract out for “PCP” oversight and all done by a NP on a schedule. Nurses cost a fraction of what physician billing is, so shifting from MD visits to a NP is a money move unless you are in a health care professional wasteland where there are very very few doctors. AL flat are not regulated & licensed like what SNF/NH are. It’s imho become the Wild West out there to open a AL and toute it as “excellence in caring” bs, without clearly letting potential residents their POA and families know that staff is overwhelmingly slightly above minimum wage aides and CNAs.
I’d suggest that you find out what the staffing is for where your mom is and if it’s the above, it flat is not going to ever work for you. So…
- Start to look for a different AL for your mom. Clearly ask how their staff deal with medical appointments and suddenly occurring issues & also if they have an affiliated NH / SnF facility that their AL residents all tend to move to. Then visit it.
- If mom is likely not to have the $ to afford private pay abt 2 yrs of NH, ask the NH if they have LTC Medicaid beds.
- Review the current AL admissions contract mom did as to what Notice must be given for her to leave with the least financial consequences. Timeline & lil details (like keys turned in with their original hanging tags) are mucho importante in all this. Otherwise they will block refunds.
- I’m assuming that your mom did NOT somehow make the AL her representatives payee for her SSA monthly income. BUT If she did that, it has to be changed by her. SSA does not recognize POA.
- Contact her old MD to see what needs to happen for them to see her. By that I mean was there any insurance changes that could be a glitch in this plan of mom returning to her having a PCP she sees on her own. It’s open enrollment right now for Medicare and the window to do changes is narrow. So if this is needed, you have got to get on it.
Good luck in your quest!
And cancel the contract immediately. They already breached it by not including you or notifying you about the appointments. If you're POA & HCP then secrecy is 100% not ok.
And talk to someone higher up than the nurse. Blast them about how shady all of this is.