I have a dilemma that I need input on. Mom is bedridden with Alzheimer's, Dementia, COPD, and Parkinson and one of her legs is a bit contracted. What do you do when she has to go to the doctor and they will not permit a stretcher, but even with wheelchair they will not work on her unless she is on their table; BUT they will not assist you at all to get her from the wheelchair to their table!! This is just for a podiatry visit to look at some nail fungus! To make matters worse I have to hire a private ambulance to make this visit work.
The bigger issue is when mom says she doesn't feel good but when you inquire where it hurts, she is unable to tell you exactly. At what time do you call an ambulance to take her to the ER as that would be easier then arranging for a doctors visit?
As we age we have days that we feel punky, nothing specific just generally not feeling good. I would watch for symptoms before I called an ambulance. Unfortunately the older we get and the less mobile we are the more we tend to feel not well.
Have you talked to hospice yet? It may be time.
My mom uses a walker and can no longer get on exam table either. Can’t they elevate her legs onto a stool of some sort?
My mom had the fungus thing before. What about home health? Ask if it will be covered under home health and if it is something a nurse can treat. The nurse mom had with home health treated certain skin issues. They may not but worth asking about. Medicare pays for home health.
There is a cream for it. Ask your pharmacist also.
Best wishes for you and your mom.
Some people by necessity must be transported via stretcher.
Are there any visiting doctor agencies in your area? That may be an option for you as the ambulance cost for transport is expensive & I believe, an out of pocket expense.
As far as when to call an ambulance when she isn’t feeling well that’s not as clear cut. Err on the side of caution & call them if you need to.
I remember when this began to be implemented, maybe a decade ago, when office staff proclaimed they will lift no more. I guess I understand why - the possibility of employee injury.
But again, it’s yet another obstacle the CG has to navigate through that takes physical strength & puts the CG at risk. On the other hand, there are many immobile obese people in wheelchairs these days and most of the time the ancillary support staff in MD offices are MA’s or CNA’s who weren’t taught proper body mechanics and maybe in an office setting they are not required to lift to keep insurance and liability costs down.
But I so agree with you in being upset that you are responsible to get your mother up on an exam table. Another reason office staff also don’t have the time it takes to transfer someone as they are constantly seeing patients all day.
At 93, God Bless her. Doing everything medically aggressive for her may cause more harm than good.
Consider Palliative Care for your mother. Also, Look up visiting podiatrists in your area as many, many areas have podiatrists that will go to the home to treat & Medicare pays for it (quarterly or semiannually perhaps if the person has a diabetic ulcer).
Why put mother through all the trauma of getting up and dressed and then transported via litter/ambulance outside in whatever the weather may be, exposing mother to the elements as well as contact with people who may be ill?
Palliative Care would be a great resource to pursue.
Find a doctors' service that will make house calls and fire that lot. Meanwhile, take a good picture of your mother's nail on your phone, take it your friendly local pharmacist, and ask.
By the time my mother was literally bedridden only two things would have made me force her out of the house: one was an echocardiogram, which still seemed like a good idea at the time (though looking back I'm not so sure); and the other would have been, but by the grace of God this didn't happen, any injury requiring sutures or reduction. For anything else, I'd have asked them to come to us; and I'm more grateful than I can say for all the dedicated and resourceful people we had to call on.
But! - don't give up :) If you'd like any help with finding resources, try your local Area Agency on Aging or do very specific online searches. Remember, you are *never* the only one who needs the kind of help or service you're looking for, and the odds are good that some practitioner will have spotted the demand.
Some of the things I was asked to do:
Help tie the shoes of a women whose shoes were covered in horse manure.
Help a patient with Hep C and personal hygiene issues dress, when I was obviously pregnant. I refused this one. Nope, nadda, I am not touching you if you have a communicable disease and I do not know when you last washed your hands.
Help morbidly obese patients up and down from exam tables and treatment beds. How is one person supposed to help someone who cannot lift their own leg 4 inches off the ground?
I did help a when I could without risk to my well being. But I put my foot down at other times.
My job was to book appointments, take patients to treatment rooms, clean the rooms between patients and do the billing. I was not hired to touch patients, put my health and my unborn child's at risk, nor risk personal injury.
We had and still have in our community PT's and Foot Care Nurses that do home visits.
Second, the treatment for toenail fungus is oral or topical Rx medicine. The topical does not work well at all, it is more of a placebo. The oral ones is very expensive has to be taken for a long time to be effective and likely would not be appropriate for your mother based on other health concerns.
Yes, I worked for a group of Podiatrists for about 10 years. I am not a medical professional, but you do pick up knowledge from the pros.
Do you have Foot Care Nurses in your community? We are lucky to have them in many Canadian communities and they are far more likely to do house calls. The Podiatrists I knew did some house calls too.
The doctors often worked with patients who could not get out of their wheelchair and although it was not ideal (wheelchairs are not sanitary), they would work on their knees to trim nails etc.
Some swear by Tea Tree oil to help clear up fungal infections, there are other 'home remedies', nut when you have an elder with multiple medical issues, generally it is best to leave it alone. You could cause more issues trying to clear it up, than the fungus ever will.
My 86 yr old mom also has Alzheimer's, plus one broken right hip, a left partial hip replacement, and severe contracture in both legs, so no walking, but she's wheelchair bound. Her doctor's network had a house calls branch which I got her switched to once she broke her right hip and could no longer walk to get to MD office visits. They helped me get her into the hospice program which she qualified for and we used for a time based on her ailments, but she got better and we were dropped.
So, we went back to the house calls program, which offers MD or NP home visits from anywhere between every 4 weeks to 3 months, depending on the case. I found a good house calls podiatrist from a social worker, and he comes every 8 weeks, which is covered by Medicare. And I've had several home visiting PTs & OTs that have come since '16 when she had the initial hip replacement. (We're in NYC, by the way.)
Definitely check with her current medical professionals and social work folks as well as the local office on the aging, your caregiver support groups, and local Alz. Assocation chapter for referrals to house call docs & home visiting podiatrists, PTs etc, because they are out there. My Alz Assoc. chapter & house call doc. both were also helpful in giving me the names of dentists and hygenists that do home visits too!
Best wishes for you and your mom!!
Toenail fungus is NOT something I would worry about or schedule a doctor's visit for. Palliative care is called for at this stage of life, in my opinion, and the only time mother needs to see a doctor is if she's very ill, obviously so. She lives in Memory Care and I've hired the in house doctors to care for her. If/when she needs more urgent care, I have an ambulance sent for her to take her to the ER, and an ambulance to take her back to Memory Care. She's wheelchair bound, I should add. When my dad was wheelchair bound & I had to take him to the urologist, they pulled the same nonsense with me about only taking out his staples (from hip surgery) if he was on the table, and gee whiz, we sure CAN'T help you get him ON said table. We don't even have a walker for him to use!! I swear I almost had a heart attack that day from the sheer stress of that doctor's visit. From that point on, there were ONLY in house (in ALF) doctor visits for Dad, and now the same for mom.
When Dad was alive & they both lived in Independent Living, I hired a geriatric doctor that made house calls. It was SO MUCH easier......they'd even order traveling xray companies to come out if needed, and the same with nurses to draw blood. It's just TOO MUCH to try and transport your mother anywhere in the condition she's in. The other thing I've done (recently) is hire a wheelchair van to take my mother from the rehab facility to the Memory Care facility on the day she was moved in. It cost me $100 to have her driven 4.0 miles, but hey, I thought it was worth it b/c it was 100% stress free.
I would choose my battles here........in other words, use your own good judgment to determine when your mother truly needs ER attention and when she just needs plain old attention. Otherwise, YOU are going to have a heart attack yourself!
Best of luck!!
Please inquire about hospice or at least palliative care.
I still don’t understand the difference between palliative care and hospice. Is palliative the same across the board everywhere? I know there are different hospice companies and it is a ‘business’. Is palliative care similar? All of us as caregivers need to know these things. Could you explain in detail what you know about it? I’m in Louisiana. Is it different in different states? Forgive my ignorance on the topic. I’d like to be better informed about it in case I need this service for my mom.
We had hospice for my brother but I have no experience with palliative care. Is it less restrictive than hospice?
Here Hospice provides support to the dying and their families. There has been an ongoing fundwaising campaign to raise money to build a Hospice House, which will have rooms in which residents can receive Palliative Care. Locally we used to have Hospice volunteers who would sit with the dying so their family could get a break. They did not provide any medical or care giving, just company, perhaps reading a book, watching a show, playing cards. Currently they had programs for the dying and their families. Mum has been going to a grief support group sponsored by Hospice since David died. It has been a great support to her.
Palliative Care in this part of Canada, refers to keeping a patient comfortable, but not providing any further life supporting treatment. No feeding tubes, no dialysis, or chemo. My step dad received Palliative Care in the hospital as there was no way for Mum to care for him at home.
On a hospital visit itcwas found Mom had a thickening in her upper stomach. Had to see a specialist to determine if it was cancer. No, probably caused by her acid reflux. But we went every six months and then a year. When there seemed to be no change, her Dementia was getting worse and she was in an AL, I stopped seeing him. She had graves disease. Again a specialist. After a couple of years it seemed to be under control. By this time she was in LTC. Specialist said as long as the facilities dr. Tested her ever so often and her numbers were good he wasn't needed. He was also 45 min from her NH. Then there was her urologist. She had bladder cancer at 80. He was still at 87 doing scopes on her oncevavyear. With her Dementia we would never had put her thru the Chemo u need to go thru. So, I chose to stop him. There are things u need specialist for but after ur stabilized I think a PCP can continue monitoring.
I would think there would be extra people to be called for help in moving patients onto tables etc. Of course I also know many times they are worried about liability.
I have no advice for you. Just wanted to say how disappointing it is to see a profession that is supposedly human oriented w little care about patients.
BTW, I teach preschool and many times have had to deal w bodily fluids. I put on gloves and deal with it.
The problem of getting my bed bound mom to the doctor in a wheelchair and hiring a van all went away when she was on hospice. The time before that was terribly rough, so I fully understand where you are coming from.
If anyone is listening that could invent an exam table that goes up and down, please do so! You could make a bundle as this is badly needed!
Perhaps there is someone who would make a house call in your circumstance. Again, I would ask the physician if this is possible. Or if your mother is in a facility, is there a podiatrist on the staff?
With Hospice you would also get a CNA that would come in and help bathe, dress, order supplies....And you would also get a Social Worker, Chaplain if you wish as well as other services.
Oh, the nail fungus...don't worry about it it does not cause pain and most "cures" either take a year to work or they don't work well and if it is the oral medication it is toxic to the liver and she would probably be required to have blood tests every few months.
I don't know how old your mom is, but nobody has ever died of toenail fungus. I treated mom's toenail fungus with over the counter topical stuff -- it took about 10 to 12 months of daily treatments twice a day but it went away.