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I have always felt that my parents had way too many doctor appointments due to their excellent insurance beyond Medicare, and we have recently been asked by the facility to let them do more of the doctoring. I realize that it is generally a two to three hour visit with transportation, waiting, the consultation, and then waiting for the transport back. This is hard on everyone, including the patient. The facility has a doctor who comes once a week, a physicians assistant who comes every day, in addition to all the nurses. I agree with allowing them to take care of general illnesses, but what about my mother’s psychiatrist who has treated her for decades for bipolar disorder? Or her oncologist who sees her twice a year for aftercare of breast cancer from 10 years ago? The ophthalmologist who treats them both for glaucoma? They have not been there very long, so this is all new to us, and we took care of them for so long. I would love to hear from some of you with more experience in this as we have a care meeting coming up pretty soon.

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This is interesting to me. Our family found that the specialists my mom saw, the same ones whose offices called regularly to remind and set appointments, dropped her like a rock when she entered a nursing home. We mostly used the in house doctor, which was normally fine, but there were a few times she had to see a specialist. We did all the difficult transportation and the specialty docs she’d loved before were competent to her, but only minimally kind, sort of like she wasn’t a person anymore. It’s amazing and sad how quickly a person can disappear from the outside world once they are a nursing home resident. But thankfully, for the most part, the doctor at the nursing home was good and kind. If I were you, I’d be asking what all the facility doc is comfortable handling and which things they’d prefer you have handled outside
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My folks went into AL a little over 2 months ago, both late 80s, both with increasing dementia, mom with multiple health and mobility issues.

All the doc appointments had been a huge hassle, Dads scary driving, having to sit for hours in waiting rooms only to be told YOURE GOOD, SEE YOU NEXT MONTH.....And this usually by an assistant.

When they went into care I immediately signed them up for the in house doc service. The place has a doc, nurse practitioner, LPNs, RNs and can take care of all their needs. Does mom really have to get loaded up and driven to her cardiologist, her urologist etc? No...Staff can assess her meds and adjust if needed.

It has been a huge burden lifted for me and my folks.
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I do wonder why an oncologist would be needed 10 years after cancer. My mother had cancer of the breast and colon. Once she was in remission 5 years, no one suggested further visits. It's been over 20 years now. If the nursing home has good in house medical care, I would go in that direction. It will mean a better information flow between providers and daily caregivers. If there are specialists that she sees for eye or dental care perhaps keep those but try to find out if you can minimize the number of appointments. I wish there were an in house doctor or visiting doctor at my mother's AL. One wonderful benefit to me is the transport service provided twice weekly since my mother is mostly in a wheelchair. Getting her to doctor appointments was a horror show for me and led to permanent injuries (mine) from awkward transfers from her big old house to outside and then to my car. Also getting that heavy wheelchair in and out of the trunk. My advice is take whatever services are provided by your mother's nursing home.
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Dear Treeartist, I'll be watching this thread with you. My mother, who recently moved to assisted living, has 8 health care providers: PCP, dermatologist, neurologist, cardiologist, ophthalmologist, dentist, audiologist. The ALF doesn't provide reliable transportation and no real mobility assistance to passengers. I'm trying to figure this out, too.
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My father is in a Personal Care Facility (like Assisted Living) and due to his Medicare supplement it is more cost efficient to transport him to his own Doctors. If he were to see the facility's physician the supplement he would be responsible for 40% after Medicare paid their portion. I think at times it would be worth it to see their physicians as it is becoming more difficult to transport him.
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When my husband was admitted to the skilled nursing facility, he had been on home hospice care for a while. Hospice continued to see him at the facility, but he did not live long enough for me to consider contacting his other specialists. When he fell and broke his hip in the facility, I was given a choice of their sending him to a hospital for surgery to repair it or "letting it heal" while he was in bed in the nursing facility. I told them not to send him to the hospital because, due to his poor heart and lung function, I was sure he would not survive the anesthesia. I didn't want to live with the thought that my choice might have killled him.
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My dad sees the NH physician as his internist. The only specialist he had was a retinologist who was watchful waiting on his very early macular degeneration. I’m not going to have the wheelchair van transport him there for more agonizing testing that goes on for hours. He needs new dentures since he’s lost so much weight. He and I went to a dentist 5 visit’s for new ones and then he refused to wear them so he could get used to them. Called the doctor a quack and now wants to go to a different dentist. I don’t think I can go through that again. The first pair was $3300 down the drain. He also acted out and was embarrassing as this dentist was someone I had worked for in the past. The other day I asked the DoN to have the doctor check his ears to see if they need to have wax removed and she said he might be referred to an ENT!!! WTH? I said NO! You all can do that there, I’m not sending him to an ENT. Lazy assses!! Sorry for my language but that just made me so mad.
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The answer may depend n the type of Medicare and supplemental plan you have and whether the in house doc is an employee of the facility, in a private practice that takes your LO's insurance or is in an HMO that requires being a member. My parents have such amazing supplemental insurance with all free meds that they want to keep all their independent doctors. At 92, they still take the IL transport to appointments; however, we are moving them closer to us this month so we can help them with that. We are going to use the internists that come to the facility as part of their practice as well as the podiatrist that does the same, but we will have t keep going outside for urology, vision, dental, dermatology, etc. So, it is important to take a lot of things into consideration. I would be wary of a facility that pushes a particular doctor or Medicare plan....
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Treeartist, I would make sure that you know what is going on with her care if you choose this route, I was running my dad to Drs appts, labs, etc. and frankly I was worn out with it all, then the manager of the AL said, you know we have Drs that can come and take care of him, oh what a great idea. Then the 1st time the Drs office saw him they sent a Nurse Practitioner that wanted to change all of his meds. I went through the roof he had just spent 60 days in hospital and skilled nursing facility to get stabilised and back on his feet, you see him for 5 minutes and want to change everything? No freaking way. They also had to have the breaks put on coming in to see him just because they were at the facility, come in say hi and insurance gets a 180.00 bill, not on my watch. I still have him signed up with them but I keep an eye on his insurance and I require they send me visit notes to verify if he was seen or got a hi then bill. He still has to be taken to specialists, so it helps with majority of his appts but not all.
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Thank you to everyone who answered and kept up this thread. Yes, my parents are able to keep their Tri-care. I believe what I have gotten from your answers is to, of course, keep the specialists that cannot be duplicated at the NH, but find out what exactly the NH is capable of doing. I think they had so many appointments prior to going into the NH because, not only did they have excellent insurance, but we were hesitant to go against the doctors’ recommendations. I remember having a conversation with my brother over this issue of multiple wellness visits, and he said “ I don’t want to make that call, and then it be on my head”, so the numerous visits continued.
I think we are going to feel more comfortable with letting the facility determine the necessity of all those requested specialist visits. I agree with the need to keep her psychiatrist. The doctor or nurse practitioner there is not qualified to treat my mother’s bipolar disorder. Any one of you aquatinted with this know proper treatment means the difference between functioning normally and utter hell. I was surprised to learn that it may not be necessary to see her oncologist after so many years of being in remission. I will look into this.
I do want to address one of the misconceptions someone posted about that residents in a NH don’t need curative medicine. It is true that a NH is the end of the line residence. My parents were never in an Assisted Living facility because, we, their children, Assisted them to live in their home for over 15 years. When it became too hard for us to do this, their ADL’s (adult daily living skills?) were so poor that they wouldn’t qualify for AL and had to go to the NH. Nevertheless, the residents in a Nursing Home need more professional care, both medically and physically, but many will live for many years in this end stage residence. Yes, there are those there who never leave their beds, but the cafeteria is also full of residents who can feed themselves, and then make their way back to their room or to some activity. I’m sure there are Hospice patients there, but the majority are not, and those residents will continue to get curative or preventive medical attention the same as anyone else outside the facility.
Again, thank you to everyone who answered. I am going to share your answers with my siblings. Your help is so appreciated and such a blessing. God bless all of you.
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