MC doctor visits

robinja

Hi, all. I posted a couple of weeks ago about my mother in MC. She’s been there since March after a chaotic couple of months following my dad’s death in early January, a brief stay in AL, hospital and rehab for COVID, and a couple of stints in the geriatric psych unit. I live 3 hours away, and my mom and both brothers live in my hometown. My oldest brother is primary POA for Mom. 

When we admitted Mom to MC, they suggested that we use their healthcare service but said it was optional and she could continue seeing her existing PCP if we preferred. At the time, we opted to keep her PCP for a few reasons: she and my dad had been seeing him for decades, he is my younger brother’s next door neighbor (personal relationship - we trust him), we were concerned that the MC facility might influence them to prescribe medications that might make her easier to handle, and we thought it would be good to have medical opinions unaffiliated with MC.  

MC called my POA brother in to revisit this decision. Mom has lost some weight and they feel that the regular nurse visits from their healthcare service could be beneficial in monitoring this.  She has also fallen a couple of times. We have more trust in the MC facility now and are considering making this change. She only sees her PCP a couple of times of the year, and the healthcare service nurse would see her much more frequently. 

I would appreciate any input as we weigh this decision.

(I probably messed up some of the lingo here, so sorry if any of the above is vague or doesn’t make sense.)

MN Chickadee

When you refer to the nurse, do you mean a nurse practitoner? Most facilities employ their own nurses (RN, LPN etc)  Many of the providers who do rounds in long term care are Nurse Practioners, not doctors, but they essentially act as a doctor and can be a person's primary care provider. They do check ups, prescribe medications and send orders for therapy or whatever is needed, and act as a primary care doctor. They can do urine tests and draw blood right there on site. 

We have always used the visiting provider and it's always been either a nurse practitoner or physician's assistant. I personally like these professions as providers for myself and loved ones, I find they often have a really good approach to primary care and good bedside manner. In mom's first facility there was just one clinic option but it was fine. In her new facility since a move there were 3 or 4 different companies/health systems that sent providers so we had a choice. 

Not knowing how good a provider the neighbor doctor guy is, all I can say is that we have very much liked using the in house provider. They are usually there weekly so they can quick stop in on my mother for any little thing or to review things like weight gain since they are there anyway. I have much more access to them than I would an outside doctor. With most doctor's offices you play a game of telephone with nurses and receptionists just to ask a simple question. In the facility I know every Tuesday the provider will be there so I can show up and speak to them, be there if they are going to assess my mother. It not only improves communication between the facility and the provider but also the family.  Additionally, the people who do rounds in long term care usually either have some educational background in geriatric care or at least practice mostly in it, so they tend to really get it. The 3 different ones my mother has had were very experienced in dementia because they only work in nursing homes so they've seen it all. 

of course this is just one opinion, but hopefully it helps. I can see using an outside provider in the early stages but once dementia becomes more advanced I would use the in house one unless there is a good reason not too. Not having to get her out of the building to a clinic is worth a lot. It's traumatic for her and hard on me, so bringing the services to her has been a blessing. 

robinja

Thank you! My brothers were able to talk to the care provider and ask questions, etc. They were also able to discuss it with her PCP, and he was supportive of making the change and would be happy to consult if needed. Finally, they were able to talk to another family who has a LO there, and they are satisfied with the care. So we are going to make the change. I am hopeful that the additional attention will be good for Mom and that we can better monitor her for any issues (eating, mobility, UTI, etc.).

towhee

Using the facility contracted medical staff usually works very well if they have a single dedicated visit day. If they have multiple days or no real schedule it can be difficult to get in touch with them. Does your brother have Healthcare POA? Is your mother capable of making her own medical decisions? If she is not, as a backstop, it might be a good idea to have a note in her medical record from her previous doctor stating that she is not capable of making her own medical decisions. Then for any changes they would have to consult your brother. If there are any problems you can also ask for a note on the outside of her medical record saying that the HPOA must be informed before any medication changes. It is also wise to verify changes with the floor or charge nurse after doctor visits or calls, communications can get garbled.