Telehealth Contact for Dementia & ALZ Incompetence Evaluation?

aspendecker

I have both parents declining significantly at the same time. Very overwhelming. Trying to get them evaluated virtually if possible. Too complicated to get them anywhere these days. Does anyone have a good recommendation for telehealth doc for evaluation?

Emily 123

Hi Aspendecker,

I think you might have difficulty with this--the providers usually will prefer to have the evaluation in person.  If it's a full evaluation it can take 2-3 hours for the testing. 

Have you tried to coordinate a consult from their primary care physician's office to a neuropsychologist or neurologist, to see if they can help finding one that might do telehealth?  They might be able to help with setting up a schedule that works. 

MN Chickadee

I'm sorry, that is a lot on your plate. If legal paperwork is not done I would o get a POA in place before any diagnosis. That way it's done and if and when a formal diagnosis is made everything is in place for you to take over legal affairs and medical decisions. And it would give you authority to be more involved in health care. If they have a primary care doctor you might start there. You will likely have to be involved in the process - driving them to the appointments and speaking with the doctors and providing them information on what is going on at home. 

If I were you I would start with an attorney who works in elder law - they can help you form a plan for getting things in place. 

harshedbuzz

I am sorry you are dealing with the decline of both your parents.

I sincerely doubt you would be able to find a reputable clinician willing to evaluate a new patient virtually. A proper dementia workup requires bloodwork and imaging as well as paper testing and history. Dad's initial appointment took half a day; if this is beyond them, I would contact their PCP for guidance.

HB

Jo C.

This is indeed a challenge; I am sorry for what is happening.   Do you live near your parents or are you at a long distance away?  I also wonder if you have DPOAs for each parent; one DPOA for Healthcare and a second DPOA for Finance.

I also wonder if either of them has already been diagnosed as having one of the dementias or if that is what you are looking for an online assessment for and what their living situation is.

It is true; you will not find a credible physician or other healthcare professional who will do such an assessment online if you are wanting dementia to be ruled out.  Such an assessment is also by far best done by a dementia specialist. Reason for this is; our primary care MDs are awesome at so much, but they are not on the cutting edge of dementia dynamics.  The dementia specialist would be best at making a diagnsosis for what type of dementia is present. There are multiple different kinds of dementia of which Alzheimer's Disease is only one.  It makes a huge difference as meds/treatment for one type may be contraindicated in another and make things even worse.

It is extremely important to have an in-person exam and testing. There is no shortcut for this.  There are also many other health conditions that can mimic dementia, and those too would have to be ruled out with labs, etc.  If the parents are declining, are they adequately receiving nutrition, hydration, and meds being dispensed on time and appropriately?  Sometimes those things can make a huge difference in an elderly parent's cognition, function and behavior.  Something as small as a "silent" undetected UTI can cause huge changes in an elderly person's cognition, function, behavior, etc.

I am sorry that there is no easy answer to all of this.  It will take a bit of effort coupled with a little bit of time to get the parents conditions assessed; but it will make things much simpler when all of that is done.

Do let us know how you are and how things are going; we are all here in support of one another and there is a lot of experiential wisdom here from others who are farther along their journey with their Loved Ones (LOs).

J.

Jusb

Please note if you go for DPOA that you may want to ask about a trust from parents if they own their own home. Medicaid ....usually doctors, facilities home health care etc will switch them to medicaid  so they have more care paid. But then medicaid will take the joke and possessions for payment

Jusb

I'm sorry ...not joke... medicaid will take their home and other possessions for payment. Most people do not know this. Especially if they will need nursing home care

MsReliable

So sorry that you are dealing with this - I managed my Dad's descent and it was hard enough. Remember to look after yourself. I am not so good at this - take it from me, you are worth it.

Now some good news:

My dad developed (worsened) vascular dementia after a stroke. When I triggered his long term care insurance, they were able to do his assessment over video. It took about 2 hours  -asking him questions, asking him to write/Draw something and then show it to them on the screen.

I had to hold the phone up (and keep my mouth shut, not helping him, which was tough). 

When we moved him to a memory care community, they did the assessment the same way.

A full medical assessment might not be so easy, but I would bet that a geriatrician would have worked out ways to handle this during the height of the pandemic.

One suggestion  -whether you do the assessments from home on 2 different days or do one after the other, definitely have someone around with you to help. Even though it's a virtual assessment, it's a big day.

And the advice on DPOA, Medical POA and advance directives is spot on. Get it all in place now, and if you don't already know what their wishes would be, try to find out. It will make your future decisions much easier. I am living through this last part now and glad I put the work in up front.

Hang in there - one day at a time. You can do this and we will support you.