Spinning our wheels

ESkayP

I got a call this week from a speech therapist my mother saw a year ago. She said the staff at the MC facility had asked her to renew her services with my mother and that she sent me paperwork via email to sign that would allow her to begin a consultation. There is a copay agreement. Apparently, the staff was having trouble communicating with my mother and determined that speech therapy was warranted. I'm annoyed that they didn't talk to me about it first. Why is the same speech therapist, who saw my mother a year ago and discontinued service due to lack of progress, going to start up these sessions again when my mother is now even less capable of responding to therapy than she was before? She does get agitated, but isn't that Alzheimer's 101? Maybe the staff should get some training instead. Aren't they more likely to retain and apply those communication strategies than my mother? I highly doubt that she is the only resident in MC who is having trouble. I saw a former thread about speech therapy from last fall, and I can now commiserate with the exasperation I found there. Before we finished the call, the therapist assured me that she would include the staff in my mother's treatment. She said the staff's training often depends on the findings in one-on-one sessions with individual residents. I guess I have to be satisfied with that. I just don't have much confidence that speech therapy will work for my mother or for the staff, and we'll be paying extra for nothing. I'm going to hope for a miracle breakthrough.

SusanB-dil

Is it a one-time pay or does it appear to be continuous? If one-time, just for assessment, then maybe. Otherwise, I would check into the agitation rather than the speech therapy.

psg712

Agree with Susan. As my mom's Alzheimers progresses, I have been more particular about interventions like this. If there are not achievable goals and a well-defined time frame, I smell Medicare milking in progress.

Call me suspicious, but my mom experienced this a year ago in a rehab facility. The admin even told me when I asked about mom's projected time in the program, "oh, we normally just keep them till we get a cutoff notice from insurance." I should have reported them to Medicare, but I couldn't get mom into MC after her hospital stay without some rehab. The physical therapy was good for her. I just had to stay on everyone to get her out when her goals were reached. I hate being the squeaky wheel, but there was covid, flu and RSV in the rehab SNF and I wanted mom Out. Of. There.

Sorry for the personal digression. Back to your situation. Are you sure that the speech therapist is not just drumming up business? I'd suggest talking with a supervisor at MC and getting their take on the communication issues that the staff is having with your mom. Ask how they have handled similar situations with residents in the past. Bring up your very realistic concerns that speech therapy is even less likely to make a lasting difference for her now than it was a year ago. You don't have to sign that consent for treatment. And you can revoke it if you aren't seeing results.

--Rebecca--

Trust your instincts. Maybe ask memory care about their speech therapy order, and its goals. If is seems like it won't be helpful, tell them "No thank you. I do not consent." If she needed a swallow test, that would be different.

ESkayP

https://alzconnected.org/discussion/comment/234210#Comment_234210

I will be continuous at 2X per week, but the therapist told me she would definitely set goals with a limit of ten visits at which point she will conduct a re-evaluation. If mother wasn't meeting or even approaching those goals, she would discontinue service again. I had a virtual visit with Mom's neurologist about her agitation. He is going to start her on Seroquel, low dose for six months. I am reminded of the trial and error phase I went through for Mom before she was diagnosed with dementia. She suffered high blood pressure, confusion, extreme weight loss… It was a myriad of issues, and her GP was metaphorically throwing darts at a board trying to figure out how to treat her. The difference is that at the MC facility, they see Mom everyday, all day, so they are more likely to see either progress or side effects. I'm going to be quite vigilant following up.

ESkayP

https://alzconnected.org/discussion/comment/234234#Comment_234234

Thanks for your insights! This speech therapist is very familiar with the staff at this facility and admitted the high turnover rate for CNA's was part of the issue. I did talk to the head nurse and healthcare director about it. They explained how each resident is different and individual treatments are preferred over nonspecific "general" training. I understand their perspective, but I also know that at some point ALL dementia patients experience frustration when communicating. I don't believe they are incapable as health professionals to redirect or help calm my mother. It's not so unlike having a toddler who can't communicate and gets frustrated. You can't just drug everyone! That being said, I am supportive of helping Mom manage her overall anxiety. The neurologist has prescribed Seroquel. Mom had tried Lexapro before she moved into MC, and it seemed to make her worse. It's still trial and error. I actually hope the speech therapy helps. I just hate that feeling of being suspicous in a financial way.