responsibility for taking to doctor from MC

MsLadybug

I'm new to all of this. From a recent assessment and from what I read here, I think DH is at stage 5 dementia. So I think placement in MC is needed, within the year probably. General question: I assume that once placed, I will be the person to take him to MD appointments as needed? (I have done that for him for years). I'm sure it depends on the facility, I'm just asking as a general question. I live close to a large HMO, we are MC Advantage members. So it would seem prudent to find a nearby MC facility to facilitate medical care as needed, yes?

Damiross

Medical appointments transport would probably be taken care of by the provider. My wife is in the Medicare program called PACE (Program of All-Inclusive Care). They pick up patients for medical appointments and return them to the memory care.

However, this may also depend on how severe your husband's and dementia is. My wife does not like to get into the vehicles that they use to take patience to and from the medical center. As a result, I take her to my own car.

ARIL

MC facilities typically have their own doctors on call who also visit the facility regularly. You can choose to use the facility physician or to continue to use your own doctor. If you use your own, then yes, ordinarily the family would arrange the appointments and the transport unless the facility has some kind of transportation program. (The three I’ve dealt with did not.)

A number of people on this forum report good experiences with facility physicians (I count myself in that group). A recent discussion of the topic is linked below. The original question was about AL, but several of the responses talked about MC.

https://alzconnected.org/discussion/75952/use-assisted-living-physicians

Jgirl57

Many facilities are able to arrange healthcare for your loved ones with the house physician . They usually go frequently to the facility to see patients

Damiross

My research indicates that memory care centers do not typically have onboard physicians.

At the memory care that my wife is at, a doctor from the Center for Elders' Independence (CEI, her Program of All-Inclusive Care( PACE) provider) comes to visit her every couple of weeks or so. CEI also provides transport for the residents to go to and from the CEI center for treatment. I have noticed that non-CEI patients also have the similar coverage.

If you are satisfied with her doctor, I wouldn't use the facilities on call doctor. When they have learned about dementia patients is that they don't take to change too good. About to see you he comes by the facility or if they provide transportation. If your HMO is Kaiser then check with member services. Many plans do provide non-emergency medical transportation medical conditions.

Below is the summary of what I found in several different AI engines.

Memory Care Facilities and Medical Care

Onboard Physicians

Memory care facilities typically do not have onboard physicians. This means that residents are not assigned a doctor who works directly at the facility.

Most facilities have primary care doctors who visit the facility.

Some families find it convenient to switch to facilities visiting doctor. But there are also programs such as CEI's that pick up and return the patients to medical appointments without the family having to do it in most cases.

Many memory centers have 24/7 nurses or trained caregivers for daily medical needs such as medication.

Does this focus more on dementia support such as safety specialized activities and behavior management. The medical treatment is expected to be done by either on-call doctor are the patients regular doctor.

Factors to Consider

If you are deciding whether to switch, here are some points to keep in mind:

Using a Facility-Associated Doctor	Keeping Your Current Doctor
Convenience: No need to transport your loved one for routine appointments.	Continuity: Retains a physician who knows your loved one’s full medical history.
Responsiveness: Usually faster to get a visit if the nurses notice an issue.	Comfort: Maintains an established, trusted relationship.
Communication: The doctor often works directly with the facility staff to manage medications.	Coordination: You will need to manage all transportation and record-sharing yourself.

harshedbuzz

@MsLadybug

There is no one answer to your question.

IMO, all other factors being equal, when choosing a MCF it's important for it to be near enough so the DPOA can meet an ambulance coming from the facility and the PWD will be sent alone. Falls and UTIs are common reasons for transport.

Many MCF do have an affiliated PCP who visits patients regularly; some even have podiatrists, dentist, optometrists and geri psychs who visit regularly. Most have mobile X-ray and phlebotomy services as well. Your MAP may or may noy interfere with that option if an in-house provider is available.

One downside I've not seen mentioned to making the switch is that often the facility's doc or NP doesn't maintain a strictly traditional schedule. They may be covering several facilities and will be adjusting their appointments to accommodate urgent calls. This means you likely won't be there when your LO is seen. In my dad's situation, the doc was great about relaying information by phone, but he talked to mom who doesn't fully understand the implications of what she's being told or ask follow-up questions.

During dad's time in MC, he did have one outside appointment with urology for a Lupron injection (prostate cancer). He wasn't safe on his feet, so we hired medical transport.

HB

MN Chickadee

Depends on the facility. The two facilities I utilized both had visiting primary doctors who came right in to see residents, and I had mom use them. It was hard to take her out to appointments so this was easier, and her medical situation was not super complex. The facility would tell me what day the doctor was coming so I could be there to speak with them. The providers had the same type of patient portals as anywhere so I could message them and see visit notes. If your loved on has specialists they will continue to see you will need to arrange those appointments and take him to them. Facilities generally do not have enough staff to send out of house with an individual, nor do they have the legal authority to be making or attending appointments. That aspect is a partnership between staff and the family. They report what they are seeing and call you about issues, you decide how to proceed and make the arrangements. In my opinion the proximity of the facility to your home and the emergency room is an important factor in choosing a place. Eventually you will get the call that your husband is in an ambulance and you need to meet them at the hospital, and in those moments you will want to to be able to get there fast. Facilities are legally required to send them to the ER for evaluation for many circumstances unless the person is on hospice, and falls are extremely common at even the best facilities, they are just par for the course with dementia. My mom got sent to the ER a half dozen times for falls and a totally out of the blue seizure (caused by the dementia.) She was ok and released all 6 times but I was always glad to be just a few minutes from the hospital, since she could not even relay her last name let alone her medical history, and she was often very anxious in the ER.

JDancer

Another thing to consider- as our LOs decline. many of us choose to reduce medical treatments. Early on, I stopped a lot of standard preventative care and testing for my spouse

H1235

Moms Al facility offered a visiting np. I found she was much more aware of dementia related issues than her old pcp. I continued to take her to specialist appointments (sleep dr, podiatrist, eye doctor, hearing, and dentist). I eventually stopped taking her for hearing appointments, since she is unable to use her hearing aids anyway. I don’t think I will do another appointment with the sleep doctor. She spent 10 minutes explaining the advanced setting on moms sleep apnea machine to mom (I figure we are lucky she still knows how to turn it on).

terei

The facilities my mom was at had geriatric MDs and support staff that came in. I would recommend that arrangement as long as you are satisfied with the care. They are very experienced with PWD and I found them to be very responsive. It was certainly more convenient and it gets harder and harder to transport your LO as their disease progresses.

JPJardinel

This is such a practical and thoughtful question to be asking at this stage, and the fact that you are already thinking about proximity to medical care and how appointments will work tells me you are approaching this transition with real intention. In most cases, yes, family members remain the primary people responsible for accompanying a loved one to outside medical appointments once they are in memory care, since facilities typically handle on-site health monitoring but don't usually transport residents to specialist visits or HMO appointments unless you arrange otherwise. Being close to your MC Advantage network makes a lot of sense from a logistics standpoint, since coordinating care between a memory care facility and a large HMO can get complicated quickly when travel is added to the equation. Some facilities do have relationships with mobile physicians or telemedicine services that can reduce how often a resident needs to leave, which is worth asking about during your tours since it can make a real difference in your day-to-day load. You are asking exactly the right questions at exactly the right time, and getting clear on these logistics before placement will save you a lot of scrambling once the transition happens.

I hope these references can help:

https://hopebridge.care/memory-care-medical-appointments-what-families-need-to-know/

https://en.wikipedia.org/wiki/Dementia

https://www.ncoa.org/article/does-medicare-cover-memory-care-a-comprehensive-guide/

Maru

https://alzconnected.org/discussion/comment/274886#Comment_274886

JDancer: I am interested in your response. Could you be more specific on how early on did you stop preventative care and testing, and what was that care and testing? My DH is 91 and other than a pacemaker, is in very good health, stage 3-4. Mentally, he still has days when he seems mostly "normal". I have no desire to rush him into the next world, but on the other hand, but he was clear from day one of his diagnosis that he did not want to live with dementia. Such hard decisions.

JDancer

https://alzconnected.org/discussion/comment/277428#Comment_277428

My spouse developed EOD at age 59. Other than osteoarthritis and alcoholism, he had no chronic illnesses. I discontinued annual exams, blood work and colonoscopies immediately. His only meds were for gout prevention and pain as needed, which we continued. We also continued dental exams and cleanings every 6 months. When he started sitting all day, he developed some venous insufficiency, but I didn't persue diagnosis or treatment. He died last month , at age 67, from dementia after a month of home hospice care.

SecondStar

There are a lot of good responses here and in order to be valuable to you I can offer you this: since you're new to interacting with these organizations and facilities do not be afraid to call them and ask questions.

As a matter of fact, when you have an issue or a question sit down with pencil and paper and jot it out. Take the pencil. Take the paper. Maybe write your name and then his and state the question or problem. Travel.. Getting there... now write all the solutions down, Go over it and really think about driving. really think about him taking an Uber really think about going from point A to point B and things will start to pop into your head; things that you didn't realize were important or could be a potential obstacle actually are important and actually are a potential obstacle- right along with their opportunities and solutions.

Obviously, you can pick any method in doing this. There are many to look at and use. It's up to you but the key is to get outside of your own head and to look at the process all the way through from beginning to end. That's going to be a huge asset to you when you come across any kind of problem like this.

Let's use your transportation question as an example, on top of asking about ride accommodations for him also ask about personal reimbursement, Uber, Lyft, Rideshare, shuttles reimbursements, travel out of state ( you never know when you may need to see a specialist in a different state)... arm yourself with options and authenticated knowledge!

Keep your head up: it is okay to prioritize yourself when you need it. I hope this helps!

Maru

https://alzconnected.org/discussion/comment/277522#Comment_277522

Thank you for taking the time to answer my questions. I am so sorry for your loss.