AL care plan, doctor's weak follow-up

lilacgirl

I had a care plan meeting at Mom's ALF 2 weeks ago. I left the meeting feeling really good because the staff there really seemed to understand everything that was going on with my mom, have observed the same things I have, and seemed to have a good plan of attack for helping her with some things like her anxiety and her back pain. I've also been told since her last appointment 3 months ago that they would do some more intense cognitive testing this time. They know she has anosognosia and they seem to handle her really well.

So we had an appointment with her PCP there yesterday (he is the doctor for the facility, comes in a few days a week), and it seems as though he did not get the memo from the care plan meeting. My mom was big-time "showtiming," and he only spent about 10 minutes with her — asking her things like, "How's your anxiety?" ("Not bad"). "How's your back pain?" ("Not too bad, Tylenol helps"), "How's your memory?" ("I don't think it's bad.") She made it clear in front of him that I'd better not contradict her answers, too. The extent of the cognitive testing was to ask her if she ever leaves her room and has a difficult time finding it when she returns.

He ultimately told her she looks great, and made no changes to her medications.

(As an aside: why would a doctor in an Assisted Living Facility ask someone "Any big plans for the weekend?" Seriously!?)

I am wondering what I should do in response to this waste of an office visit. I think I'm going to ask the Director of Wellness for another meeting and ask her exactly how they do plan to implement the care plan we discussed, since the doctor does not seem to be on board… Any other suggestions??

H1235

What additional cognitive testing you are looking for. Has she already been diagnosed with dementia? If so, what would be the purpose of this testing? I don’t think most pcp’s are capable of more intensive testing. My moms pcp was useless. She did the in office testing and found no problems. I had to insist on a referral to a neurologist. The visit with the neurologist was 2 hours long. It was a lot for mom. If she has already been diagnosed I wouldn’t recommend putting her through that. Is there any way you can talk with this doctor, communicate through a patient portal or leave a written message for him? A dementia patient can not be trusted to report their medial needs, that’s ridiculous. At a meeting similar to this I made an excuse about something I needed to talk with the doctor about (that I knew mom would be ok with, when will she see him again or something like that), then caught her in the hall and explained the real situation. The lack of insight and basic knowledge (plans for the weekend?) is just mind boggling. At least it sounds like the care plan meeting didn’t include your mom. My mom’s nursing home said she has to be included. It’s a joke. I can say nothing for fear of making mom very angry.

ARIL

Yeesh. Plans for the weekend???!

This doctor reminds me of an ER doctor I encountered last year. My dad had been brought to ER from MC—a fact known to the doctor. The doctor asked him: “Before the episode this morning, how have you been feeling over the past month or so? Any dizziness?” My poor dad, who did not know who she was, where we were, or what had happened that morning, said, “I am doing fine.” Right. He was embarrassed. I was incredulous.

It sounds as though your care meeting was productive, so that’s a win. I agree that in your place I would talk to the key staff again and ask about the plan. I would not hesitate to mention that you aren’t sure the doctor understands the situation. I wouldn’t complain much—I would keep the focus on the care plan—but I’d share the “plans for the weekend” example if you need one to show why you aren’t sure he gets it.

Good luck!

lilacgirl

https://alzconnected.org/discussion/comment/278155#Comment_278155

My mom has never been formally diagnosed beyond “Memory Loss,” so we are just hoping to get a more formal diagnosis of dementia because that will make it easier to get her Long Term Health Insurance to kick in. Otherwise I don’t really care; we believe she’s in Stage 4 of what I believe is Alzheimer’s for many reasons.

Quilting brings calm

A PCP isn’t going to do the extensive cognitive testing. That’s what a neuropsychologist does. You need to directly request the PCP for a referral to one. Explain that you need it for the insurance to pay the MC.