If a loved one is in a memory care facility and they are taking care of the Activities of Daily Living (ADLs), bathing, dressing , toileting, transfers, grooming, feeding, who takes care of the other needs? What resources are available to find optometrist, podiatrist, and dentist when someone has cognitive impairment and cannot leave the facility?

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My 94 y/o mother lives in a Memory Care ALF for the past 2 years & since she's wheelchair bound, I do not take her out of there for appointments; it's just too much of a burden to do so for many reasons.

A podiatrist comes into the MC regularly to cut mom's toenails. When she has a dental need, there is a traveling dentist who also comes in as needed. I will tell you it's quite a bit more expensive than the regular dentist b/c they charge a lot for each travel visit in addition to the dental services. I make arrangements for that dentist to do so via the nurse who works at the MC where mom lives. She broke her eyeglasses a couple of months ago, so I took them from her, went back to the optometrist's office where she got them originally, and chose another set of frames that the lenses would fit into. The new glasses were made for me on the spot. There is also a doctor who comes in weekly to visit the residents, so I signed up for that service as well. If my mother has an issue that the visiting doctor cannot address, it's off to the ER we go.

Get in touch with the Executive Director or the nurse in charge of your loved one's MC and have a chat about your questions. Get everything you can set up in advance so you'll have the least difficulty in the future.

Good luck!
Helpful Answer (1)
Reply to lealonnie1

I live in assisted living and I personally take care 99.9% of my needs. I would never trust them to do it correctly based on experiences that are not good. I take care of myself or lord help me. I assume in memory care with no brains left, the staff has to do it - the family can get involved to make sure it is done.
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Reply to Riley2166
lealonnie1 17 hours ago
My mother lives in a Memory Care ALF and guess what? She DOES have 'brains left'. What a rude thing to say Riley/Rusty. I also wonder why you choose to stay in a facility that you have no trust in and have had 'not good experiences' with? Sounds like you should have 'the brains left' to find a better ALF for yourself.
Imho, you should direct these questions to the MC facility.
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Reply to Llamalover47

Many facilities have Podiatrists that make rounds.
As far as eye exams and dental visits you make arrangements to get your loved one to the appointment. If you can not transport them there are medical transportation companies. Often facilities will also provide transportation to local appointments.
If you are not in the area but are managing care for someone you can hire a Geriatric Care manager that will go to appointments. Or it is possible that someone from the facility could take your loved one to the appointment. In each of these cases you will pay for the service. Geriatric Care Manager would be the most expensive, but probably be better at relaying information to you and to the medical personnel that they are seeing.
But just because someone has been diagnosed with dementia does not mean that they can not leave the facility. As long as you can transport them safely you can do it yourself.
Helpful Answer (5)
Reply to Grandma1954

Is there a reason why she cannot leave the facility?

Until the virus came along, I scheduled my mother's appts and took her to them. I found doctors and dentists local to the facility (less than 20m away), with the exception of her Mac Deg treatments - it is harder to find them, and also I felt it was better to stay with the place that had been treating her for many years.

When she refused to stand and walk without help, it became more difficult - the eye treatments I handed off to YB, as I could not support her weight. It was only 4x per year, but you'd think I was asking him to take her weekly! Moan, groan, complain. He played no part in her care and I don't even think he was visiting, so boo hoo. His inability to remember/read text messages resulted in her being too late for the last dentist appt I had scheduled. We were charged $50 for no show. Because of their inability to schedule her is less than 1 year, she didn't go again. Her regular check up was at the beginning of the lock down, and they wanted to do TeleHealth. Between dementia, hearing and eyesight, plus I was not allowed in the building, I said no. There was really no point (can't do BP, pulse, listen to heart and lungs, etc.) Same for me - I take no meds and have no health issues, so I'm not about to struggle to set up some kind of video or just use the phone - NO point! So, she didn't see the doc for over 1.5 years and only then because her records were outdated, resulting in hospice denying benefit after she had a stroke. The nurse handled the TeleHealth to get that updated and somehow they managed to verify she was losing weight.

Anyway, if she's bedridden and/or far into dementia, can she even get through an optometrist visit or sit through dental cleaning or worse? As others noted, the dental issues *could* present a problem, IF there is infection. Otherwise, the staff should be ensuring she brushes her teeth well or has them brushed well to help prevent dental issues. An infection may need to be attended to, or be treated with antibiotics. My mother's facility brought in someone who trims nails (I was not impressed with the last supposed trim, just before her second stroke. I saw her feet and they didn't look like they'd been trimmed in quite some time! Had she survived, I WOULD have been checking her feet every time I received an invoice.)

If she has mobility (with a walker even), you can take her or the facility may have transport services (but you'd want to attend to the appt as well.) If her providers are not local, ask around to find a new one that is close to the facility.

If she's not mobile, but can stand with help and sit, try a transport chair. That's what I used, even when she was using a walker - it was quicker to get her in/out if I did the walking and pushing vs waiting for her snail pace! The transport chair is not as heavy as a wheelchair and much more portable.

If she's bedridden, some places have a facility doctor. They may not be on site all the time, but they should be able to get him/her in if there's an issue. I wouldn't worry too much about her eyesight - likely not much can be done that would really benefit her or outweigh the difficulties in getting her checked. If the facility doesn't have regular nail trims scheduled, you can likely find someone online who will come in - that would be self-pay and they would have to follow facility rules. On that note, you might also be able to find mobile docs or dentists, if you really want to have issues checked. More likely to find these in more urban areas, less likely in rural areas. It can't hurt to check though!
Helpful Answer (5)
Reply to disgustedtoo

You have to ask at the facility if they have visiting PCPs. My mom was at 2 different facilities.
First, if she had straight Medicare there was a visiting physician for non emergencies. Mom had an Advantage program and I had to drive her to her docs when she could use a walker.
Second was at a place where she could prorgress to different levels of care up to SNF. There was a 24 hour nurse practitioner that could contact the facility MD for med changes. However I would be responsible for transportation to specialists.
For emergencies for both places, the family is contacted to ask whether they wish for the resident to be transported to the ED. In the last 6 years, mom experienced 3 ED trips and 2 hospitalizations.
Once people are bedridden, the specialty trips stop unless I want to pay for scheduled transportation to coincide with doctor appointments....a royal pain.
I would ask this question, once bedridden is it really that important or would it be best to just let the disease process take over. Both the resident and the caregiver are suffering to make this whole process work.
Helpful Answer (3)
Reply to MACinCT

For the most part, visits to the doctors you mention are over unless there's an emergency. Taking a resident out of MC to a scheduled appt poses some problems. She may not understand why she's at this drs office and resist being there. Once out of the facility, she may not remember it when she returns and think she doesn't belong there, or question you why you're at this place (the facility). Being in MC pretty much precludes leaving for any reason. When in the early stages, however, it may still be possible to venture out for a drive or get a snack, for instance.

As already mentioned, the facility should have a podiatrist visit on a regular schedule and should also have a doctor who visits this and other care facilities. Your wife must be in at least the middle stages of AD, and at that point I wouldn't worry about her eyesight. As her disease progresses, her eyesight will continually change. Most likely she'll lose some of her peripheral vision and her spatial perception will change. A change in her lenses won't matter.

Dental problems could be an issue. One day while having lunch with my wife in MC, one of her caps came off. I knew this was something I had to address. Luckily, there was a dental office next door and I made an appt and told them she had AD. They were very accommodating and the dentist said we should make an appt to see see their orthodontist. We returned the next week to have the ortho tell us that she couldn't tolerate a root canal. He wouldn't put her to sleep for the procedure because that could cause delirium and have other bad effects on her already damaged brain. We decided to chance it and do nothing hoping no infection would set in... it didn't and she lived another 12 months without any complaints. If your wife should develop any dental problems, I think you will have to follow up with a visit. Dental problems can become very serious. If there's pain involved. She should be able to tell you, or if she's non verbal, look for signs of pain like grimacing or crying. The staff should be able to see this also.
Helpful Answer (9)
Reply to sjplegacy
Ricky6 May 4, 2021
I am in the same boat regarding dental care. The patient is crunching his teeth and has pain. I contacted his old dentist and got no response. I spoke with the dental office manager and PCP, but there is little they can do. If there is an infection the ER would treat it, but not provide any dental procedure, so I do not where to go or what to do.
I know my mother's AL facility has a podiatrist that regularly visits and I transferred her care to the CCC physician since COVID. Pre Covid I was looking to place her closer to me. Many of those facilities had dentist and optometrists that came to the facility. Check with your mother's facility. If they don't offer these services then check your mother's community/city to see if there are providers that would visit at your mother's facility - though they may need to get an ok with the facility.
Helpful Answer (2)
Reply to cweissp

You should discuss this with the facility your elder is currently in. Facilities vary. You may be down to the POA or guardian finding these doctors. Some facilities have visiting MD. I have never heard of visiting dentist. Call your local council on aging as well to find resources if you are the POA in charge of your elder's care.
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Reply to AlvaDeer

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