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Mom fell 5 weeks ago, Dr was not scheduled to be a facility, so off to ER we go. That next week still in pain so we call him, they’re not coming but we can bring her? Appt was a joke said they’d follow up in two weeks. Nothing. Since then she’s developed second UTI and on second round of antibiotics. Still has not been seen at the facility. We’re told by visiting nurse she can be “fired” by Dr if she continues to be a problem? I’m at a loss now, we’ve not had a full time nurse since May, but ones starting Monday. How do others work?

AT1234: I know. That's why I wrote it.
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I have an additional question, goes along with one of the posters here. Is there an online service people have had good luck with for disposables/pads etc?
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disgustedtoo Sep 14, 2019
Mom's disposable panties are ordered through Walmart. I order enough to last a while and cover the free shipping. Price is comparable and they do come quick (competing with amazon!) They are shipped to me and I provide them as needed.

The bed pads were also ordered from them, but only once so far - we're hoping the UTI treatment eliminates the nighttime wetting that happened because of it. Hoping we might not need these again, or at least for a long while! I did buy some pads for extra coverage at night, but got them in store, hoping we don't need those now either.

Haven't used any of the auto-ship options as it isn't clear how many she needs (started the disposables this year, but when she should be out, there are extras, so unclear how often to order, yet.)

If anyone else knows of any less expensive but good places to get them, chime in!
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The facility doctor is actually supposed to SEE the resident?  Really?  News to me!  The only facility doctor who saw my mom was at a facility where I KNEW the doctor, and he KNEW ME, and each and every time he saw my mom, HE CALLED me and let me know how it was going with her, and encouraged me to call if I had any questions.  All of the other "facility" doctors haven't done this.  I didn't know any of them, never saw them, never returned any phone calls, didn't do a thing that I ever knew of.  AND NO FOLLOW UP APPOINTMENTS UNLESS I MADE THEM TO OUTSIDE DOCTORS AND TOOK HER MYSELF.   Sound familiar?
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Perhaps your mother needs a higher level of care.
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AT1234 Sep 11, 2019
That will be true sooner than I’ll be ready.
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AT1234 - can you clarify the AL, aka is it regular AL or MC/AL? Given all the issues you list in your profile, it sounds like perhaps mom needs to be in MC. AL, in general, is geared more towards people who are still relatively independent, but have more needs, both physically and perhaps a little cognitively. Too often the needs become more than a regular AL can provide. They SHOULD have a nurse on duty all the time in regular AL and in MC. There are fewer people to help in AL than in MC, so when a resident's needs become more excessive, they might start suggesting a move to MC. Firing by a doctor? If that is true, it sounds like that doc took the hippocritical oath, not the Hippocratic Oath!

To the best of my understanding, the facility our mother is in does NOT have a doctor on duty. The facility is IL/AL/MC. Some may have in-house medical staff, others will not. Sounds like yours has a "resident" doctor, but s/he isn't there all the time, just at intervals. Recently mom needed a test for UTI and I found out they now have an assigned day of the week when they might perform tests like this at the facility. It was VERY helpful not to have to take mom out for something like this (she has been refusing to stand/walk since having a few tumbles - no injuries - but I cannot support her weight anymore.) More effort to get her out there and back, just for a simple pee test?

They also have transport if she needs to go to ER when one of us is not available. Initially when she moved in, any fall they would want to trundle her off to the ER. Once they sent her and left her there alone! Not what I would want done with a dementia resident. After a few times, this stopped. Now they document it, report it to me, and monitor her for a day or so. No issues, no running off to doc or ER.

Question for you is do you HAVE to see this doctor or can you choose your own? Clearly having a doc in-house for needs would be ideal, but I can see where this wouldn't be a full time job in AL (NH sure, but not AL.) If this is how it was for mom, I would find another doctor, someone I can rely on. It is difficult, but not impossible, to find one who does "home" visits (but if your facility has a doc, they may not allow this? You would have to check with them.)

The first doc we had, outside the facility, was not as helpful or responsive as I would like. Dismissing mom's pain by saying dementia patients often can't express their pain just doesn't cut it! Our mother isn't that far gone - she CAN express pain when she has pain. Since her Medicare and BCBS cover pretty much everything, I would want testing to be done, to avoid the problem getting worse. She also was VERY reluctant to renew her Rx for anti-anxiety, giving multiple excuses. It was only to be used 'as needed', such as when sun-downing with UTI. We changed doctors (funny that just before her first appt with new doc, we found out the other was retiring!! She isn't even all that old...)

While OTC tests are not as good as a lab test, you could test for UTI yourself. They make those "hats" that sit in the toilet so you can collect the specimen. Your profile indicates UTIs and incontinence, so I would test her on a regular basis. Many times these are missed because the symptoms are atypical - aka no pain. Mom's first one in MC resulted in some excessive sun-downing. The more recent one was causing excessive nighttime wetting (she wears disposables, but it was so much that she was ending up soaking the bed, her nightwear and herself!) If you suspect UTI, it would be good to get a culture done. Sometimes the meds need to be more specific (and sometimes these don't show up with the dip stick test.) Being incontinent does often lead to more UTIs. Follow up testing, allowing enough time after the meds are finished, is important.
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AT1234 Sep 10, 2019
Let me clarify, my mom is in AL, not MC. The criteria is she must be able to get herself out of building without aid in case of emergency. She is moderately cognitively impaired.
The facility physician is not in house, he and his PA are available or visit several facilities. No one is in house. We understand a full time nurse will be on board in house this week which is what our contract requires. Testing like UTIs are done in house after ordered by dr. The entire process is filled with communication problems and are anything but seamless. I’m working on solution. MC is beyond her need.
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I understand your issue. When each of my parents entered assisted living I mistakenly thought my worries were over. That did not turn out to be the case. The assisted living facilities did have doctors that would come by once a week but as we all know, people get sick on random days. So if one of my parents got sick and the doctor was not scheduled to be at the AL facility until a few days later, I was responsible for getting them to an appointment. It was very frustrating.
I would also get frequent calls from the facility saying things like "your mom is out of supplies" or "your dad is not eating". So I found that the word "Assisted" in assisted living did not mean very much.
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disgustedtoo Sep 10, 2019
Problem is that many people don't understand what AL is really geared for. It is 'intended' for seniors who are more or less self-reliant both physically and cognitively, but need assistance with some ADLs, such as bathing, cleaning, cooking, some mobility, etc. If someone can no longer drive, but can do most other tasks, this is a potential solution for them. It isn't IL, but it isn't MC or NH either. The more assistance that is needed, the more it costs or the more likely you have to either help more, or hire outside help, or find a place that offers more assistance.

In our case, mom went straight to MC, skipping the AL. Funny that in HER plans was a potential move to AL, but when dementia kicked in and we needed to move her (she was living alone in a 55+ condo community), she refused to move ANYWHERE, especially AL!! Stated she would NEVER live in one of those places!

Supplies generally are something either they need to be able to secure for themselves or family/friends have to provide. Even being in MC, supplies not provided are needed (initially they required TP which was a HUGE pain in the butt, but later they relented on that.) Any OTC meds I pick up and regular meds I also take care of (they usually use a "Service" which is VERY expensive!) Disposables, tissues (she is a tissue MONSTER!), etc, I might get calls if I don't keep good track of usage.

NH, if/when it gets to that point, provides supplies and medical oversight, but generally not AL - our mother's facility is IL/AL/MC, but there is no doctor on duty. However, many people don't understand that NH is generally geared for those who need more specialized nursing care, hence why it is more expensive.

While it is a pain when someone gets sick or hurt on the "off" days, think about it - there could be many days a doctor would be there and have nothing to do! In the case of facilities like this, it doesn't make sense to have a doctor on staff. Doctor either doesn't get paid or facility would have to pay for their time whether they provide any service or not - increasing the resident cost. Even being on-call could be a problem, as they would likely have regular patients in their office and can't just drop them and run.

While I understand your frustration, "So I found that the word "Assisted" in assisted living did not mean very much.", think about what you would have to be doing if they were still living in their own place or yours. I bet it would be a lot more than getting frequent calls for supplies or to report an issue...
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MIL is in AL and uses it's medical team. According to the Medicare statements, a nurse practitioner sees her about twice a month. Not sure how often the doctor visits.
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My mother’s PCP has a nurse practitioner who comes in twice a week. I call or text her if there is a problem between times. If it can’t wait she goes to one of her drs or the ER. They aren’t really for emergency care. Is there a nursing Director? At my mother’s ALF the director calls me, the dr or NP if the daily nurses suspect a problem
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See them every Tuesday, the problem is they don't tell the doctor what is wrong with them, they just sit there, never ask any questions.
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Around here a lot of ALs advertise that they have an in house physician but that sometimes isn't all you might expect, in one place I know of the doctor will only see people by appointment once every 6 weeks or so, this is obviously not helpful for those with acute needs.
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AT1234 Sep 10, 2019
Right, they have access to dr. He’s got quite the route he “services” four large facilities. Doesn’t spend anytime with residents unless an emergency then sends to ER. Basically monitors meds, PA and Dr charge Medicare same rate. They are not required to write in chart each time they see them so there is no record.
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The “fired” comment could have meant that your mother may need a higher level of care than what she is currently receiving & may need to be transferred to that level.

On another note, visiting nurses often shouldn’t say things like that with no explanation to whoever they are speaking with. Being a nurse myself you catch yourself before saying anything & think through your responses because anything said can be interpreted differently and/or cause unnecessary panic.

My MIL (95) is in an AL and is followed by their doctors. The only thing she goes out for are corneal injections for macular degeneration. My SIL takes her.

If it is getting too much to take her to appts she may have to reconsider. Maybe she will get too weary to commit to dressing up & going out.

Usually counties have their own senior/handicapped transportation buses that residents can apply for and use. In that case if you enroll your mother, you can request a wheelchair van and either meet her at the doctor appt or ride with her on the bus. Lifting a w/c and a senior into your vehicle can be physically difficult for us.

Wishing the best for both of you.
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My mother lives in the Memory Care annex of Assisted Living. She uses the in-house physicians who come in regularly; the doctor and the PA who we particularly like, who comes in monthly, or more often if called. These docs have always treated mother for whatever ailed her, pretty much, including ordering urinalysis, blood tests, xrays and other assorted tests as required. She's fallen about 3 dozen times and has never needed to go the ER yet, believe it or not. The nurse at the ALF checks her for injuries, checks her vitals, calls me, and determines if there is a need for treatment. If so, there are traveling lab companies, traveling dentists, and traveling xray companies too, who all visit the ALs on a regular basis. Mother's Medicare pays for all of it, with a bit of a higher co pay if they're out of network. They do NOT pay for dental work of any kind, to the best of my knowledge. A couple of times the PA has ordered xrays for mother after a fall when she complained of pain (but where the PA did not feel a break had occurred). At the AL, in both annexes, there is a full time LPN on staff 24/7. My mother is wheelchair bound and it's pretty difficult to get her back & forth to appointments, so the docs who come to the ALF have been a lifesaver for us. I do take her to the ER sometimes, and to the dentist, and to the ENT for vertigo treatments, which is PLENTY.

I'm confused by you saying your mom can be fired by the doc if she 'continues to be a problem.' What? Are elderly people in Assisted Living Facilities supposed to be healthy all the time? I don't get it. Of course they are going to continue having problems, continue declining, and continue to need medical attention until they pass away! That sounds to me like an off-the-wall comment, if I'm understanding it correctly. If the doctor considers your mother a problem because she requires medical care, then something is rotten in Denmark.
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AT1234 Sep 7, 2019
My mom has a driver any weekday, but I also drive her. This is not about transport it’s more about not being satisfied with answer dr gives, it’s been this way for many years, but since being in AL I guess we both expected better.
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My mom's Medicare Advantage insurance does not cover the visiting doctors. I can still take her at the moment. Open enrollment begins soon in mid October. I plan to go to the Medicare website, type in her location an search for a better plan. First I will locate programs based just on her drugs and save them from the site. Then I will do a search based on which doctors can visit her AL. This is an excellent time to plan ahead.

Meanwhile your AL should have a nurse. Your current doctor can write the lab requisition and you or the nurse can catch a sample. Follow up with her doctor in a couple of days. Many offices have email to their doctors or can respond via phone call. Docs offices usually do not ignore patients with infections just to make money on a visit. When you call the receptionist tell her what you suspect and request the lab or medication
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Does Moms contract say she has to see their doctor? Their doctor maybe just for convenience. So, take her to one u chose. One that has a Nurse Practitioner who usually does the visitation.

Assisted livings are not prisons. Your Mom is a resident. Just like paying for an apartment but with some extra help. ALs are limited in what they do. This not having a fulltime nurse at the facility is not right. Even though these places are private owned, they report to the state. My impression is that an RN has to be there 8 hrs a day and on call the rest of the time. An LPN can back up but they are usually limited in what they can do.

You may want to consider moving Mom if things don't get better.
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AT1234 Sep 6, 2019
Moves are very hard on her but not having confidence in her dr is going to be an issue. Getting to know people the routine etc takes a toll, but that’s what everyone knows. We will see, thank you for your response. She’s not in jail people!
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My brother's assisted living has two physicians groups involved with it. One, we were kind of hinted, better than the other as the nurse practioner shows up often, even if only to check blood pressure on someone worrisome. My brother has not joined with either group and keeps his own MD outside the facility. They have a van and there are two days a week that are appointment days. He goes on those days when needed. Any Emergency would be either a van visit if able or, yes, the ER. I have never heard of a facility with onsite RN at all times, unless a SNF or a Rehab.
If Mom is getting frequent UTIs please investigate D-Mannose. It works much like cranberry in that bacteria cannot adhere to the bladder wall. I swear by it. Was getting more than 4 a year, went on D-Mannose (over the counter and at health food stores or Amazon about 30.00 for 120 capsules) and have had no UTI in decades. Worked the same for two friends. As a nurse I am a western medicine gal and don't like vitamins and supplements, but I swear by this and started it when Doc threatened me with daily prophylactic antibiotics after two infections went into the kidney. It is certainly worth the try. Warning that the capsules are large, so should be given broken into glass of something or get the powder. And of course won't be given by nursing staff unless your doc orders them to be. But are otherwise otc
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AT1234 Sep 6, 2019
Thank you, so much I will get her some.
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Does your mom still have a PCP in the area? It doesn't sound like you can rely on this facility for much in the way of medical care.
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AT1234 Sep 6, 2019
In our area pcp washes hands as soon as they can.
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AT1234, the Assisted Living facilities in your area must be different then in my area. When my Dad was in Assisted Living, he was able to visit all of his doctors, there was no facility doctor. Of course, that meant I would need to set up appointments and we would take Dad to his appointments. The facility did have a Nurse on duty around the clock for minor issues or to assess a situation where 911 would be called.

On the other side of the coin, my Mom was living in a Nursing Home. Thus she would be seen by the facility doctor. Her primary doctor was now out of the picture. Wish my Mom's primary doctor could have been part of her care, but that isn't how it works for Nursing Homes in my area. The facility doctor was there daily to see patients.
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AT1234 Sep 6, 2019
ive taken her to all appointments in the past, I’m not sure this is going to work for either of us.
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