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She is a home bound, partially paralyzed 88 year old. I currently have to hire an ambulance at least monthly to take her to a pain specialist so she can pee in a cup! It’s extremely difficult on her. Isn’t there an at-home option for home bound patients?

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If she's seeing a pain management dr., there just may be no way around her monthly drug testing...but perhaps you could ask them if someone (a CNA, someone who has medical training) to come to the house for the urine collection. I know it has to be done under tight restrictive conditions, but an 88 yo, homebound woman??

Have you looked into palliative care? Or even Hospice. Hospice is not just for EOL issues, it's used for pain management also. I don't know what the rules are in TX. You'd need to ask her PCP about it.
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Hi Janet,
I go to a pain specialist too. I've never had to "pee in a cup".

Yes, I'm sure there is another option. If it's a routine straight urine collection, I don't know why you couldn't collect it at home then you take it in. What are they testing for?

Explain to the doctor that it's too much for your mom and very costly in a transport ambulance. Tell him your mom can no longer do this. Then ask about taking in specimens. If he refuses, check out other providers who might be able to accommodate your mom.

My moms doctor knows she lives in Tijuana and is practically imobile. He only needs to see her once a year.
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I also am confused about why she is peeing in a cup, if she is going to a pain clinic to get opioids then it seems obvious her urine is going to show opioids ???
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I am just taking a guess here , Ithink they want to make sure she is taking them and not selling or something? It has become a real misery here in Mass to get pain meds for my mother
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It would probably be easier to just buy what you need on the street... not that I'm advocating that (SMH).
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Recent changes in the law end up with people needing to "pee in a cup" to proved that they are taking the drugs that are being supplied. Our doc also had to start that this year.
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Yes due to the opiate crisis pain management centers are required to do urine testing. The purpose is to make sure the person prescribed the meds is taking them and also to assure they aren’t taking any illegal drugs. Most centers test every 3 months. I have never heard of any service that would come to the home to get a routine drug screen urinalysis. 
The cost of those urine tests is exhorbitant - one test can cost quite a bit ($300-600) which is totally ridiculous. Then the lab bills you directly so you get 2 bills - one for the visit and one for the lab.
That’s the cost of seeing pain management these days. Doesn’t matter how old you are.
Is she eligible for palliative or hospice care? Maybe that is an option and then the palliative care/hospice doctor can write the order for her pain meds & she won’t have to go out to pain mgmt monthly. 
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Sigh. It isn't that I can't see the sense of the objective; but it does sound like yet another policy that nobody's really thought right through...
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She has been on hospice several times but because she isn’t “declining fast enough” (their words) they discharge her. I would happily pay out of pocket for a doctor to come to the house (or another medical professional) to collect the sample but I am having no luck working with any of the pain specialists in my area. I cannot believe there is no other option than a visit to a doctor’s office for patients in her condition. This is ludicrous. What am I missing???
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Does she have to go there to get her prescriptions filled for the month? Usually that is a requirement as well. I would discuss your problem with her doctor at PM - maybe this isn’t their first rodeo & there is a way around it. But due to pain mgmt providers being under so many laws they may have to do things by the book. How ridiculous is it that people who really need pain control have to suffer because of the opiate crisis.
I am truly sorry for you & especially your mother, who at her age shouldn’t have to do this.
Maybe enroll her in palliative care vs hospice?
Situations like this anger me - that government can come in and require certain tests be done or else. A knee jerk reaction to fix opiate abuse. Never thinking of the hardship on elderly people it causes.
I hope something works out for you & your mom.
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Thank you all for your responses. You have given me a few new ideas and I will be pursuing them. I had not heard of palliative care before and will definitely be looking into it. (Why no one I’ve talked to in all these months hasn’t brought it up is beyond me!). Also, I’m seriously considering hiring a patient advocate to help navigate this mess. I have (finally!) convinced her pain specialist to try some of the other not so controlled meds. Fingers crossed that they work. They only require a visit every three months. If I find a way through this be sure that I will share it here with you. I know we are not they only ones in this mess.
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I struggled with the same for my mom. She qualified for Hospice, and it has been the world of difference in making sure she gets her pain meds and no more office visits. Her decline is slow, as you mentioned for your mom. Maybe new eyes on the hospice decision could get you different results. Good luck!
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