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Mom takes Tramadol (Ultram). She is 91. She has no more cartilage in her right knee. She has osteoarthritis. She suffered a fall in her bathroom and was transported to hospital. She had CAT scan, executive panel blood work, X-ray and ultra sound,(she has a pacemaker so no MRI).


Hospital suspects TIA. I believe it might be her second based on a previous episode. She has not seen her Internist in a year because she was unable to sit for the long waiting period prior to seeing her physician. And, she doesn't want to be 'messed with'.


She uses a rollator to move from her bed to toilet, it is a very long and arduous process and is incredibly painful for her especially after her fall.


Her doctor refuses to refill her Rx without seeing her even though his office has access to her hospital records from one month ago. It makes me wonder how bedridden patients that are being cared for in their own homes get their meds?

When you call in just answer the questions as the patient and they will fill it unless you don't have a doctor's order. Sign up for a home Pharmacy dealer as long as they communicate with the doctors they will deliver the meds. Good Luck
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Reply to Mchllc1
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Is she living in a care facility or in a private home. I guess I did not see what type of care she has and housing.
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Ruffles63 Aug 9, 2018
Mom is in her own home. My sister and I take turns staying with her.
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A few suggestions:
Home Health Aides
VNA
RX by mail
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Reply to Llamalover47
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Oh boy, not a pretty picture here for either her doctor or the assisted care facility.

Have the State send a person who works with Adult Protective Services. Make sure that they meet you at the facility under the guise of being a friend who has come with you to go out to lunch, let's say. Make sure that the door is closed so that the staff cannot hear what is going on; hopefully Mom is in a room by herself.
Ask APS to also have an RN or RN practitioner tag along too.
Call her doctor, make an appointment to see him/her and find out WHY they will not send someone out to checkup on her and do a wellness exam.
The assisted living facility I have my Mother in now has a contract with a Mobile doctor's practice and they come every month to examine every single resident.
Do you have any family members close enough that they can help by stopping by unannounced periodically to see for themselves what may be going on.
IF the staff tells you it will be just a minute or two before you can enter her room...ALARM BELLS should be going off!!
Walk in immediately just so you can see why they want you to wait.

A friend of mine, her Mother died in a care facility and it wasn't until the Mortician was doing the exam required by the State, they had to call the police in on the death because he found bruising in areas that shouldn't have been, slight skull fracture as well.

I don't know what the outcome was with the investigation, but I do know that they changed the death certificate to suspicious.
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Reply to dkentz72
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In this town the docs dont start their clinics until 9am and spend from 8am visiting such situation patients in their own home.
One that means they are not holding up the rest of the clinic, the Dr can assess the situation better by seeing the environment and no pain to the patient.
In the cities there is often a taxi that is set up for wheelchair clientele, .IF you could phone around and see if there is one near you.
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Reply to muffincat
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I had a similar issue after my mom had a stroke.She couldn't walk very well,and her doctor didn't have a handicap ramp.Due to some grandfathered law he didn't have to.I asked if he wouldn't mind making a house call when need be,and he agreed.My mom was a long time patient of his, and it wasn't a huge inconvience since his office is near the house.He would come by at the end of his work day.Ask your mom's doctor if he wouldn't mind doing the same because of her mobility.I hope it all works out for your mom and you.
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Reply to Concerned43
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HomeHealthCare can arrange for a home visit by a doctor/nurse practitioner and they can prescribe or call the doctor for refills.

Requesting to see the person before refilling is actually a good practice. How many people do you know who have "handicap placques" for their vehicles that have been handed down from deceased relatives?

No patient - really should be no refills. Call HomeHealth and arrange for her to be seen and evaluated.
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Reply to RayLinStephens
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Need to check with local resources and find an MD that makes home visits. Not many are out there but hopefully you can find one.
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Reply to gdaughter
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My Husband was on Hospice the Nurse came to us and ordered medications.
We also had the VA and the VA has a Home Based Primary Care so the Doctor came to him.

But if your Mom is Hospice eligible that is the best way to get the meds she needs.
The nurse will come to her, the medications will be delivered to your door. I suppose one of the down sides is the medications will be delivered in 1 week supplies not a 30, 60 or 90 day supply. But the nurse will come every week and the deliveries will come every week.

The word Hospice scares a lot of people. Many think that it is for the last days of life or at most 6 months. My Husband was on Hospice for 3 years. As long as there is a continued, documented decline a person will/can remain on Hospice. You will get supplies delivered to your door, equipment delivered, you will have a Nurse that will come every week, a CNA that will come a few times a week to help bathe her you will have a Social Worker, Chaplain as well as access to volunteers that will, if you want, come and sit with her while you run errands of your own or just so you can get out and relax and have time for YOU. there are also Art, music and other therapists that work with Hospice and you can use those services as well. All from the comfort of your own home and this is covered by Medicare so it will not cost you.
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Reply to Grandma1954
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It sounds like she may be a candidate for hospice in which case they would come to her for visits and supply all the meds she needs.
If you can't get her on hospice you could apply for adaride.com. I did not find out about this service until recently and it has been such a good thing for getting my wheelchair bound mom out of her memory care facility. Mom never has to get out of her wheelchair and companions ride free. Cost is only $3.50/ride each way which is so much cheaper than using private wheelchair transport services. Not sure what all areas of the country they service. Can do the application process online and it just needs a doctor to fill in the form which confirms your mom is not able to ambulate independently and would not be able to ride a city bus independently. Persons with cognitive impairments also qualify since they could not ride a bus independently.
Hope this works out for you.
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Reply to Marysd
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Dear Caregiver,

Inquire with Medicare or your current physician about assigning a visiting physician.

I Just signed my mother up. We've had one very encouraging visit thus far. Many home services are offered: dentist. physical therapy, lab technicians for bloodwork ect

Help is available -
Stay encouraged! ⚘🌹😊
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Reply to ACaregiver
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I’m so sorry for you and your mom. This is very tough for both of you. I, too, am going through the same issue. I finally had to firmly request a “phone visit” with her doctor. She wasn’t able to have this service until we switched to Kaiser, however. My mom is very immobile. Her doctor also ordered mobile lab services.
They normally don’t announce this service but call and ask the insurance directly.
Plead your case of your mom’s immobility and hardship to her health. Unfortunately, some people use this as a lazy way not to get up and go to the doctor and they are very strict with this service.
I hope your mom can benefit from the “phone visits”.
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Reply to ScrimbleB
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Good Morning Ruffles63

My Mother has recently became bedridden after being hospitalized.

She is on home hospice from the hospital since June. I am not sure how long she can stay on home hospice
My mother has Alzheimer’s disease and is in the end stages of the disease,
I had the same problem her doctor wanted her to come in to follow up and meds refills she is still bedridden and can’t go anywhere.

I had to change doctors, I was referred to a doctor who does home visits and also works wiith hospice and goes to nursing homes, daycares centers and has an office as well, he works with a group of doctors and referred me to a podiatrist for mom as well.

You may have to do the same.
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Reply to faith05
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I got my mom a bedside commode so she could use that at night instead of trying to get to the bathroom. I would try every resource possible to find a home service for your mom's medication. Everyone failed me on this a few years ago...My mom had a UTI, her doctor was a coward who wouldn't prescribe an antibiotic because he wanted to send her to a urologist. She was not mobile. Her rehab nurse got a nurse practitioner to come in for the medication. All this loser woman did was talk about herself ....then she disappeared without getting mom the medication. Until my mom was on hospice, it was a battle to get any help she needed. I hope things have changed from a few years ago. Try a bedside commode to make it easier on your mom and keep trying. I hope people are kinder to you than they were to us.
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Reply to Katie22
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Hi Ruffles,

The easiest way may be to start with your mother's insurance company as they should have that info. If they can't help you try calling nursing homes and ask them what doctor comes to see their patients. I know the home health practice that I found travels to some nursing homes in our area as well so that may be a lead for you.

There are also traveling Physician Assistant groups that can prescribe or renew meds as well.

This is one of those areas that is tough to find but once you do it is worth it.

Good luck!
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Reply to PaniniSandwich
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Are physician house visits and mailed prescriptions an option for them? I know my pharmacy offers a mailing service for no extra fee. My grandmother's primary care doc used to come every 3 months to do a health/wellness check and Medicare was paying for these visits.
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Reply to AliBoBali
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See if you can find a geriatric primary. I think they are more willing to work with seniors than folks who treat all ages. Ask about hospice or palliative care. Has she seen an orthopedic surgeon?
My mom wasn’t a candidate for surgeries so her ortho ordered ongoing physical and occupational therapy to keep her muscles strong. The Home Health managed this care. Since your mom is home bound she is probably eligble for ongoing home health. An aide will also come to bath her. You need to consider a more “user friendly” doctor.
My aunt has HH, a geriatric dr and ongoing PT. It’s been over a year since she’s seen her geriatric although we are in communication as needed.
She does not take pain medication. Perhaps if she did she would have to go in. Not sure. She does take 5 prescriptions.
The type of Medication has rules attached. Also the doctor may have restrictions based on their own conduct.
Ask your pharmacist about the South Carolina laws for your mom’s drug.
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Reply to 97yroldmom
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When mthr graduated from hospice because she was doing so much better, I realized I was not willing to do everything it would take to get her out and about to the doctor office. And what abut flu season, where 95% of the waiting room is contagious? That would probably kill her right there!

I immediately (after asking here) looked on the internet for visiting medical doctor services. I found one in my state, and it turns out that if the person is mobility impaired, there is no extra housecall fee. That applies if the person is not able to leave their home without help. So your loved one is eligible.

The service sends out NP's but they are overseen by a doctor. The services are very basic for med checks, bp and pulse, but it complies with regulations. Mthr gets her meds and we are all happy. She can go back to her regular doc, but she likes the convenience of a mobile xray unit and the phlebotamist taking her blood in her easy chair!
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Reply to surprise
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Both my parents are bedridden. Their primary care physician put us in touch with a geriatric group that makes house calls. We live in Northern Virginia. A doctor or nurse practitioner comes to the house and prescribes meds. Please check with your doctor to see if such a service is in your area.
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Reply to demstress
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I guess she is taking Tramadol for pain? This drug has side effects. Weakness and dizziness are two of them. My Mom had hallucinations from it. I was told its not a med recommended for the elderly.

Its a law that her doctor cannot represcribe her meds without seeing her. This med is a controlled substance so under strict rules. It has been suggested on this site to have her transported. I know you told them the situation. Did u ask if he has a Nurse practitioner who could come to the house. Maybe find a traveling doctor. Any doctor can prescribe Tramadol.
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Reply to JoAnn29
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Ruffles63 Jul 25, 2018
Thank you JoAnn!
I am aware of the side effects. She was on stronger opoids several years ago but those she did have side effects with. She's been taking Tramadol for several years without side-effects. Her rx is one every 8 hours and she normally took one or two in a 24 hour period.

It's good info on the Nurse practitioner; I'll check that out.
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Because of Medical Malpractice Laws, physicians are bound to see each patient at least once every 12 months. That’s
true for everyone, elderly and disabled or young and healthy. It doesn’t matter what medications they’re on. For those medications to be refilled, doc has to see their patient.

My husband is on a whole slew of meds as well. And, he is also bedridden. When hubby was in the hospital and rehab, he did not see his regular PCP but the doctor on-staff at the rehab. When that doctor changed his meds, there were no refills on those prescriptions. Technically, when hubby left the rehab/hospital, he was no longer under this doctor’s care.

The discharge planner told us to see his regular doctor within a month after discharge. His doctor did have all the records from his hospital and rehab stay prescribed by those doctors and refilled the prescriptions. But, we did have to make the trip to the office.

We are lucky in that that we have Community Paratransit, a wheelchair accessible van comes right to our door. It’s not free, but it’s cheaper than Medical transport. We have a lift and a power chair and it’s a monumental struggle but somehow, it gets done.

If you absolutely cannot get her get her out of the house, many large hospital systems have a group of doctors who make home visits. I’ve considered this because of the work involved getting my husband out. Check the hospitals websites in your area or call their social services departments for information.
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Reply to Ahmijoy
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Ruffles63 Jul 25, 2018
Thank you, Ahmijoy!

I will have to check on the Paratransit situation here in Columbia, SC.
Inside Mom's home is 'disabled-proof' but there are stairs that must be navigated from the outside. Mom's 5'9 and 200lbs so not the easiest person to manuver. I will definitely check on the transport.
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Since Ultram is only a schedule IV drug, it can be called into a pharmacy. You say the internist hasn’t seen her in a year? That’s the reason. By law he must see patients every 6 months. So she’s long overdue. I hear you about sitting in the doctor’s office waiting but the doctor has a lot of people to see and that’s why they ask you to bring her in.

I think there are some doctors that will make a housecall. The hospice industry requires a doctor to see patients on hospice wherever they are be it a nursing facility or in their own home.
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Ruffles63 Jul 25, 2018
Thank you HolidayEnd!

It is the lowest schedule drug but even so I was told that there is a booming street-side business in selling this drug. We had to sign waivers that we would not sell the drug.
It's evidently a weird drug since a lot of people have laughed when I told them how effective its been for Mom. The usual response is 'I might as well drink a glass of water to get the same amount of pain relief.' I don't get it but...
I understood completely the 6mos stipulation I just thought that after all the test a month ago they could just refer to that since her Internist and hospital are affiliated.
It did make me wonder how on earth chronically bed ridden patients get their meds refilled.
Now, I know!
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I think it is a law that they must see the person at least annually to fill rx. It is a pain in your situation but if you think about it, it makes good sense, things change and reassessment is a needful thing.

Check into home visits. There are tons of dr groups that will come to her. Contact your insurance, hospital, local area on aging care, do a Google search, look in the phone book I'm sure you will find someone.

In the mean time, did she see a dr that was not the hospitalist at the hospital? If yes, call them and ask if they would be willing to write a 30 days script so you can find her a new PCP.

Best of luck!
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Reply to Isthisrealyreal
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Ruffles63 Jul 25, 2018
Thanks Isthisrealyreal!

Like your name, by the way. I ask that question several times a day these days.

She did see the hospitalist while in the hospital. The tramadol wasn't addressed since she takes it very little. Her last refill was from a year prior (for 60 days)and she still had a few left. Her pain in the hospital was superseded by her pronounced confusion and obvious mental decline. TIA was suspected and that was the focus. But everyone has made superb suggestions and I am going to pursue each one.
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