How do we invoke my mother’s health care proxy when her doctor won’t? She is suffering from significant diminished capacity and needs help.

I’ve been in this exact position regarding my own mother. I had to start calling 911 whenever she fell down or behaved erratically, and they’d quickly arrive and whisk her off to the ER. There, she was evaluated thoroughly (three times) and deemed diminished and in need of assistance and supervision around the clock. I dumped her DEADBEAT, money-hungry “doctor” and found her a new one - one who is attentive, caring and thorough. He answers all our questions, returns calls promptly and is so caring and gentle with Mom it almost brings tears to my eyes. He quickly assisted us in getting Mom the help and services she needed. I went striding into her old doctor’s office and DEMANDED a copy of Mom’s records on the spot. When the startled staff put that thick envelope in my hands, I sailed on out of there, loudly warning the PACKED WAITING ROOM that “Dr. Nobody” will take their money and then completely ignore them. One person actually APPLAUDED… and there are no words to describe how deeply satisfying that moment was.

Find a new doctor in my opinion take her to a geriatric doctor

Court of protection - or change her Dr. Either involve the courts to get her assessed (it might be surprising what a letter from a lawyer or a court will get her Dr to do), or simply move her to another Dr. It sounds like the one you have thinks of her as one of his cash cows and it suits him well not to lose his income from having her as a patient. Money for nothing is not care, so move and then see if you need to get the courts involved.

Definitely, find another doctor. But next time anything happens, call 911 to take her to the ER. They will do an evaluation/assessment. When the social worker talks about sending her home you say she is not able to care for herself and you cannot take her. The social worker should make arrangements to send her to at least a rehab facility initially. If she qualifies, immediately apply for Medi-Cal to pay for long term care.

Call another doc
preferably a gerontologist. Though not essential
Read some reviews on the new doctor. Look for words like ‘understanding ‘ ‘ kind’ ‘ patient ‘ used to describe the doctor
a woman will be more understanding (generally) about a woman’s needs
Dont complain about the last doctor. You will come off as the difficult party

If possible get a home visit & ask for what you want politely & clearly
Avoid “complaining & explaining”

Be patient with yourself and life
patience & a sense of humor can get you through even the most difficult of times
”acceptance & Adjustments are the keys
Keep your head up

Amerimum: Do NOT waste another second of your time with this inept physician!! Seek another physician STAT. The current physician should actually be reported to the medical board.

I think only your mother can designate with whom her medical issues can be discussed. You cannot just step in from "outside" and take over if she has not given the doctor permission to share medical informatipn with you.

You should be able to replace your mother's lifeline necklace. I'm sure that the company does this often when people lose them. You say that your mother thinks she is fine. Yet you do not agree, when you observe what she is doing. This makes things much more difficult, when people don't realize that they need more assistance. Is all of her paperwork in order, and are you the POA for her medical and financial affairs? If not, this should be done while she's still capable of signing legal papers. She also needs a living will with her medical directives. Most banks and financial institutions have their own POA forms, which she'll need to sign, hopefully you can go with her to the bank, etc. Also, you need to be on file with Medicare and Social Security as being able to speak on her behalf. You can do this with a phone call with her sitting next to you. First try having a talk with her about taking over some of what she is not doing, perhaps taking over her financial matters. If she agrees, have all statements sent to your address, and pay her bills, get all her accounts set up online to make it easier for yourself. Talk to her about getting aides and others in to help her with house cleaning, bathing, taking meds, etc. You have 2 basic options: have aides help her in her own home, or placement in an assisted living facility. You may need to speak with an attorney who specializes in elder law about activating the POA. Also get connected with a local social worker who can explain your/her options in your area.

Do it legally thru an elder attorney

My mom's HMO doctor refused to discuss mom's condition with me, evading me and hiding behind HIPAA, until local cousins managed to cajole a 'permission slip' out of my mom to allow her doc to give me details so I could get what she needed. It was frustrating and infuriating, not least because this doc was actually under-treating her (he knew I lived in another state, so was not witnessing her care/treatment.) If you mom is not able to give this 'Release of Information' ('permission slip' sort of thing to break the blockage) I would suggest switching doctors; easier than said or done I know, since many feel their longtime doc is akin to 'Doctor God' to them (my mom would get gussied up to go she her doc, like it was a 'date', lol) But sometimes you have to make an 'end run' around an obstacle. Consult an elder specialty lawyer/agency for ideas, too. All the best.

My mom's HMO doctor refused to discuss mom's condition with me, evading me and hiding behind HIPAA, until local cousins managed to cajole a 'permission slip' out of my mom to allow her doc to give me details so I could get what she needed. It was frustrating and infuriating, not least because this doc was actually under-treating her. If you mom is not able to give this 'Release of Information' ('permission slip' sort of thing to break the blockage) I would suggest switching doctors; easier than said or done I know, since many feel their longtime doc is akin to 'Doctor God' to them (my mom would get gussied up to go she her doc, like it was a 'date', lol) But sometimes you have to make an 'end run' around an obstacle. Consult an elder specialty lawyer/agency for ideas, too. All the best.

Get a new doctor TODAY.

File a complaint with the medical board against the current doctor once you get Mom sorted out. I'm going to guess that this has been her doctor for a hundred years, Mom loves him/her, and the doctor himself should have retired years ago. This sounds exactly like my mother's doctor who darned near killed her by prescribing antidepressants when in reality her lungs were filling up with fluid and drowning her.

Doctors can be replaced. There is no reason why your mom cannot be seen by someone else.

I also think you should try to get guardianship, but that can be an expensive process, so be prepared.

First and foremost, you contact the Office on Aging and Protective Adult Services who can step in to help. Second, you find another doctor at once. This is deplorable and you alone cannot fix this. She obviously has dementia and her actions and behavior are destroying you. That alone is enough - she must be placed, Get help from others to get this done. This doctor is dead in the water.

Please seek another physician immediately for your mother before it's too late. As her HCP and because of the mental state of your mom, she has already authorized you to intervene on her behalf.

Definately find another doctor. Health Care POAs and directives mean diffenerent
things in different states; But i think the doctorjust doesn't want to deal with the
problem.

Get another doctor. Send a letter to the state medical board describing your doctor's responses. Time to start a trail on this person. Not all nursing homes are terrible; some certainly are. Many frail people's home situation are also terrible. Start asking around about nursing homes in your community. Facebook neighborhood sites, Next-door sites ( a similar internet site, but smaller and more localized) can be helpful. Medicare has ratings of nursing homes online. You might check with your area's aging agency about available help or ratings of homes. Some cities have visiting organizations that check on people. It is a difficult situation, but not so uncommon as we become older and dependent. Was your mother married to a veteran, or a veteran herself, I believe there are resources with the VA. Good luck and bless all of you.

In short, you are putting all your eggs in one basket by relying on her PCP who -for reasons unknown - cannot or will not help you. I understand that your mother clearly needs supervision, but what exactly are you expecting to happen once you have the dementia diagnosis? You will still have the issue of a mother who will deny her limitations and refuse help. Then what will be your next move? You will still have to force changes on her, no matter what.

Try not to put her on the defense, on some level she knows her body is changing but she is most likely confused and scared internally. I know my mom was. Losing ones independence is frightening for anyone. You mentioned she is on the verge of pushing you and your brother away, why not re-set and invite her to be with either of your for the holidays where you can access (and document) her in a loving environment and perhaps win back her trust. She may then be more open to changes and suggestions such as in-home help. Enlist the help of her friends if you can.
Some steps you can take in the meantime is to visit her and access her current living situation. Be on the alert for everything that is potentially unsafe there. There is a clock you can buy - American Lifetime - which has a nice display and you can program an alarm that will ring (alarm will stop after one minute) and read out "take your medicine" as a reminder. Make sure there are no tripping hazards such as scatter rugs, wires, clutter, etc. Install a bed rail to help her get in and out of the bed, grab bars in the bathroom, brighter led lighting in lamps, motion lights for the darkness. Purchase and install a couple of wifi cameras in which you can monitor her from your cell. They are inexpensive and don't require monthly fees.(ex Wyze brand).
If her PCP isn't a cardiologist, find one and get her there to get her on the proper meds, plus perhaps get the assessment for dementia you want. I know that Medicaid has specific forms for this that would need to be filled out if you are planning to get Medicaid assistance.

If by some chance she ends up in the hospital, you do not have to accept release back to her home. If you tell them there is no one to care for her, the social worker there will help find you placement for her. Stand your ground.

Don't panic! You are not at the mercy of her PCP - move on and take control of this dire situation. Find a local eldercare advocacy group who can guide you through this process. I know it seems overwhelming now but you can do it, step by step.

Uneeds you plan to let her live with you in your home til she dies, you should let her stay where she is.
Nusing Homes are a Horrible Place to live! They are all understaffed and Patient to Nurse and Aide Ratio is like 21 patients to 1 Nurse and 1 Aide. They over medicate if they deem you trouble and you end up more like a zombie.
If you don't plan to have mom live with you, she's better where she is.
can she afford someone, Caregiver to drop by an hr or 2 in the morning and an hr or 2 in the afternoon?

If not, make a schedule and have a sibling, friend or other relative drop by every day to check on her.

Install a couple Nest Cameras so you can check on her 24 7 at anytime from your cell phone or lap top.

Go through her pills and see what they're for and see if any can be taken off her med list.

Mout Seniors are on more meds then needed.

But a weekly pill container and put mom's pills by the week, so each day she can take them and they'll all be in one place.

Beleven me, mom will be happier in her own home and actually just as safe if not more than a Nursing Home.

Prayers

Your brother, as mom’s HCP, can change her doctor. Find a doc that the VNA has worked with successfully.

You can get a healthcare proxy copied online and you sign it and she signs it . You have a couple witnesses . You can go to the bank and also have it notarized there with her . While your at it get POA also notarized and signed . Someone needs to help her if she is alone and falling . Switch Doctors . She needs help and a family intervention before she seriously gets hurt .

I can only say that a GP doctor cannot and will not diagnose dementia. The most they will do is diagnose cognitive impairment or cognitive impairment. I was told that we needed a specialist to make that diagnosis. Once it was done, with several days under evaluation, my sister was diagnosed with dementia. She was prescribed meds and it made a huge difference in her demeanor and attitude. She is now in assisted living, in her own apartment. But from what I have been told is that a determination of some level of incapacity can not and will not be given by a family doctor. They are not qualified/trained to make that call.

I don't know how technically ethical this is - and honestly I don't think in our case he really cared to be honest - but we needed to be on FIL's HIPAA and needed his permission. We wanted to be able to speak to his doctors because we knew he was starting to go downhill and we were going to need to start asking for assessments soon (getting ready to do it hopefully this month in fact) and we needed to have the ability to talk to the doctors. At least one of the four of us has to accompany FIL into the doctor because he needs physical assistance and honestly he has kind of checked out because he refuses to wear his hearing aids and we spend half of our time yell-translating for him. So we used this to our advantage. We asked the front desk to add us to his HIPAA. She asked him if that was ok. He asked us what she said, we yell-translated - I'm not sure he still even knew what we were talking about - and he said yes and she had him sign the paper and it was a done deal. I'm still not convinced that he actually knows that he gave them permission to talk to all 4 of us that day. And I KNOW he doesn't realize that at any point he could technically ask to revoke it. We keep that kind of information to a minimum. And we only involve him directly in what we have to when we ask the doctors questions. We discreetly pass off notes or put notes in the portal- which we have the passwords to because he never remembers and has us reset them. And honestly it has also gotten to the point when he isn't really engaged with his doctor and the doctor will ask a question several times and if he doesn't answer after we yell-translate he will ask us to answer - it would comical if it wasn't so sad. FIL only gets upset if he thinks it makes him look bad or he doesn't agree. So he IS listening. He is just often not wanting to participate.
But a bit of therapeutic fibbing has gotten us to the place we need to be I guess. His physical need for accompaniment became our saving grace because we knew he was leaving out a lot of pertinent information from his doctors when he went alone.

Sorry to hear about your Mom. Your family will have to take over and make decisions for her. We had a similar situation and had a intervention with my Mom and family. There were tears, but necessary because it was for her safety and well-being. Once she was in the hospital, we had her discharged to a ALF. You can call “A place for Mom”. Who can help with the search. I found doctors usually do not get involved. Establish Healthcare Proxy, POA or guardian. Best of luck!

In what state do you live?

" We can’t force her to a doctor. She’s doesn’t go unless the doctor office calls her for a required visit after her hospital stay."

How does she get to the doctor's office for the post-hospital appt? Does anyone accompany her?

"He has said she is not safe in her own house, but won’t engage with us so we can get her the help she needs."

When did he say this? Did someone accompany her to an appt?

Take her to another doctor immediately and ask for a mental capacity evaluation. She will get a more thorough evaluation from a neurologist as well as a more pinpoint diagnosis so she can be treated. After having her declared "mentally incompetent", please put everything into place to have her well cared for.

I would also suggest you contact a lawyer who deals with medical malpractice. Since her doctor is not acting in her best interest.

You are saying "we". Actually the health care person at least in our country is a single one, with perhaps a second, or at most two appointed under an advance health care directive. This person can communicate with the doctor, etc when the elder is deemed to be incompetent to manage own health care.
Firstly and most importantly is to deliver the advanced directive or health care proxy papers to the physician's office. Also the person who is appointed should be there. There will be no communication with "we" but should be with this one person. IDentification may be required.
Explain when you visit the office your difficulty in getting anyone to speak with you. Let them know that you will report them to the entity that regulates medical licensure in your area.
Do know that if your Mom hasn't been deemed incompetent, and has expressed to her doctor that she doesn't wish her health to be discussed with others, they are under no obligation by advanced directive or proxy to speak with the appointed person. This comes after diagnosis.
Unfortunately, with an MD who will not even speak with the concerned proxy a Lawyer may need to be the first step for temporary guardianship and the neurological exams JoAnn mentions.

You need a Neurologist. He will run the appropriate labs to determine that its nothing physical wrong. Then an MRI that will show if she has a Dementia. He can do a simple test to judge her capacity and competence. Does she not have a cardiologist? Dementia goes along with heart problems especially CHF. Not enough oxygen to the brain.

If she lands in the hospital again, ask for an evaluation. I would also have a doctor there look at her saying that her PCP has been no help.

Until your POA and HCP come into effect, no one will really talk to you. If they do its a courtesy. But, I think Moms PCP is handling Moms situation all wrong. If the problem is he can't talk to you because you aren't on the HIPPA paperwork or HCP is not in effect than why does he not tell you that and say that Mom is not competent? This doctor seems to be a jerk. He won't even respond to a Visiting Nurse. I have no idea why doctors do not want to declare someone incompetent.

I suggest either someone stays with Mom or you bring her for a "visit" to one of your houses. She should not be alone. Get Mom another PCP. She is on Medicare so you don't need a referral to a Neurologist. If she had Medicare Advantage you need to talk to them about changing doctor's and referrals.

I would find another doctor and accompany her to every visit. I would also call back and be sure to get the name of the idiot that hung up on you. That needs to be reported to the doctor and the licensing board, against him, if he doesn't take it seriously.

Unfortunately, because of past abuses by ill intentioned individuals, autonomy is protected to the detriment of many seniors. Leaving the family to wait for the emergency that takes away choices.

Next time she is hospitalized, start telling all of her care providers that sending her home is an unsafe discharge and you all need help. Repeat often, to everyone until you get help.