How to choose a primary care physician in an assisted living facility?

Msblcb: The most logical response to your question is to consider the fact that an assisted living facility will have an in house physician that is better suited to take care of your elderly loved ones' needs in lieu of them having to traverse out of the building, causing hardship for your loved one.

Check out the in-house person. Is this a gerontologist, internal medicine or family practitioner? What kind of reviews do they have from patients and colleagues? Any history of malpractice? How long in practice there? What did they do before? What support staff do they offer? Mom loved her PCP before she moved (I did not!) Her senior residence has a gerontologist on staff. He is much much much better at accurately diagnosing the types of problems seniors have, and is super responsive. He is supportive of families and appreciates their involvement. His nurse practitioner is top notch too. We definitely lucked out with this.

In my experience, PLEASE STAY WITH HER OWN PCP! I have no choice but to have in house doc. The guy is a QUACK!
I have Bipolar Disorder. I can tell when my meds need to either be adjusted or changed altogether. A few months ago I told the "Dr." -and I use the term VERY loosely-that I needed to change either the dose or the med altogether. Long story short, he didn't do ANYTHING until AFTER I did irreversible harm to my relationship with both my oldest sister who'd been there through thick and thin and an old friend who I had for 50 years. BOTH of whom want nothing to do with me-I don't blame them.
Stick with what or in this case WHO works!
Good Luck.

you can keep your PCP in an AL. However, any prescriptions or notes from the appointments must be given to the "Med Tech" the person who handle the medications-or the unit manager. And most appointments are made though the facility, unless other arrangements are made prior to moving in or shortly thereafter.

Good Luck

I’m 1985, My mother was in a nursing home that became an Assisted Living Facility. As long as it was possible I took her to the Geriatrician she had before placement. At some point - around 2003 - we transferred her care to an in-house MD. She’d had no serious medical condition except for dementia and whatever caused to not be able to walk. The in-house doc discovered an oozing lump on her breast and recommended a lumpectomy. She was 98. I had had a lumpectomy and knew that even my tho mine was a tiny CA it required effort to recover.
Point: if a procedure is recommended check out the recovery time, the effort involved by the patient and risks vs benefits. I didn’t hesitate to say “no.” Mom died peacefully at 99.

Is the current PC a gerontologist? If so, I'd keep him/her as they have history w/your parent. My in-laws had a PC assigned by their insurance. He was family medicine w/residency is ob/gyn! When they went to AL, we changed them to the gerontologist who serves the facility who came to see them shortly after the change.

Always!! keep your original primary care doctor and never use the one at the facility. I worked for one doctor who had 6 NPs and 1 PA on his staff. He contracted to service all the senior care facilities in the city. He spent most of his time traveling. While the NPs and PAs were great, we were stretched too thin and turnover was atrocious. I could not give good medical care so I quit after 3 weeks. I felt I was violating my oath to do no harm. I'm sorry to tell you this but medicine is a business these days. Stay with your primary care doctor and please do not blame the NPs and PAs. They are truly overloaded.

And by the way...every single medical chart I reviewed had atrocious medical errors, wrong drugs, and misinformation in them, including weight and diagnosis. When I asked the families to meet with me so we could discuss care and I showed them the medical chart, they were as shocked as I was!

It really depends on the doctor. Please check reviews on both doctors and go with what is a better fit for your lovedone.

Yes!

A lot depends on the quality of care your LO receives with either choice. My mom was in an ALF and the in-house doc there was a joke. No one knew when he was coming so we couldn't be present. He'd pop his head in and say, "Good-morning and how are we today?" Mom, hard of hearing and often confused, didn't even know who he was, so he'd call that a visit and move on. Yes, it was convenient, but...

My DH is in MC now and their in-house practice is wonderful. He's seen monthly by a NP specializing in gerontology. More often, if needed. She's personable, smart, and thorough. The portal is a great way to keep in touch and also alert them to any concerns I have as a family member. I know when she's coming and if I'm not there, she always calls me to let me know how it went.

Like everything else, there's no one correct answer, but some pros and cons to consider. I would maybe make sure you could change your mind if the in-house providers don't work out for some reason. Good luck with your decision.

A lot depends on the quality of care your LO receives with either choice. My mom was in an ALF and the in-house doc there was a joke. No one knew when he was coming so we couldn't be present. He'd pop his head in and say, "Good-morning and how are we today?" Mom, hard of hearing and often confused, didn't even know who he was, so he'd call that a visit and move on. Yes, it was convenient, but...

My DH is in MC now and their in-house practice is wonderful. He's seen monthly by a NP specializing in gerontology. More often, if needed. The portal is a great way to keep in touch and also alert them to any concerns I have as a family member.

Like everything else, there's no one correct answer, but some pros and cons to consider. I would maybe make sure you could change your mind if the in-house providers don't work out for some reason. Good luck with your decision.

All good reasons to keep in-house docs but …

check billing.

my mil was in mc and dying. Facility called me at work and i came over. I was a nurse aide working evenings.

after she died the nurses told me that they had called the doc but he wouldnt come. BUT he still sent us a bill for a visit.

i wrote him a nasty letter and said we’d better never receive another bill from him etc. if he was asked to come up didn't show up.

i can understand him not going but dont bill us for a visit !

he never contacted us again.

so i would ask about the doc’s role … is that the only facility they service or are there more or are there more facilities AND a regular practice or ??? Is a bill received … or sent to medicare/medicaid … automatically just since they service the facility even tho you see an outside doc ?

My mom is still in her senior apartment in a senior community. Her mobility is steadily declining and most of her day is spent in her wheelchair. Right now she can transfer to bed & toilet. She has PT caregivers.

Mom has a wonderful primary from a Visiting Physicians group that comes to her. Unfortunately there are no after hours care except the ER. Mom does have mobile lab and Imaging services. She is also enrolled in palliative care due to her dementia. Our goal is to avoid the ER and a hispitalization if possible.

If she moves to ALF I would definitely use the in house physician because of convenience and timeliness of care.
Fortunately for us mom's primary also is part of the ALF team.

As aging increases so does the health issues they are dealing with now. There will be more needs for doctor visits

I need to "expand" my answer a bit. My Mom is still mobile, therefore it is easy for me to take her to her appointments. She really likes going out. Hence, continuing with her current PCP is an excuse to take her out and I have the time. Also, I am happy with the care her current PCP, a geriatric doctor, is giving her.

Should there come a time when it is too risky for me to take her out, I will look at changing her PCP. In that search, I will consider doctors that make house calls (very few do), as well as doctors within the in-house physician group.

When we get to the stage of palliative care, I will definitely change the PCP to an in-house doctor.

...yes, some doctors will "ghost" patients for various reasons. In fact my Mom's previous PCP took longer and longer to return calls. That is what prompted me to move her care to this geriatric doctor, whom so far, has worked well.

With my mother, who lived in a continuing care residence, it turned out to be much more convenient to use the in-house primary care physician. As her health declined, when she was in assisted living, the in-house PCP would make calls to her room, if she wasn't feeling well. He also was there to do the paperwork for her transition to skilled nursing when that was necessary. He was an excellent geriatric physician who had a good manner with seniors and didn't over medicate. Be sure that you know your loved one's advance medical directives. There may be a time when you want to switch from an aggressive approach to "fix" things to a more gentle approach of just keeping your loved one comfortable.

We changed MIL and FIL PCP from the one they had for 30 years to the Assisted Living Facility PCP. For a couple of reasons but primarily in house PCP can see them almost immediately. Within a day usually. The Nurse Practitioner is on site 5 days a week. If I request I can be there for the visit or they can coordinate the video call so I can see and hear. I get copies of all lab work, imaging, physical therapy that are done. It was a difficult decision to change doctors but well worth it. Assisted Living doctors specialize in geriatrics. That's their specialty.

Two family members in a home, one AL the other MC. Both use the homes primary care physician, if a specialist is needed then we decide who and where.

They both have good portals so we can check on everything right there.

The whole purpose of AL is to manage your loved one's life in one place. I like to call it 'one stop shopping', kind of like my insurance *Kaiser* works for me. I go to one place and get almost everything taken care of. My PCP, prescriptions, blood work, etc. If you use the PCP at the ALF, then you get to manage your LOs care in one place too. You get to set appointments w/o having to schlep them out of the building, the PCP can arrange extra services like blood work/tests/xrays etc from traveling companies while s/he is there visiting your loved one, and so on. So if the PCP sees mom today, for instance, and notices a swollen ankle, she can order the xray tech to come in and take some xrays, send the results to her, and then she can order meds to be delivered directly to the ALF. That, to me, is one stop shopping. Plus, she can also order physical therapy which is normally located on the ALF property, and coordinate it with the nursing staff. Everything is taken care of FOR you and your loved one in house vs in 12 different locations YOU are driving to. Plus, there's the added benefit of being able to call the ALF nurse and get an update about what happened at the doctor visit, and get messages sent back and forth to the doctor. Win/win.

Good luck!

I kept my Mom’s PCP. Throughout her life, my Mom became combative and refused to follow their advice if she saw a doctor she did not believe in….and there were quite a few. She was a registered dietician and came into contact with quite a few of them who prescribed pills rather than a change in diet. In addition, many of her brothers and sisters and my cousins are doctors.

The reason I didn’t want to switch was that I wanted a doctor who was familiar with her medical history and provided more holistic care rather than “treat the symptom”. I also wanted a doctor who would involve me in any decision he made, whether it was an over-the-counter stool softener or a recommendation for compression socks. No more blood draws. The last time that we got a blood draw from my mother, it took over 30 minutes and a lot of bruising afterwards, because of poor circulation and they barely got a half of a vial.

Having an external PCP means I am present for all visits. It also means that I can answer any questions she has and bring up items that occurred in the past. It also means I am kept abreast of any and all treatment that my Mom has, therefore less likely to fall victim to Medicare fraud.

If I had signed over my Mom to the in-house practice, my Mom would have gone to the emergency room 5 more times in 6 months to get X-rays to ensure she didn’t have a concussion, a stool softener would have been added to her daily pill regime because they wanted BM every day regardless of how much and what she ate, she would have been checked out for UTI more times than I can remember as she started into another down cycle of dementia and she would be back on high dose prescription pain killers since she is resistant to most prescription pain killers.

I want to be totally involved in her care. Not everyone has the time or wants to be that involved.

I'd use the in-house one. The one at my mom's place checked out all the patiients at least once a month regardless of whether they needed to be seen. (Obviously those who needed to be seen for specific issues were seen more often.) I liked that he clapped eyes on my mom often enough to be familiar with her.

The only thing I didn’t like about the in house Dr situation is appointments where not in stone… meaning, set fit 12:00 but they came at 9 , or even the week before… BUT , they had a great patient portal for good communication

Going with the in house physician is often a good choice, because as in my brother's ALF, some of them have a PA who stops by, keeps an eye on diabetes numbers, blood pressures and such. HOWEVER, in some areas this means that you have to go on their special medical plan and insurance. If that is the case and you are satisfied with your own supplemental and your own doctor, I would keep mine.
Discuss with the MD service at your facility what your options are and does it mean you must change your supplemental plans would be my advice. It would be more convenient to have the MD at the facility but you need to understand all this means. For instance, in some areas it means you go to an entirely different hospital when ill.
I wish you good luck in exploring this option completely and trust you to make the best decisions for yourself. My best wishes out to you.

How often does your LO have to see the doctor?
How easy is it to get them out to see the doctor?
How well does the current doctor care for your LO?

If your loved one needs to see a doctor every few months it might be easier to use "in house" medical staff.
If getting them out is an ordeal and sometimes unsafe then using "in house" medical staff would be safer and easier.
If the current doctor spends their time looking at the computer as they are writing notes rather than looking and talking to your loved one and you if you are present, if your loved one is a patient number and not a person then using "in house" staff would probably be just fine, as they are getting input from the AL staff as well.

The in-house doctor usually sees several people in one visit, which is more cost effective for the doctor.. This avoids the need to take your LO out for the appointment, or to try to arrange a ‘home visit’ - which may not be possible or may be a much higher charge.

My MIL managed to fall out with the in-house doctor because he wouldn’t prescribe her favorite sleeping tablet (understandably – it’s now on the banned list). The result was that my DH had to spend most of a day each time she needed a doctor’s appointment, as no doctors near the NH did home visits.

My LO is in a NH, not an ALF so maybe it's a little different, but we use the "in house" person for primary care. In fact, I had called the primary care doc's office (the one she'd used for many years) to inform them of the move to a facility and they actually discontinued her as a patient. They said protocol for general care is to use the in house and an outside primary care doc is not needed. I was fine with this as I really didn't know. Specialists are a little different, but the majority of those issues can be resolved via the in house doctor(s) as well: podiatry, diabetes mgmt, ortho issues, dentist, eye doc, etc.