Does anyone have a suggestion on whether, when transitioning to an ALF, if it is better to keep your current primary care physician you have for your loved one or change to an “in house” primary care physician?
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.
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
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.
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.
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.
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.
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.
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.
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 ?
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.
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.
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.
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.
Good luck!
By the way, no guarantee you'll see the PCP for every visit. If they have a little business within their practice, he/she could send an NP instead
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 ?
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.
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