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I recently placed my 81 year old mom in a care home. She had a stroke 6 years ago. Dementia and Alzheimers followed..progressively getting worse. She can still toilet and take showers independently but is unable to write, pay her bills, drive and manage doctor's appointments, cook, clean and pack out meds and take them when she should. I have been handling these activities on my own so she is half and half with adls. I figured AL was the solution.


Yesterday the house doctor visits her for the first time. Talks to her for 30 minutes and then tells her she doesn't belong there. He then calls me and reads me the riot act about how would I feel if I was dumped in a facility. Tells me I should understand what happens when an elderly person has a UTI..which she did prior to moving her but I saw decline prior to that. He then tells me need to figure out what to do with her. This conversation occured as my mother was sitting next to him. She is particularly lucid right now but I know her memory loss is bad because I know the facts.


I have already received an apology from the owner of the facility. This doctor is an independent provider and does not work directly for facility.


What do I do now? My mom called me last night to ask when she was leaving because of what this doctor said. She wants to come home or live in an apartment alone. She cannot live alone.

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Your story makes me livid! The doctor's behavior is beyond reprehensible. How dare him question your decision to place your mother in a care facility. Many residents in AL are high functioning, i.e., can pretty much take care of themselves with little help from the staff.

“How would you feel if you were dumped in a facility” is an outrageous and inexcusable statement. I'm sure this doctor has never been a caregiver, nor does he understand the emotional and physical toll caring for a LO with AD takes on the family.

If the facility director has apologized to you for the incident, you might ask for the doctor's dismissal. Your's is only one case. How many other families has he embarrassed or made to feel guilty?

Don't move your mom. Stand your ground. As Ann suggests, get a assessment in writing to support your decision. If she's already been diagnosed, get a statement from that doctor.
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To give everyone an update... I'm not sure what you would call the doctor I don't know if he has a contract with the facility because they do bill insurance. He's been working in this facility for 3 years but he also has a private practice where he sees other patients so that's why I'm a little confused.

I have talked to the facility director who reassured me that they would be looking for a new provider and that they would take my mom to any provider I wanted them to. The facility is approximately 40 minutes from where we live which is where my mom's regular primary care and neurologist are.

They apologized again for the doctors behavior said that he has never done that before and they were shocked by the fact that he would even say something like that.

I'm leaving her there for now as I really like the facility and the people that work there just not the doctor.

Thank you for everyone's support a lot of you brought up the same issues that I had of how unprofessional the provider was. I have forbidden him to see her and they better follow through on their promise that they will find a new provider to come into the facility.

I politely threatened them and told them I would pull her out in a heartbeat. That if that were to happen I would be reporting them to the state and the doctor to the medical advisory board.
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disgustedtoo Sep 2021
GOOD FOR YOU!!!! I would follow up with them, to be sure they do change providers, not that they really need one. She can see her own doctors, which is better, if she's been with them a long time.

To the best of my knowledge, mom's facility (IL/AL/MC) did not have a doctor affiliated with it. Mom had her own providers that we would arrange to see.
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You change doctors at once because this one sounds pretty insane, to tell you the truth. Your Mom is in Assisted Living? So was my brother. He was "with it, able to walk on good walks with his cane, up and about, out and about". But there were reasons and indeed not as many as you describe you Mom having. I also had (one) medical person tell me "It is too early for him to enter care " and I would even visit him in his small home to make sure he was OK. However, both my brother and I made the decision for him, knowing he had balance issues and he has a diagnosis of probably early Lewy's Dementia.
You say this is an "in house" doctor. THEN you say this doctor is NOT affiliated with this Assisted Living Facility, so I am confused. But first of all, ANY doctor who discusses this in front of a patient is nuts. First of all, if she is perfect then it is up to HER when to leave; what does it have to you. He can send her home. Why would it be on you to decide "what to do with her". Secondly, you tell us your Mom has a dx. of Alzheimer's Dementia. Yes, a UTI may have brought this placement choice to a certainty. Yes, she may be better. Which is GREAT!. But yes, ALF is the right place for her.
I am irate. It all you say is true this physician should not only be banned from your Mother but should be reported to the licensing board. He is not only inappropriate, but he sounds completely loonie.
I sure hope you will update us after speaking to administration about how to proceed with a new doctor and reporting this one.
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You say that this doctor doesn't work for the facility. Someone has arranged his services and in my experience, it is the facility that does this.

You had to have signed up for this service, if not, you have to get the authorities involved pronto, because receiving medical care without consent is illegal. And this jackazz is causing harm. Go after his license if he was not approved by the POA to provide services.

My dads facility had a set up with a "doctor" that would come to the facility, what they neglected to tell us was that they would be coming in twice a month. Whether he had anything going on or not, 200.00 bill to his insurance company. Unethical behavior to say the least. I would file a complaint against him and his office, who needs to see the doctor twice a month? Besides being on hospice this kind of setup is nothing but insurance fraud. (My personal experience, these "doctors" do this type of work because they are incompetent and can't hold a job or patients in private practice and they should never be able to treat anyone.)

If your mom is convinced that she can live alone, then she can arrange for her own move. No assistance from anyone to prop this up. I had to do that with my dad and he eventually got well enough to actually pull it off. The point being that he had to work harder at his mobility and taking care of himself to be able to do it and it ended up being a good thing for him. Just the trying is beneficial for anyone, so let her know that she is free to do whatever she can do, that doesn't mean ordering others around and having someone come pick her up or anything else, she must do it.

I would also be telling the owner of the facility that their service provider needs to be replaced and stay away from your mom. I would also tell them to deal with her, it is their fault that this guy had access and did this, so they can deal with the fallout.

Sometimes we just have to step back and let our elders figure it out or flounder.

Don't get sucked into the bs from this idiot. Putting someone in care IS NOT abuse. I think that I would speak with the owner and ask them how they see that accusation working out, because they have committed fraud if mom really doesn't need care. I know that a needs assessment was done, it is standard procedure all based on what they can charge. So they accepted an individual that had no care requirements and they are charging for care not needed and their service provider is accusing you of elder abuse by placing her, please dear owner, help me understand exactly how this works?
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Tyger;

My mom initially went to AL and it was "too much care" and not the right kind. But she only had Mild Cog. Impairment, not a long standing dx of Dementia.

My mom's Independent Living Facility had a doctor who was not "staff" but who had an office on the premises; he saw both IL and AL patients. There was a formal "handover" of mom's care from her PCP to this doctor. Did that happen? Did mom initiate it? In our case, mom informed us of everything she did (part of her kinda dependent personality, and she trusted us, God bless her).

There is a double edged sword here, as I alluded to in my first post. If mom is so all-fired able to tend to her own affairs, then certainly she can arrange to move somewhere, right? At least according to this doc?

I am wondering if perhaps this doc comes from a culture in which it is the norm for adult children to drop everything to care for their parents. And not realize that you need to earn a living.

In my mom's case, her new IL gertiatrican invited me to his second visit with her and called me afterwards to verify the validity of her responses.

He wisely refered her to a geri psych doc; that was the saving grace for all of us.

I am sorry that you are having this experience and would seek out a well-recommended geriatrician to see your mom, asap.
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Is this a regular AL or is it memory care? If it is not a memory care I'm a little confused by the doctor's comments, AL is designed for people who need/want minimal assistance with tasks like housekeeping, meals, and medication management, although it is true that some facilities are now accepting people who need much higher levels of care. People often ask what the difference is between IL, AL, Memory Care and a NH, the reality is that the lines between them have become very fluid.
If this doctor is not affiliated with the facility how and why did he get access to your mother?
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With what you have written an AL is where Mom needs to be. Independent living is just that. She needs to be able to do everything for herself. Maybe Mom was having a good day when this doctor talked to her and I have no idea where he was coming from. ALs are not just for Dementia residents. Its for anyone that needs some kind of assistance. The good ALs keep their Dementia residents on a MC side. My Moms didn't. But it was a nice place.

What you need to do is get Mom to a Neurologist for a formal diagnosis. Make a list of what she can and can't do and make sure he sees it. Tell the facility that this doctor is not to see Mom again. He was very unprofessional. He should have approached it as "why do you feel your Mom needs to be here". 30 min is not enough time to make that kind of decision without knowing Moms history. I continued to take Mom to her own doctors when she was in her AL.
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I'm guessing you put her in memory care assisted living and not regular assisted living? I see nothing wrong with regular assisted living as the care needed can be zero up to whatever she needs. If she is in a memory care and the other residents are really advanced, then that is a quandry I faced with my dad. He WAS high functioning and I thought assisted living was better for him and the he could negotiate and thrive with assisted living. I was wrong. He needed memory care because he needed to be in a more open living arrangement instead of tucked away in an apartment. He needed to be brought out to communal activities and kept an eye on. He was moved to memory care (a nice one with open floor plans that seems homey) and he really likes it. I wish I had done this to begin with. He now NEEDS it for sure and is no longer high functioning.

You know what's best for you mom. just fire that doctor and hire someone else.
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I recently read an article about how many attorneys are believed to be practicing law who have dementia.

They miss filing dates, court appointments, have their files in a mess and although they can talk a good game when securing clients, they are way past the time they should be practicing law.

I assume the same could be said about some doctors and other professions. as far as I know dementia is an equal opportunity disease and not everyone who has dementia has a caring spouse or child alert to the changes going on.

This one lawyer they were featuring in the article would get dressed appropriately and drive to the office each day. He would show up at the court rooms at odd times. The attorney he hired to help expand his practice discovered the mess and had a hard time getting the law board to help her do anything about it.

The demented attorney was furious with her and of course he had a large number of dissatisfied clients who were calling non stop.

He is dead now and the lawyer they interviewed for the article is working at another firm but if she hadn’t blown the whistle on him he would have gone on to harm other unsuspecting clients. It read like there was little that could be done to stop this practice. It’s pretty much up to the clients to realize they shouldn’t hire the guy.

This doctor needs a closer look.
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disgustedtoo Sep 2021
I recall reading about that situation. It is difficult, sometimes, to identify the issues in the early stages. Some can pass off minor "glitches" as senior moments, or being very busy. Only those who really know a person well might see the decline and question it. Sometimes even those closest to the person don't realize the enormity, as it can be such a slow progression that it isn't noticeable. Often those who know the person well, but don't see/interact with them on a regular basis can see the problems well before others. This was the case with my mother. I wasn't there all the time, but often enough to know most of her quirks and behavior. A lot of phone calls as well, which allowed me to note the repetition. I did miss some of the really early signs, as they only popped up briefly and weren't really repeated (accusations of items being "stolen", which was likely her misplacing said items - they weren't of any real value.)

My brothers poopooed the whole idea until months later, then it was like "what's wrong with mom?" Ohhhh, NOW you see it? One isn't local, so it was a weekly phone call he would make. The other just lives in his own little world!

Regardless of background, no one has the right to talk to a person like that. I do question if that's really the issue. I've encountered doctors in the past who have dismissed my concerns, with my cats, my kids and my mother, and they were WRONG. Some "professionals" and others have the mindset that they alone know it all and we are just mere idiots. In all the cases of caring for others, two and four legged, the medical people need to understand that I know the patient much better and I know the habits and while sometimes we can overreact to things, in most cases I have been right! Change of docs at that point! Any doc/vet I deal with needs to work WITH me, not just for me.

What this doctor did was inexcusable. I wouldn't want him taking care of a guinea pig!
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Since mom is "competent" tell her she is free to arrange a move. Buy yourself some time.

Give yourself some time to digest this information. Have you asked the doctor what level of care mom needs? Independent Living with pill packs delivered and meals served 3 times a day? That model served my mom well.

Does this facility have an appropriate IL placement for mom? What is THEIR assessment of her current nerds?
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disgustedtoo Sep 2021
Based on her description of her mother, she sounds very much like my mother was initially. IL would NOT be a good fit. My mother was, technically, in IL, living in her own condo, but it was not safe.

While "blister" packs sound great, they really aren't geared for dementia, just for staff. Remembering to take them or whether one has already taken them is the issue. AL can provide medication management and MC does the management. Even a timed/locked dispenser like we tried in her home wasn't working because she wouldn't always see/hear it, so there were days that were missed (it DID make it easier to note the missed days, as they were no longer accessible to her, but NOT getting her meds defeats the purpose!)

Being able to dress, bathe, feed oneself and "seem" relatively normal with some memory loss is common with some dementias. The inability to perform higher functions like finances, cooking, etc isn't going to be apparent to this "doctor." Anyone having a brief chit chat with my mother might not have realized she was in the earlier stages of dementia. Show-timing anyone? That certainly doesn't mean she shouldn't be there.

I repeat AGAIN, that doctor is an IDIOT! I would request that he NOT see my mother in any way if they can't request he not be part of the "rotation."

My YB kept insisting she'd be better off in AL, not MC. He said she wouldn't want to live with "a bunch of old farts." His conception of AL and MC is sorely lacking, to say the least. When I said AL isn't locked down and she could walk out the door at any time as it isn't monitored (daytime anyway), he said she doesn't do that now.... AUGH! NO, of course not, because she's at HOME and self-isolating. Being here, able to leave her room wander down the hall, see the door to outside, boom, she'd be lost in a flash! Thankfully staff said no.
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