My mom is 86 in what I think is the early stage of dementia. Physically, other than knee and back pain, she is pretty healthy. She only takes one prescription, which is for her thyroid. She does not see a primary care doctor, but a nurse practitioner, which I think is becoming the norm, as there are fewer and fewer doctors around.

Anyway, to my question. I have been taking her to her appts for the last two years or so, since she can't remember when or where they are, nor what happens at them, so she wants me to go because I can "hear better and remember what he says." So I go. What I find strange is that he wants her in there and with blood work, every three months. To me, an annual visit is all that is necessary for a relatively healthy person. I only go to my doctor once a year.

My sister thinks he is just trying to make money -- that is is some sort of medicare fraud. Mom had been going to him every three months before I started taking her. She went in Nov. 2019 and then was supposed to go back in April, but I rescheduled due to COVID. She just went last week and he wants her back in Dec for a "medicare checkup." What is that? He said they would ask her to draw a clock when she first got there when it was a medicare checkup. They have NEVER done that since I've been taking her. Even the neurologist I took her to didn't do that.

This NP is sending her for blood work again as she is deficient in vitamin B12 and D. She had vitamin B12 pills, but hadn't been taking them, so I put them in regular rotation and got her some D as well. He said I could message him through this online healthcare thing, but there is no way to send a message. I think it is okay to call and tell them she hadn't been taking the B12 and to just reschedule this appt to sometime later - maybe in the spring and have her blood work done right before that. The blood work order doesn't expire until 3/14/22. Shoot, I could just bring her back in a year, couldn't I?

Opinions please, as I have no real experience with this and I don't work in healthcare. Maybe that is why I don't understand why he wants her in there for some kind of check up or other every 3 months. Is this normal for geriatric patients?

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She has a B12 deficiency he is watching. As long as there is a REASON, then I think you should get the bloodwork. I don't think the actual appointment to see the doctor should be necessary. Speak to the doctor. B12 may need to be administered SQ if patient not taking it by mouth, and in all truth by mouth may not be enough.
Discuss with the NP.
Now to drawing a clock. It is one of the most common Dementia tests. Inability to draw a clock set at a particular time indicates there is dementia. Has Mom been diagnosed with same? If not, it is time to see a neurologist, yes, so you can get information and know what stage you are on.
It is now crucial you have done paperwork for POA and etc? If not, time to do it before you have a diagnosis. She likely has not entered any stage where she cannot understand POA; She should do that, because once you have diagnosis of dementia it is unlikely you can get any of this done. You need advanced directives, posts, POA, make certain you know her wishes now.
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Reply to AlvaDeer
disgustedtoo Sep 22, 2020
The test for dementia includes drawing a clock, but it should be MUCH more than just that! Just because someone can draw it and properly identify placement of the hands per the instructions doesn't mean they don't have dementia. Perhaps that is the one thing they can still do/recognize!

I even question why they keep that in the test, as future generations might not even know how to draw one, with all the digital clocks around!
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Until this past year, my mom saw her primary every three months to monitor her thyroid levels, since she is taking levothyroxine. Since she entered hospice, however, she isn't seeing her primary anymore.

You know, it's ok to ask the NP if you can stretch out the visits to every 4 months, especially with the pandemic still rearing it's ugly head. The worst he can do is say no - and then you can absolutely ask why are the 3 month visits necessary? It can be done without being accusatory.

One of the biggest things I have had to learn in this caregiving journey is that, as the primary caregiver, I feel I am entitled to know everything that might have an impact on how I manage my mother's care. Sometimes we're a little intimidated by those in the medical profession, but a GOOD doctor should be willing to address and answer ANY concerns or questions you might have. Because, if you don't ask, chances are they won't explain. And, when it comes to caregiving what YOU don't know *might* hurt your LO.
Best wishes!!
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Reply to notgoodenough

Older people are often asked to come in every 3 months. That's not unusual. Things can crop up relatively quickly and can be found when the patient is seen every 3 months.

However, if you feel it's excessive, cut back to 6 months apart. After all, the dr is YOUR employee!
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Reply to Midkid58
disgustedtoo Sep 22, 2020
Definition is what for older? They did ask if my mother wanted to come in again at 6 mo, but didn't push it. She was actually still on 1 year and it got delayed due to the virus - so when hospice came in, they looked at her MC chart and DIDN'T EVEN QUESTION that the information was over a year and a half old!

As noted above, I don't know why one would assume everyone over 60 needs a checkup every 3 months! I'm over 60 and I am okay with 1/year, unless something comes up. I don't take medications and don't get sick, so why would I want to go every 3 months? I did NOT agree to TeleHealth when they had to cancel my July checkup. WHAT are they going to do for me, healthy, no meds, not sick, via a screen? They can't do weight, height, BP/pulse, listen and look, nothing!
Hand raised, I am also part of the every 3 month doctor thing, which for us seems unnecessary as our health issues are under control [we are in our 70's]. So when a new appointment is scheduled for 3 months down the road we later call up and reschedule for 4 or 5 months later.

Also deficient in vitamin B12 and D. As for vitamin D, we are spending too much time inside compared to when we were young. I remember seeing in the middle of winter, my parents [in their 90's] would have their sliding patio door open with the screen in place, wearing their winter coats, gloves, and hats, but had their pant legs rolled up to get some sunshine :)
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Reply to freqflyer

My mom's doctor told me liked to see all her older people every three months in order to become familiar with them and keep on top of any little issues or changes that might signal something major. She made sure we complied by not renewing any medications without an office visit 🙄
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Reply to cwillie
JoAnn29 Sep 22, 2020
In my state they can give a prescription for 6 months. In my opinion, you are being held hostage. I may put a call into Medicare. I may also find another Dr.
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In my experience, if she is not sick she doesn't need to go.

Thyroid, my Mom went to a specialist. In the beginning I think we went every 3 months with testing being done before the next appt. Once her levels were stable we went to once a year with a test at 6 months. That way he could adjust what was needed.

When I started doing Moms finances (Dementia involved) I found she was going to her PCP every 2 months and questioned her. She said thats when he wanted to see her. I told myself if he asks her why she is there, I am cutting down on those visits. I even had one of his nurses, a family friend, ask why we were there. I told her I had no idea but if he asks why she is there, we won't be coming every 2 months unless she is sick. He asked, I walked out without making another appt at that time. Yes, he isn't actually defrauding Medicare because they probably allow for so many visits a year but he is taking advantage. I cut back visits with a couple of Moms Drs. once she was stable. A yearly visit with labs in between if needed is enough.

Where I live a NP works with/for a Dr. Even though my RN nurse says with the training they go thru they might as well go for an MD, they are not MDs. They are limited in what they can do. Sometimes the Dr. needs to intervene. I would not trust a NP to handle my Moms thyroid. Some medications can cause damage to the liver. Liver enzymes need to be looked at. Mom had to go off cholesterol and couldn't take Tylenol. Both effect the liver. In my state, you need to see a doctor every 6 months for renewal of certain perscriptions. The Medicare checkup is not a have to. Its just the basic labs and checking vitals.

So no, if Mom is healthy in other ways, other than Thyroid, I think 3 months is a little too much. I would say maybe 6 with you getting her labs done before the appt. If he gives u the order at the appt, then he can have you come into the office for the results. This is also something I find doctors are doing. If labs are good, no need coming back in. I do think they are milking Medicare.

If you plan on continuing with the NP for her Thyroid I would learn to understand what is involved. In the beginning, yes the dosage of the pills will need to be adjusted till her numbers are normal. Once Normal for a while, the dosage may be reduced. I would research what she is taking. Like I said, the one Mom was on effected the liver so her enzymes should be part of your mothers labs. Once Mom reached normal numbers her dosage was reduced and she eventually only took it every other day.

We have to be advocates for our parents as they age. We need to be there with them and question, question, question. We need to research everything they take. The Thyroid gives off hormones. Without these hormones doing their jobs, health problems form. With my Mom she had Graves diseases and it effected her heart rate.

I know, you feel if you go against the NPs recommendations something will happen. If it does, deal with it then. The NP is not dealing with a person with Dementia. He is not the one having to make sure she is ready and driving her there. Some people have to take off work and some employers don't appreciate that. I looked at it as, its now my responsibility, so its done in my time sort of thing.
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Reply to JoAnn29
mally1 Sep 22, 2020
I'll bet lots of medicos are "milking medicare"; way too many "required" doctor visits.....
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Dosmo, I do think you'll get more responses by creating your own thread.  You have valid concerns, and they're similar to those that many others have and for whom advice has previously been requested.    The time factor is also relevant to your situation.

As to transportation, are you located near a city which has public transportation, and provides what is variously known as "small bus", or something else depending on the system?   These aren't the full size buses, they're smaller, about the size of an ambulance.

The purpose is to provide transportation for people who don't have it, and can't access full sized buses with established routes.

Some Senior Centers have these buses, through arrangements with the local transit  company.

When I shopped around for transportation to a surgery center for my cataract surgery, I called a lot of companies, but found that most were expensive, charging $3 or more per mile, plus a flat fee.    The local transit company provided small bus service, with pick up, delivery, and pick up after surgery.  The cost was either $1 or 2 each way.    Can't beat that!

I also learned that some ambulance services have nonemergency vans also providing service.  It wasn't cheap, but it worked for me.  

Your profile doesn't indicate where you live, so I can't do any research for you.   But you might want to read these threads and posts on point to point transportation and do some research on your own.

Another group of similar threads:

Anyone who wants to criticize me for redirecting the tenor of this thread can feel free to do so.    I felt that Dosmo needed some support, regardless of this not being "her" thread.
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Reply to GardenArtist
Dosmo13 Sep 24, 2020
Sorry for posting inappropriately or on a thread I shouldn't have. I don't really know all the rules and tend to just jump into a conversation without thinking... as if it were a real-life face-to-face conversation. Thanks for the suggestions, GardenArtist. I appreciate your patience and tolerance. I'll find answers, eventually to all my concerns, I know.
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Here in Canada is is routine for seniors who take medication to be seen every three months. At least in my experience as a MOA.

Doctors will often only do three month Rxs, to ensure the patient comes in.

B12 is not something to mess around with. The under the tongue tablets are easy to take, if they do not boost her levels, then she likely needs B12 injections. Often these are done weekly, for a month, then labs are done, if the levels are up monthly shots may be prescribed.

Lack of B12 can lead to odd behaviours, including dementia like symptoms.
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Reply to Tothill

FYI: Medicare offers a yearly Wellness visit - however this is NOT really like a yearly checkup visit.

A "Wellness" visit is primarily to "develop or update a personalized prevention plan to help prevent disease and disability, based on your current health and risk factors. Your provider may also perform a cognitive impairment assessment."

That's not the same as getting a yearly exam. I had to specify to the doc office I wanted a REAL checkup, along with the usual lab work. No clue what Medicare covers on that - I have an advantage plan, so the only thing I really have to pay is copay for the lab work.

This page does list more "coverage", but I don't see lab work on it:

"What it is
The cognitive impairment assessment is performed to look for signs of Alzheimer's disease or dementia.

The personalized prevention plan is designed to help prevent disease and disability based on your current health and risk factors. Your provider will ask you to fill out a questionnaire, called a “Health Risk Assessment,” as part of this visit. Answering these questions can help you and your provider develop a personalized prevention plan to help you stay healthy and get the most out of your visit. It can also include (**my note = this says "CAN"**):

*A review of your medical and family history.
*Developing or updating a list of current providers and prescriptions.
*Height, weight, blood pressure, and other routine measurements.
*Detection of any cognitive impairment.
*Personalized health advice.
*A list of risk factors and treatment options for you.
*A screening schedule (like a checklist) for appropriate preventive services. Get details about coverage for screenings, shots, and other preventive services.
*Advance care planning"

A link under that is "Preventative". That shows:
"Medicare Part B (Medical Insurance) covers a “Welcome to Medicare” preventive visit once within the first 12 months you have Part B."

SO, you get this ONCE, after you start Medicare, but with CAVEAT - if doc orders additional tests/services or items not covered, you could pay deductible or all for the not covered items.

See the link above and follow other links from there for more info.

I laugh when the chant Medicare For All is going on... I don't think they understand that
1) Medicare ISN'T FREE (Part A is),
2) plain old vanilla Medicare A only covers inpatient hospital stays, skilled nursing care, hospice care, and limited home health-care services. You typically pay a deductible and coinsurance and/or copayments,
3) Part B isn't free and covers more but not everything,
4) even with gap or advantage plans you could have high co-pays and/or deductibles,
5) there are any number of not covered medical issues and
6) you have to sign up for a medication plan (often included in advantage plans), but there is still the issue of the "Donut" hole you might fall into and also non-covered medications.

I understand somewhat the desire for Universal Health Care, but it will NEVER be "free" - you either pay for coverage or you pay higher taxes, or both.

Comparing other countries is not the way either. GB's NHS really covers basics - many people buy medicals plans/insurance so that they can get better care and go to private doctors. So, UHC isn't always a better way. Granted, our way is awful! The last year I was on company retirement insurance, it cost me almost 12k and all I got was a lousy checkup. That plan added that we had to cover the first $700 of ANYTHING. One ophthalmologist appt and one tick bite appt didn't even cover that, so almost $12,000 to get a lousy check up!!!

I am thankful to be on Medicare now, as it is a LOT less, but dread to know what might happen if I get *really* hurt or ill....
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Reply to disgustedtoo
Bridger46164 Sep 22, 2020
Medicare For All will cost everyone a lot of money and the program could be weakened by so many people being added en masse. Part B has premium increases almost every year. Social Security Cost of living raise barely covers the Medicare premium increases. Seniors rarely get a real raise.

Every year Medicare loses providers because the reimbursements to doctors are so low. Overhead and malpractice insurance go up every year. Private practices struggle to stay afloat. It’s a better income to work for a hospital.
Caroli wrote:

"Doctors can get damaged financially (even with malpractice insurance)and sometimes professionally with a malpractice conviction."

It's not my desire or attempt to criticize you, but I do think that some errors should be addressed.

A "malpractice conviction" is not an appropriate description.   Malpractice is a civil issue; a conviction is a criminal issue.   If a doctor were found to have been negligent, by legal standards, governmental prosecution could ensue, resulting in a conviction.    Civil suits result in judgements, no cause for action (a legal term), or settlements, but not convictions.

Perhaps you understood this but just used the wrong terminology.  Again, it's not my intent to criticize, but to explain one aspect of law.

"Especially with an elderly patient, by scheduling return visits frequently, the physician minimizes the risk that something serious goes wrong between appointments, and the patient or patient's family ends up suing for negligence."

Suits alleging negligence are malpractice suits and must conform to very specific legal and case law standards.   This I think is an error that many people make.   Someone can't just file a suit and allege malpractice.   It has to be documented, and when I worked for medmal law firms, the standard was to have the patient's medical records reviewed by a medical practitioner in a similar field, with that practitioner agreeing to testify.    That established medical standards, which most nonmedical people (including me) are not familiar with to a degree of determining negligence.
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Reply to GardenArtist

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