Question about assisted living, can anybody help? - AgingCare.com

Question about assisted living, can anybody help?

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If you have (or have had) a family member in assisted living, please help me understand how it works with medical appointments. Are residents taken to their appointments by assisted living staff? If so, is this an added charge to their monthly bill?

My mother has a slew of medical appointments, tests and procedures. My therapist tells me that if she were in assisted living, they would take care of that. I don't believe that, or I believe that if they do, they would charge extra for it.

Can anybody help with this?

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I worked for a AL in Illinois for 10 years. We didn't offer transportation to Dr's visits unless it was on the regular transit day. We had two days a week where we would take residents wherever they want to go. (Walmart, the doctor, uptown for a coke etc) We didn't provide someone to accompany them to the doctor to take notes. If you are thinking assisted living, visit and tour all the communities in your area. Ask what their transportation policy is. Honestly, your mom sounds like she requires more care than we could handle.
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They also have an eye doctor that comes in regularly.
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The community where my Mom and L are have a gerontologist that comes in to see patients, they have a dentist as well. However, any specialist visits are arranged by family, if they continue. For example in L's case he has been receiving hormonal injections for a high PSA. He was due to go in August, had appointment scheduled, he decided he does not want to continue with the injections. That is his decision as he is competent. I had taken him to the urologist before the move in June. At that time he changed his POA to his daughter, at daughter's urging. When the change was made, I sent an extensive e-mail to his daughter telling her all of the scheduled appointments he had, doctor's names and office contact information. It seem to have gone over her head. At L's request I have not reminded his daughter, maybe one day she will reread that e-mail and figure it out. She thinks that her noninvolvement that went on for four years will suffice now that she is POA, and L is very hurt by that.

He is tired, and just is not happy. Yes, he is on an antidepressant. I have expressed my concern about this to daughter, but too bad she just does not seem to care.

So, back to the question. Yes, a geriatrician and dentist will see them regularly at the facility. But, any specialists must be arranged by family, and attended by family if there is dementia as in my Mom's case. The transportation to doc would be covered in L's fees, but I cannot imagine the wait since many people are transported at the same time. Worse than riding a bus, expect there is door to door service. But how many hours will he be out for a half hour appointment? What is doc is running late, and the transport comes to pick up and resident still waiting to see the doc. If outside appointments are necessary other transporation and attendance at appointments should be arranged by family, IMHO.
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Carla, I have visiting several AL facilities near my parents home. One of the biggest benefits in all of them is on site docs, RNs, and visiting podiatrists and other specialists, and they all offer transportation to residents doc appointments.

My Mom toured one place with me and loved the thought of not having to go through all the prep, driving, waiting rooms etc. with the doc appointments. Not to mention the bingo, activities room, dining room and beauty shop. I can't wait to get her in this place. It would make her life sooooo much easier.

One place rolls all services into the monthly bill while some include so many trips per month but one way or the other you will pay for the services.

It seems to me that your Mom has a ridiculous amount of docs. I can't imagine trying to keep up with all that. Are they all really necessary? Between my Mom and Dad they have about 4 doc appts per month. It's doable but still a huge hassle at their age.
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I agree with Sunny, different states, different regs. Also, Carla, the fact that there are folks more impaired than your mom in an AL does not mean that they started out in that condition. It sounds to me as though your mom would qualify for NH care based on her medical needs. I seem to recall that Igloo has a whole post about the extensive medical documentation that one needs for NH admission. Is it possible that's what her doctor is gathering?
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Yes, I have discovered that Assisted Living facilities vary from state to state. So, you would need to check your state's AL features. I think the ones in NC must be quite good, because there are quite a few residents in them that are from NY, NJ, Connecticut, PA, etc. I think the cost must be lower here too.

In NC, all of the AL facilities that I came across, provide transportation to and from the doctor appointments, tests, dental appointments, eye exams, etc. This was true with regular AL and Memory Care AL.

The facility maintains a notebook of the resident's medical records, charts, prescriptions, etc. and they take it with them to the appointments and have the doctor review and sign off on the medications, renew prescriptions, etc. They will make the appointments, if the family wants them to or the family member can. I meet them at the doctor's office. They transport the resident to the appointment and stay with them for the appointment, even MRI's and other tests. If needed they buy the resident lunch or snacks. This was part of the monthly fee and there was no extra charge for this service. The rep from the facility and both go into the exam room and discuss her progress, condition, etc.

Sometimes the transporter would have conflicts and have to reschedule an appointment, but that has not happened but once with my cousin at her current place. I was given the option of doing the transporting if I wanted, but since she is in a wheelchair and they handle that better than me, I allowed them to reschedule, since it was not an urgent matter.

In all of the AL facilities that I saw in NC, each patient had their own physician. The facility did not have a resident physician.
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Babalou- I believe there are people in assisted living who are far more impaired than my mother. I visited one a year or so ago where some patients were in wheelchairs and others were obviously suffering dementia - staring into space or making nonsense conversation with nobody.

My mother can carry on a conversation quite well - it's just learning new things, especially technical things, she has trouble with. And her logic isn't quite where it needs to be to converse with her doctors. For example, she had a very low blood count a few weeks before her appointment, at the same time as she was having bad bleeding from her hemorrhoids. She told the doctor she wasn't having any bleeding, and when I reminded her about the hemorrhoids, she said "oh that was a long time ago". Not realizing it was only a few weeks before and the blood test had been run at just about the same time. That sort of thing.

I believe assisted living places vary a lot in the level of patients they take. I have heard that some don't allow wheelchairs or even walkers but I've seen some that do.
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Carla, why do you think that your mom would qualify for Assisted Living? She does not sound independent enough at all.
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Thanks for your responses, Babalou and MaggieMarshall. A couple of answers:

Right now my mother is seeing a lot of specialists in addition to her geriatrician (who is making all these referrals). A gastroenterologist, nephrologist, neurologist, cardiologist, dermatologist, and now a hematologist. She's suffering from anemia and they can't figure out why, so she's on her third round of diagnostic tests. She's also having some kidney function abnormalities. She needs to see a dermatologist for recurrent skin cancers on her face (we live in Florida). Her eyes are okay now, but there was a long series of retina specialist appointments because she detached a retina in a fall. She has twice-yearly evaluations with a neurologist and neurosurgeon because she has a shunt in her brain for hydrocephalus. She sees a cardiologist a few times a year because she's had stents put in her arteries for blockages a few years ago.

My sister (who also takes Mom to a lot of the appointments) and I have tried to eliminate or at least delay some of these specialist appointments but it seems there is always a new health problem cropping up that requires a bunch of new appointments and specialists.

My mother is not mobile enough to take a cab or other public transportation, and she's not mentally competent enough to attend most appointments on her own. She will forget or deny symptoms, or will get the instructions wrong, or misunderstand what the doctor said. Somebody needs to be there with her to take notes and ask questions, and correct misinformation.

I found it hard to believe that this function could be turned over to assisted living staff (which my therapist insisted it could) without paying a hefty fee, at least. So thanks for confirming what I think I already knew.
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In truth, each AL IS different and sets their own policies. You will only find out by asking each one.

There is generally a base rate, and then a menu of service levels, based upon the level of need, shower, ambulation, dressing, etc.

My mom is now in a NH. We pay for an ambulette to her rare doctor's appointments ($150. Round trip). Medicaid would pay for this if she wasn't private pay. An aide accompanies us, I meet mom and aide at the appointment. I can't manage mom, the wheelchair, bathroom AND talk to the doctor, I found.
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