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My 90-year-old mother has dementia and can barely walk. She does fairly well at home in her familiar environment and our desire is to keep her happy and as comfortable as possible for as long as possible.



Last week she had a follow-up with her cardiologist. Although I transported her as carefully as possible, the whole episode left her disoriented and unable to even walk the next day. I decided I could not do this to her again, especially for a checkup where they just listen to her heart and send her home again.



Unfortunately, the doctors require checkups to refill her prescriptions so I'm trying to figure out what people do in this situation. She's on Medicare and TRS insurance, so I'm currently checking into the home visits but no one can tell me about the specialists.



If anyone has any experience or information that I can begin my search with, I would be more than grateful.

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I'd drop the specialists if it were me, and see about getting the visiting PCPs to come into the house to see your mom. My mother lived in Memory Care so her doctors came there to see her, thank God, which was one of the many reasons she lived in MC to begin with; she was wheelchair bound and weighed 190 lbs, so there was no way DH & I were schlepping her around in the car; it was impossible. Specialists did NOT go to the MC, however. But when mom was in the hospital the last time in 2019 and I saw what the 'specialists' did NOT do for her, that's when I made the decision to stop using them entirely. With dementia at play, along with other health issues, the last thing I wanted to do was extend her life and/or give her more meds to take and trauma to suffer. And that's what these doctors DO: they cause more trauma with tests, and poking/prodding, etc.

If there was an urgent need, the ambulance would take mom to the ER for a few tests, but she got shoddy treatment there too, I found. If it wasn't "Covid" related, they gave her the bum's rush & out the door she went after a blood test for CHEST PAIN!

You can always hire a wheelchair accessible taxi service to take your mom to the doctor, but be forewarned that it's very expensive (in my experience) and you'll need to hire the van roundtrip.

Leave mother alone to get the minimal PCP care and medication; let nature take it's course while you allow your mom to stay comfy and relaxed at home. That's my suggestion. Otherwise, you may wind up extending her life by a few months or a year and what kind of 'life' is it that you're extending ANYWAY, with dementia at play? IDK about your mother, but mine was in a lot of pain and plagued with Sundowner's and ready to leave this life for the next one anyway.

Wishing you the best of luck.
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Find her geriatrics doctor who makes house calls.

Your local Area Agency on Aging should be able to help with finding one.
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Clairesmum Mar 2022
The memory care facility. may also know of home visit MDs or nurse practitioners.
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You need to rethink your moms care plan. With my mom I did one annual visit to all docs including specialist. When her CHF progressed we were transferred to a heart transplant center. We did one visit in person and the remainder was managed by an RN over the phone. No problems with getting meds.
She used home health services through Medicare for the homebound. Your mom would qualify if she has original Medicare. They did blood work, X-rays, UTI tests, etc from home. She had pt, ot and cna for bathing as well.

With my dh aunt, we found a geriatric primary and worked with the same HHA. She has transferred to their hospice group with the reason for hospice being dementia. She has a dr through hospice and still has her geriatric doc for everything else. We do Telemed when needed.

The last time I took my aunt to a specialist for an eye problem I decided I would never take her by myself again. Wheelchairs are available at offices and she had all the mobility equipment but it was too difficult for me alone. So I understand the feeling of it is all too much. Since being on hospice we don’t see specialist.

My mom did not have dementia and I took her where and when she asked but I believe she would have stopped going long before we did If I hadn’t been so burned to a crisp that I didn’t realize how hard it was for both of us.

I would never see a specialist or any doctor that wouldn’t work with me on an alternate plan of care for a senior such as your mom.

I hope you find someone to work with you soon.
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MamaChar Mar 2022
I so agree with you on not dealing with any doctor who won't work with me on this! Thanks!
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The one specialist that does come to my mother’s Memory Care facility, is her Geriatric Psychiatrist.

Her GP is affiliated with the hospice company that we use. He also comes to see HER.
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Cover99 Mar 2022
..and bill her as well
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You need to speak directly with the specialists.
Truth told, in this condition it may be time to stop with specialists. Palliative care may be the answer if you want merely the medications to prevent complications of such things as weakening pump/heart and CHF, blood pressure control (which monitoring can be easily done at home and is a more accurate measurement than a confused senior in pain and distress, and etc.
In the palliative care community the doctors are familiar with seniors who can no longer make it in.
In lieu of going that far, speak with the professional about learning to do in home BP and heart rates, about zoom calls, and let them know the problem.
Best to you. Were your Mom in an ALF facility many of them are connected with MD groups and advantage programs in which they are visited in the facility itself. This was the case when my brother was in ALF.
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Remote telehealth appointments from your home. This is the greatest thing that has come out of having covid.
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Thank you all for the insightful comments and advice. I just got off the phone with a local medical facility that provides house calls which I believe is what several of you were referring to. I agree completely about stopping the specialist and concentrating on keeping her 'comfy and relaxed at home'. Thanks to all of you who took the time to reply. I feel validated in my decision and am hopeful this HC program will be the answer to our problem...will keep you updated as I learn more.
Blessings to you and yours.
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InFamilyService Mar 2022
Good luck to you and we are all here to help each other and make our lives easier.
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Specialists don't do anything at this point other than order blood tests, listen to her heart, and write a prescription. Any primary care doctor can do that.

Consider getting a consultation for hospice. Contrary to what many think, they won't take her off her medications and "let her die," but you'll have the weekly services of a visiting hospice nurse and a hospice doctor who'll prescribe her meds.

The nice thing with hospice is the nurse will really get to know Mom and will be able to tell you if the meds are no longer doing their job or need adjusting. My mom was on hospice for seven months and all her heart meds were refilled every month.
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My Dad is assisted living where he sees a primary care provider regularly and she and I have come up with basically a triage list of doctors visits that are important. Since he moved from another state she wanted me to take him to initial visits with a few (neurologist, cardiologist, urologist, etc. He has a lot of health issues!) but then she's been working with me about what others he might see and also, when he needs followup. A lot of specialists schedule followups three months or six months along, and the question is, is there are specific reason? I've learned to ask that, and then talk to his primary about it. Going to doctor's appointments is probably the hardest thing for him (and for me) so having his primary help me decide what's actually necessary is huge. It's also possible that her primary care doctor could write her refills. Another option is a telemedicine visit — that could work for the cardiologist, especially if your mom is under the care of a primary doctor who can report her blood pressure, etc.
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My mother 85 lives in her apartment on a senior living campus. We discovered "Visiting Physicians of Jacksonville" and changed her insurance to cover this geriatric physician. He does her monthly check ups in her apartment. I found a mobile lab service, x-ray & ultrasound that provides services in mom's apartment. What a relief to me and mom, who is wheelchair bound.

She also is enrolled in palliative care and was eligible due to her dementia. This offers another layer of support.

Check your mom's insurance and see what is available. You may not need to change her insurance.

Her primary can probably prescribe her cardiac meds like BP meds & lasix.
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Why are you trying to make her agony last longer? Her mind has died already and her body is giving up too. May be it's time to realize that her time to go is around the corner. No doctor specialist or wonder drug is going to make her younger and healthy again. One has to listen to Mother Nature more than to the doctors. They also know that they can't fool Mother Nature, but as long there are people and insurances willing to pay for their services, they will try to keep her heart beating to the last, even after her body has already turned into a carcass. Look for hospice service
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CaregiverL Mar 2022
Best advice, TChamp
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I do telemedicine appointments for my mom which work for us. I provide updates on whats going on or problems with my mom to the doctor. It's way too hard to get my mom dressed, put in the car, getting her out of car, and then walking is another major issue. I only deal with 2 doctors Neurologist and Primary Care Physician. Try to keep it simple. Tell the doctors you need 90 day prescriptions with at least 1 refill or more. Tell them your moms health has declined no longer able to come into doctors office. The doctors should not have a problem with doing a TeleMedicine appointment for you. Please check into it.
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I had that experience with my mother, who had advanced dementia. She didn't understand what was going on, found the trips very burdensome, and was not verbal. Her primary care physician agreed to hospice care with a "no hospitalization" directive. Her doctor worked a couple of days a week at her assisted living facility and was able to make "house calls" the few times it was needed. He stopped most of her medications, including the dementia medication. I felt that she should continue to take eye drops for her glaucoma, and her eye doctor agreed that he'd continue to order refills, even though she was not capable of coming to the office.
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My last caregiving job was for a bedbound invalid with LBD. Her primary doctor insisted on seeing her or he wouldn't refill her prescriptions.
There had to be an office visit. She had to go by ambulance and I'd follow in my car. She couldn't even get on the exam table because there was no one to transfer her from the stretcher to the exam table. All they did was listen to her heart, take her blood pressure and temperature, and put the PulseOx on her finger. All of this could have been done in the home. The doctor also asked her questions that she couldn't answer because she was out-of-it. The doctor visits were always a nightmare. She would get upset, agitated, and scared. She'd always crap through everything the minute she got in the ambulance too. So everyone in the doctor's waiting room had to suffer. The whole place stank something terrible because a stretcher with an incontinent, screaming invalid was parked in the middle of the room. The paramedics don't always offer to stay. When I had to figure out how to get a stretcher with a sh*t and piss covered hysterical invalid into an elevator, that was it. After that I made her doctor's appointments on my day off.
Your mother will have to go to the doctor by ambulance. The doctor might allow you to do a tele-visit because of Covid restrictions and I would definitely inquire about that. If you do have to take her by ambulance, make sure the paramedics are willing to stay.
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A home nurse can monitor everything a cardiologist needs and can hook Mom up to an EKG that reports over the phone or computer (not sure what they use nowadays). Home Healthcare Agency is a great place to start; perhaps the doctor can set her up.
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BurntCaregiver Mar 2022
They will make her come in for an office visit. Believe me, I tried every possible alternative for my client.
The doctor has to physically see the patient. They can't bill the patient for a doctor's visit if a visiting nurse comes to their house.
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There are Drs who do home visit or telemed . Any scripts that is not for dementia.. or calming down meds…can be eliminated. My mother hasn’t been able to get to a dr since before Covid. The home visit dr does telemed also & he calls in scripts. My mother doesn’t need any cholesterol meds ..she has dementia! WTH good is cholesterol…at this point? Your mother doesn’t need to see cardiologist at this point. You can get a home blood pressure machine to take her bp once in a while…if she’ll let you. Take my advice & skip the dr office visits. I even had beautician come over house to cut my mother’s hair. (Not from home visit dr company…I went to salon & asked her if she could come to house) Also, a Podiatrist comes as often as needed to cut her toenails.
Hugs 🤗
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MamaChar: While telehealth visits can be accomplished at times, eventually your mother's specialist will require an in office visit.
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Unfortunately, I think you are going to have to change doctors.

When I was signing papers for my mother's admission into MC, one of the papers I could have signed, was to turn over medical responsibility to another medical practice. The practice was full-time "go to where the patient is" and they had both geriatric doctors and specialists. I never even heard of the group before, however, they are apparently well known in the Assisted Living community.

When my friend in another state moved her father who is bedridden into a highly regarded MC with palliative care, the facility wouldn't accept him unless he signed up with their doctors so that he could have quicker, easier access to medical treatment. The doctors were 24 hour on call with automatic monthly visits with their patients and more often if needed. This was not hospice and the doctors were not dedicated to this facility.

My niece had the opportunity to intern with a company who are in the process of getting government approval for a mobile MRI unit. The company is not unique in this area.

So I believe there are doctor's practices that specialize in bringing their care and equipment, to where the patient is, rather than the patient coming to them. However, I believe you might have to change doctors so that the doctors can visit the patient, rather than go to the doctor's office. How to find these people? First, talk to your Mom's current doctors and see if they have any ideas. Additionally, since you are already searching for doctor's that do home visits, if you find one that you like, he probably already has a list of specialists that also do home visits. Another possibility would be to contact your Mom's medical insurance company or representative and see if their database can filter on the request. Another option might be to see if your state's Office on Aging, might have an agency that could help you locate this type of medical professional.

Good luck! And thank you for being her advocate during this period of her life.

P.S. Telehealth does not work for my Mom. First, she cannot concentrate or stay on task long enough to do tele-health. In addition, since she is hard of hearing, understanding the doctor is very difficult, which does not give her the confidence to do what the doctor recommends.
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CaregiverL Mar 2022
Chopped, telemed is for you to talk with her dr . Nobody expects your mother to talk with Dr
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Maybe someone has said this and I missed it, but is she on hospice. It doesn’t mean she is going to die right away but they will help you figure out what drs are necessary and what is not. If you just want her happy and comfortable at home, sounds like hospice would be the route to go as that’s what they do.
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MamaChar Apr 2022
No, she is not on Hospice. Several people have suggested this, but I was led to believe she would have to have a doctor's diagnosis of 9 or less months to live...?
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Check into medical transport options that can transport your mother via wheelchair or stretcher to her doctors' appointments.
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Update: We had the Senior Housecalls nurse practitioner come by the house yesterday and it was an amazing experience! He had all the equipment to check both my parents out thoroughly and set up an appt next month to do their bloodwork so as not to stress them too much on the 1st visit. If they were to have a fall, or just get sick, all we have to do is call and the nurse will come out to their house! Even bring a portable x-ray machine if needed. It was so nice to have someone take their time and I felt like their checkup was more thorough than either has had in a long time. Also, the NP can prescribe all their medications so another load off my mind. I have a call out to their cardiologist as to how he wants to handle their appts - I do want to keep him in case of an emergency situation - the nurse is supposed to get back with me and I'll let you know how that'll work. VERY impressive program and wonderful people. I'm seeing rainbows for a change :)
Blessed Be
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Llamalover47 Mar 2022
MamaChar: Thank you for your update.
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