Medical Professionals

The first step to obtaining the proper medical care for your loved one is getting a grasp on what medical professionals they are currently seeing and gathering their medical records the best you can. What you need to do next depends on their current situation. Are they living on their own when perhaps immediate decisions need to be made or are they already in a facility and you are just coming onto the scene? Either way, you need to familiarize yourself with what their past and recent care has been. Let’s consider each situation.

A) Living at home alone (or with their partner).

1. Probably the best first step might be a discussion with their primary physician. Most likely the best way to do this is to attend their annual visit with their primary physician. Ask all your questions.

2. Next, determine (most likely with their primary care physician) if a neurologist, specialist in gerontology or another specialist should be seen by your loved one. Which to choose?

Geriatricians treat illnesses and diseases that commonly affect individuals as they age, such as diabetes and dementia. 

Neurologists are trained in diagnosing, treating, and managing disorders of the brain, nervous system, and spinal cord. Many neurologists also have specialized training in one area of neurology such as stroke, epilepsy, or dementia.

Some psychiatrists have experience in treating Dementia.

Whether it is your loved one’s primary care physician or a specialist, generally they will perform a test to test their cognitive ability. One of the most used tests is the Mini-Mental State Examination (MMSE). During the MMSE, the physician asks the patient a series of questions or gives instructions such as:

“What is the year? Season? Date? Day? Month?”

“Where are we now? State? County? Town/city? Hospital? Floor?”

“I would like you to count backward from 100 by sevens.” (93, 86, 79, 72, 65, …) Alternative: “Spell WORLD backwards.” (D-L-R-O-W)

The physician shows the patient two simple objects, such as a wristwatch and a pencil, and asks the patient to name them.

“Earlier I told you the names of three things. Can you tell me what those were?” 

The questions are assessed different points and the maximum number of points is 30. The results are then tallied up. The general standards are as follows:

25-30 Questionably significant - May have clinically significant but mild deficits. Likely to affect only the most demanding activities of daily living. 

20-25 Mild - Significant effect. May require some supervision, support, and assistance. 

10-20 Moderate Clear impairment. May require 24-hour supervision. 

0-10 Severe - Patient not likely to be testable. Likely to require 24-hour supervision and assistance with ADLs.

See http://www.fammed.usouthal.edu/Guides&JobAids/Geriatric/MMSE.pdf

for a complete copy.

Testing is important because it will help you follow the progress of the disease and, to a small extent, help you know what to expect. 

If you are in the testing room with your loved one, realize that the tester is looking for their spontaneous response. Do not try to chip in or coax out answers or be dismayed if suddenly something your loved one answered that morning they do not answer on the spot.

Armed with this information and with the recommendations of the physician, you’re on the right path to start making decisions.

Most patients with dementia are elderly and if you are younger and relatively healthy yourself, you may be surprised at the number of doctors they regularly visit. My very healthy mom, went to a hearing specialist and obtained hearing aids that had to be regularly checked, a podiatrist to tend to her feet, her regular doctor and a good number of others. Don’t forget dentists either!

B) If your loved one is in an assisted living facility.

If your loved one is already in an assisted living facility, you still have your homework to do to ensure they are getting the correct medical care. Some assisted living facilities may have facilities for healthy seniors and special ones for those with dementia. A move into a separate division or unit or the selection of a different set of services may be appropriate for them.

The first step here is to get whatever paperwork was signed when your loved one first went to the facility. People often simply sign away, taking little time or attention to read or understand what they are signing. You might be surprised what some of the provisions state. The next starting point would be to talk to the head administrator and the director of nursing.

What I found to be great about the assisted living facilities that my mother attended was that at both facilities, they regularly had physicians of all sorts of specialties come and regularly see their residents. Thus, you don’t have to constantly be taking your loved one for appointments for routine care. This is a godsend in many ways. For example, podiatrists and dentists regularly came to see her. I would then get a bill for their services and in some cases the insurance available was already addressed.

This was one area that I had sometimes did have difficulty. The facilities would give out her Medicare information to these additional medical personnel, but almost never gave out her secondary insurance. Here, try to talk to the director of nursing or the administrator to try to get them to give the secondary information as well. Don’t panic when you see a high bill because you may have to simply provide the information.

They also had gerontologists regularly see the residents on a rotation. Here the secret is if something comes up with your loved one where they need to be specially seen out of rotation, make sure to speak with the specialist’s office directly. I found on several occasions that even though nurses were expressing concerns, that the gerontologist was not being told to make a special visit by the assisted living facility.

Also be aware that assisted living facilities have “arrangements” with physicians, but that does not mean that the choice of doctors should make them suspect or is anything shady. I adored the gerontologists at both facilities. They were both kind gentlemen, who took the time to answer my questions and properly care for my mom.

However, just because there are arrangements, that does not mean you cannot use your own doctors. You may, however, have to physically take your loved one to their appointments. The assisted living facility will not necessarily have specialists in all areas that come on site. For example, when my mom broke her arm, they suggested that she see the orthopedic physician, across the street, but I needed to take her to those appointments.

Stay on top yourself with the medical professionals that are seeing your loved one, ask questions, insist on phone calls from the physicians and nurses, and actively be involved.

One thing to be aware of is that by having your loved one at a facility, you lose a little control of your loved one’s medical care in a way. Let me explain our experience. When I first filled out all the forms, I was provided a list of specialists and was told to sign to give authorization for them to see my mom. There may have even been a choice or two.  Recognize that this is when you are filling out hundreds of forms and you are not likely to take the time to research these doctors. However, understand that you are free to change your choices.  This is best done in writing.

Things like foot care and dental generally came down to a phone call whether I wanted my mom to be seen. I do not even recall signing any additional letters. I never even spoke to these professionals other than their billing offices when dealing with a failure to go after my mom's secondary insurance.

On the occasions my mom had an emergency and went to the hospital, I would get a telephone call from either the head administrator or head nurse, more rarely from one of the staff nurses. Here, I can honestly say, I was never called immediately when the incident occurred.

This would sometimes bother me. Obviously, you want whatever first aid or other care is needed to be dealt with rather than a phone call to you, but quite frankly and with a little jaded lawyer in me coming out, it appeared that the facility’s policy was to “get their story straight” first.

So, there was one time when my mom had a fall and I was not called for over an hour plus after it occurred and when she was about to be sent to the nearby ER. I was asked if I had a preference regarding which hospital she was sent to. The facility then arranged for the ambulance and provided the hospital with most of her information. 

You may get a call from the hospital regarding billing information. Otherwise, you really are on your own to get information regarding your loved one and it is very difficult. Our situation was compounded by the fact that it was during Covid-19 and visitors were not allowed in the hospitals. Placing a call to the nurse taking care of her was very difficult. I understood that I wanted the nurses to be taking care of patients rather than gabbing on the phone, but it was very frustrating getting any updates. The nurse that had taken care of her either “just left” or was on a break or busy. The nurse who would take my call may have just come on and had no idea what she was doing. The bottom line here is set yourself in a “being patient” mode, keep calling, call again if you don’t get a call back, and insist on speaking to the doctors.

To me, the best way to pick medical professionals is to get a recommendation from another medical professional that you trust. Recommendations from friends and family can be great as well, but realize that people’s perception of what makes a great doctor vary. My very simple example is that of a vet I used many years ago. He was an elderly very gruff man with pet owners, but when it came to actually treating the dogs, he was one of the tenderest people I have ever seen. My other comment is to try to not let having lousy staff dissuade you from using a wonderful doctor.