My mother just left the hospital last week after being diagnosed with a UTI and had great care. The hospital now has her in a rehab facility which I have extended for 1 more week and then she is coming home. She is 88, has dementia/Alzheimer, COPD, Parkinson, and at this point is confined to a bed unless she has a lift take her form the bed to a Geri chair. I care for her at home and have been her caregiver for 5 years and doing it 24/7; but was told by the doctor that if she cannot come to the office they can no longer authorize future prescriptions and this is her primary physician. To make matters worse, she is now going to be required to get all prescriptions via mail order by July 1 or she will be required to pay full price for her medications. This cannot happen as these are required to keep her alive. What options do I have here as I am at my wits end? She has good medical insurance with Medicare and Blue Cross; but if the doctors are not going to budge, what do I do? We are located in Ulster County in New York. I am sorry about the urgent tone of this but I adore this woman like no one else in this universe and the amount of tears this past couple of weeks would fill all the oceans.
Call your primary and ask them if they know a doctor who makes home visits. I agree with Hospice. They will take over Moms prescriptions. You can get an aide thru them. Diapers are paid thru Medicare and other things.
My former mil has her Rx delivered by a local pharmacy, the doctor faxes over the Rx after the visit and they are delivered later that day or the next. I know he doctor (he is mine too) does nursing home calls, but I do not believe he does house calls.
That’s the way it is.
On the repeat prescriptions issue - someone in public health research added up the overall cost of drugs prescribed but not used and had to go and lie down. BP meds, diuretics, statins, analgesics... millions of pills ordered by computer, conscientiously collected from the pharmacy, paid for from the public purse and then, to put a cherry on it, having to be correctly disposed of - again at public expense! - when they were at last found among the deceased patients' effects. The waste is immense.
To help reduce it, "review dates" started appearing at the bottom of px forms (my mother's ran to two pages, nothing unusual in that) to prompt GPs to check they weren't signing off on drugs that would sit uselessly in the cupboard for the next three years. And very occasionally a GP would comment "hm, time we had a look at that, Mrs H" - but mainly they just changed the date of the review.
Much more recently, all households have received direct mail, and there's been a TV ad campaign too, urging us to sign up to an exciting new repeat prescription delivery service. This service is run by a private company contracted to the NHS, which means that there is public resistance to overcome (you think British people don't get emotional? Try telling them the NHS is a basket case of a system and wants cutting in half - you'll be lucky to escape with your life. More to the point, you will DEFINITELY lose the election); but in fact there are worthwhile objectives to it, including fewer foul-ups leaving patients without medication, easier admin for pharmacists, just a more efficient and therefore cheaper to run process.
What nobody wants to address, because the answers are all extremely expensive and in the USA this demographic receives huge public funding too, is the reality that if you're going to claim that keeping elders at home is the best option, you also have to provide services they are able to access. And when they are immobile, frail, mentally frail or even just extremely tired, some smiling adviser saying "pop along to your GP and..!" - well, it grates, rather.
I hope Redroseman will find a practical solution. Just thinking about how you all have to organise healthcare gives me a migraine, so I do count my blessings really.
From what I remember, bedridden, vegetative-like mom was required to see her doctor annually - in order to renew whatever needed renewing (current Rx, home care nurses, etc..) The same when my dad had a stroke and became bedridden - the annual doctor's visit. Any changes on their health, needing prescriptions, they were required to go to the clinic.
From what I understand, Medicare requires that the doctor actually sees the patient before ordering new prescriptions or renewing it annually. I also understand that whenever they're released from hospital stay, I have a limited time period to take the parents to see their doctor and Medicare coverage.
We had to call for a private ambulance service for each of these visits. It was $300 per way + every miles. It was not covered by Medicare or their secondary insurance because it's Not an 'emergency.'
FYI, even with the home nurse visits, they tried really hard to treat dad without requiring his visit to the clinic. They were even willing to take his blood tests here at home and then drop it off at their clinic. Clinic admin said No. My dad has to go to the clinic for the bloodwork. Sometimes, these people don't understand what it takes to force an elderly to go to the clinic. And the expenses - $600some roundtrip! just for bloodwork???
I meant to post this before, but forgot. I got the post office to allow a mailbox to be installed by her front door (there are cluster mailboxes in her condo development). If anyone has a cluster mailbox, there is a procedure for disability that one can use to allow a mailbox to be placed by the front door instead.
I have a Cardiologist if I don't come in at least once a year, and if my meds have 0 refills, she will only refill my order for 30 days then none after that. I have to see her. She wants to make sure the heart is in working order or if I need to up my dosage or change to another pill.
My parents had used mail-order prescriptions and it was such a hassle, mainly because of user error. Since the pills were mailed to their post-office box instead of at home [folks afraid mailman would take the pills, or tell a neighbor that my parents were getting pills], I would need to high-tail it up to the post-office twice a day to see if their pills came in.
Finally Dad let me transfer all his pill requests to a local pharmacy so if he ran out it was easy to call in and pick-up the same day.
My mother was forced to switch to mail-order meds a year or so ago. Lots of problems. But that was because she insisted on doing it all herself -- multiple issues with her doctor's office. No doubt part of that was her bad hearing and not following conversations. If she'd let me handle it, there wouldn't have been problems. I was called several times each day and had to hear about the "stupid" people who couldn't do what they were supposed to be doing.
Sigh...
The forced change to mail order refills is the insurance company saving money. They too don’t even consider elders human. The US has a deplorable health system designed to make only the correct people rich.
My experience is that the doctors will prescribe for a given number of refills but generally won't extend after the refills options are used. They want to ensure that the meds are still needed, in some cases, or check for side effects.
As an aside, my employer went to mail house prescriptions several years ago. Like you, I wasn't happy about that. (Do any of us truly embrace change?) NOW, I LOVE it! I have it on automatic refills. I never run out! If I somehow wind up with too much of a med, I call and take it off automatic refill until I need it again.
AND I agree with the other posters, get a doctor who makes house calls. google it with Mom's zip code.
You also want this new person to be a geriatrics doc. Not a general internist.
Have you considered getting a hospice eval? That might be the answer to all of these questions.