My colleagues in the long-term care industry are all aware of the fact that once a senior enters a long-term care community, s/he will probably not maintain a relationship with his/her personal physician. The general public may not necessarily be aware of this fact. Most long-term care communities have arrangements with certain doctors who come there and see the patients on site. The exception to the rule is, if a senior’s doctor becomes credentialed with the community and agrees to physically visit in order to see the patient, then the physician-patient relationship can be maintained. That does not normally happen, however. Sometimes if you are within a certain health system that has affiliations with certain long-term care communities, your loved one may be lucky enough to have his/her personal physician credentialed at the place where the senior moves. Let me share some experiences that you may encounter once your loved one moves.
Last summer, I was hired as Power of Attorney for Healthcare/Geriatric Care Manager for a very active 84-year old woman. She had all her faculties, was ambulatory and gainfully employed until she retired. Two months ago, I received a call from a long-term care community informing me that she had been taken there to complete rehab. She had developed severe bouts with sweating and was diagnosed with a high white blood cell count. In addition, she had suffered heart problems, loss of appetite and low potassium. When I heard about which community she had been taken to, I wasn’t impressed. Unfortunately, when the emergency occurred, I wasn’t contacted immediately. The 911 hospital, which happened to be her regular hospital, was on bypass during the emergency. She was taken to the closest hospital, treated for the heart problem, and released to the rehab community.
When I arrived for her first care plan meeting, she complained vehemently about the food and the fact that she wasn’t getting better. Her primary care physician was contacted, and she was transferred back to her regular hospital for further testing. When the white blood cell count and potassium were under control, I arranged for her transfer to another rehab community within the hospital system. But, consistent with the general long-term care practices I cautioned about at the outset of this article, my client’s primary care physician was not on staff at the rehab community. I nevertheless commend the doctor at this particular community. Many times, the community physicians will show up infrequently. Fortunately for my client, the doctor assigned to her has shown up no less than once a week and has been diligent in setting her up with additional tests and specialists.
Speaking of specialists, I have accompanied my client on appointments to the Oncologist/Hematologist (twice), Cardiologist, Neurologist, and Gastroenterologist (twice). Each visit has been an adventure. Prepare for the out of pocket expense for transportation to physician appointments. These are not covered by Medicare. Each trip will cost anywhere from $50 and up, each way, depending on the transport company. Sometimes, if the community’s bus is available, there will be a charge for that too.
This story is beginning to have a happy ending. I was able to transfer my client to an assisted living community where the doctor from the rehab community is also on staff and able to follow her case. I took my client on a tour and was able to let her sample the food. Her taste buds are happy. And she continues to improve with therapy. Hopefully in a month or so, her destination is home!