Appointments outside of memory care are becoming more challenging. How would you handle this?

Not sure what a Memory units responsibilities are but my Mom's AL got her ready for me. Doctors she had been going to for a while I had asked that her appts be once a year since her meds with them were stable so visits were "how r things going". Once she was in a NH under the care of one of her doctor's, I dropped off one and the other agreed that as long as labs were done regularly and he as consulted with any problems, he would work with the NH doctor. Mom's foot doctor came to both the AL and NH. I never told Mom when she had an appt. If I did she would be up all night trying to get ready. I would evaluate how important are these doctors. Is she stable with her meds. If so, ask her primary if he can take over her care. Going to the specialist only if needed.

Calendar would be my suggestion. I plan to get one for next year as she used to "live" by it when still at home. It gets harder when they don't know what month it is anymore. When still in her condo she used to put the appointment down and then called me multiple times the week before asking if I could take her. I would ask her to write down that I am taking her and she'd say yeah, but not write it down. I had to be very specific and say do it NOW! While I'm on the phone!

Currently she has appointment cards with the dates on them. She typically rifles through her purse and wallet, especially in the car and waiting rooms, but still goes through it all in her room. I'm hoping the calendar can work - especially if I tear off the months that have passed. I also tend to make afternoon appointments, more so because it is easier for me, but as noted by others she is more likely to be up and dressed.

Although there might be "in-house" doctors, many elders have specialists. Our mom still goes for macular degeneration treatments, which could not be done at the MC. I do not know if there is a more local place that could do this, but she has been with these doctors for a long time and my preference is to continue with them. Keeping her eyesight is important at this point. I changed her to a local PCP, and for a couple of falls, they used ambulance/transport vans to have her checked at a local ER and return. The dermatologist is a little hike as well, because I thought it was another office for the place she had used, but we had to have a basal cell on her face checked/treated and since we had this place and I like them, we'll stick with them for now. At least that will not be often. I still need to find a local dentist, but thankfully she does not have any other conditions requiring treatments and appointments!

I recently ordered a transport chair, hopefully delivered soon, as some places have a long walk to get in/out and she tires easily. She does not yet use a walker. She did tell my brother she wanted one like another woman had - I moved the ones my dad had used to my place, both a regular walker and the one with a seat and basket, so I brought the latter one up, which is what she asked for. Then it was 15 minutes of my brothers trying to explain to her that there was no cost, we did not buy it, it was dad's on and on and on... They don't get it! I taped a paper with her name on it, but that has disappeared since.

Anyway, try any and all methods. Setting afternoon appointments and just arriving early enough to ensure she is bathed and dressed might be the only thing you can do. If he/she is balking at going, insisting they don't have an appointment, just make up something, like we are going for ice cream, or lunch or something, just to get them going!

Part 2 of last post; mom refuses to use the shuttle - don't really know why, just won't. Maybe client will? I can but ask.....

Madzeena, Oh those transfers,,,, There are days I have to take my mom somewhere, then my client/friend, also (I try to do it on separate days usually) and getting in and out of van and places we go with the stupid walker drives me nuts! Now both of them are barely able to get IN the van, legs don't work right; what will we do now?

I went through the same thing you are going through now... and you are 4hrs away wow that in and of itself is bad enough.
The memory facility has a schedule I worked around so I knew she'd be dressed and fed
I didn't tell her about appointments anymore because she'd stay up all night worrying about them. Thanks be to God
I found a doctor who makes house calls. What a blessing
I don't have to make appointments get her in the car or to the bathroom 10 times
See what you can do to make that happen!

I understand this scenario completely! The elder's mind is no longer able to function properly. This happened to my late mother when I had to move in with her in another state. She then had to go to a nursing home...I would call her saying that I was on my way there from her house. She then got mad and forgot, asking me "why haven't you called me in days?" You may want to tell the FACILITY in inlieu of your mother of your prior eta because thinking that you're showing up at 6:00 A.M. is not even a lucid thought since no doctors' office is open then.

My Mom was in an AL. I told them when she had an appt. I gave them a time for pick up and asked. them to have her ready. Her NH had doctors so I chose one. I also made the decision about which doctors could be dropped or go to once a year. As Moms Dementia progressed and getting her out was harder. I allowed the doctor at the home take over her total care as long as tests were done regularly and if bad, I would take her back to the specialist.

Garden
My moms pacemaker was not one that could be checked on the phone. Wireless nonexistent in her neck of the woods. I had to drive about 10 mi in a specific direction to get cell reception. We made sure to get the pacemaker checked each time we made the trip. Pacemaker rep would come to wherever we were seeing another dr in the medical complex to do the check. It's good to know they have made improvements.

Mom's MC staff make sure residents are dressed prior to breakfast, but in the circum- stance I mentioned, Mom wanted to change clothes (why, I don't know) prior to the appointment. The problem is when Mom anticipates an outing she gets agitated, anxious, confused.

MC does not provide transportation for anything except aforementioned weekly group outing. If friends or family cannot take her out of MC for whatever reason, there remains the option of hiring an agency caregiver, who at $22/hr at a 6-hour minimum, which is pretty expensive. There is a house MD that comes to MC to check on residents for issues. She can arrange to have a mobile testing unit come to MC to draw blood, urinalysis, and some imaging, which is a Godsend. Now that Mom's long-neglected medical issues have been addressed (prior to Dad's passing she refused to go the doctor for years), the house MD can pretty much manage all but the most specialized medical issues, so in the future, doctors appointments will be few and far between.
So I think I can expect to be taking Mom out less and less.

For what it's worth, for those who have loved ones in wheelchairs, there are medical shuttles that can easily accommodate wheelchairs who will take your LO to a Dr. appointment. Here in California it's about $100 round trip (5 miles or less one way); quite expensive indeed but may be worth a consideration if transferring your LO in and out of a private vehicle is a challenge. These shuttles are wonderful; driver places wheelchair with LO on a lift that places wheelchair in and out of the shuttle. No pain or strain for you and less stress for your loved one; a possibility if it's affordable.

Again, thanks to all. Your suggestions have really helped!

What I found helpful with my mother is to use a "small" white board where I would write down the day, and if there is appt for the doctor , or anything else what timeI will be there to pick her up.. I stopped using the calendar as it would confuse her..

I just returned from taking my mom to a doctor's appt - follow up to a fall yesterday- and started reading this thread. I choose late morning appts because the staff at her Memory Care facility have her dressed, breakfast eaten, meds given, and toileted. When I arrive (and I give myself an hour to get her out of building) it's still a lot of reminders of why we're going to the doctor, getting her coat on, glasses, shoes, etc. But always dangling the carrot that we will get lunch on our way back.
It hasn't always been going this smoothly. Took lots of trial and error and once even having to cancel the appointment because she refused to move. So just when I finally have a "system" down I've pooped out. I admitted to the facility director when I was leaving this afternoon that I did not think
I could do it again. It's all too much for me. My mom weighs over 200 lbs and just pushing her around the clinic in the chair is exhausting. Not to mention the transfer from walker to chair to car to chair to exam table to chair to car to chair to walker. She has to be prompted for every movement. The director reminded me that the facility provides a transport van that I can ride in with her and it would cut out at least four transfers in and out of her chair. Duh!! Sometimes we forget the obvious because we get locked into the way we've been doing things. Next appt we'll be taking the van! Hopefully the driver won't mind going thru the drive thru at the local burger chain so I can still treat mom to lunch out when we get back to Memory Care.
Also mom checked out fine from the fall.

My parents are both in memory care and having to take them out is a big problem for me. They do have a doctor who comes to the facility but they don't have a cardiologist or any specialist.. so if you need to go to one of those then I need to take them.

I usually don't say anything ahead of time.. schedule afternoon appointments like others have mentioned. I might call in that morning and tell the facility to let them know an hour or so before I get there. They should be ready and dressed unless you go early in the am... or they had some accident that need to be cleaned up for.

Last time I took my mom to the Dr., when I came back she didn't recognize the memory care from the outside... wanted to know what we were going to be doing at this place and just take her home! If I can at all avoid taking them out.. I will .... Its sad because I would like to be able to take them out at times but am nervous about how they will react when we return... or if they will even go back in.

When I took my Dad to the Dr last.. the electricity went out at the Dr.'s office.. and we were on the 3rd floor in total darkness.. with my Dad.. with dementia! What an experience. The staff had to help us down 3 flights of stairs..

Needless to say. ... I do not look forward to their Dr appointments!

My parents live in a senior community apartments, no help. But my parents are night and day! I make their appointments, and except for lab work, I schedule afternoon appointments. It's so much easier, I can bathe her and dress her in the morning, eat a good breakfast, take their meds and get her ready for the trip. This takes time, sometimes it takes several attempts to get her in the car, she's wheelchair bound. If I did a morning appointment I would have to get up at 4am and hope that nothing goes off schedule. So I ignore dad's request and keep afternoon appointments! As for Mom, she is best if I tell her she has an appointment the day of, otherwise she gets nervous and upset, raising her blood pressure.

I've never heard of a Memory Care unit that doesn't do everything, if necessary, for the resident. They brush their teeth, wipe their nose, dress, bathe, change, even hand feed those who need it. I'd certainly expect them to have the resident dressed and ready for an appointment. I'd discuss it with the director.

My LO's MC provides transportation to all of her doctor appointments. We have recently switched to a doctor who comes to the MC facility for weekly visits. This means that she doesn't have to travel, unless it's for some particular issue. They also transport her to her dental appointments.

I would expect the MC to be more cooperative and helpful. How do other residents handle it at the facility your mom is located? Do they have a protocol?

I like the idea of scheduling appointments after lunch or some time during the day she would already be dressed and ready. Also I'm not sure what your mom's abilities are but my mom and I go over her schedulke regularly on the phone, it's a big source of stress for her too and she writes down the times and apointments for the next day herself. Doesn't always work because she has aphasia from a stroke and numbers are a problem but it gives her some feeling of control. I also make it a habit to say something like "I scheduled x apointment while they had it but I can easily change that if you want" so she has a "choice" and this does mean a long or several long discussions about why this or that appointment is important (there are things she doesn't want to do) but overall it's a better policy for us.

The other idea I had is could you call the morning of either to "remind" her or verify something about the arrangements so she could cover up that she didn't know or forgot easily enough? I had been thinking your usual evening call about it and then again in the morning so she is gently reminded of what time you are coming to pick her up. My brother often gives my mom a call when he is on the road to either see her or take her somewhere, he lives about 40 min away, (I stay with her when I'm in town for appointments and things so while I update her from the road on my arrival time it's not the same thing) this way it's a habit so she doesn't take it as she can't be trusted to remember.

97YearOldMom, you wrote that your mother's pacemaker could be checked by phone. Are you aware of CareLink, which some cardiologists use for remote pacer check? My father does have his checked annually, but quarterly, or periodically (I don't recall which offhand), he uses a remote monitoring device.

It's been upgraded to accommodate newer technology, and it's easier now than before. A handheld device is held over the pacemaker; transmissions are wireless. Only caveat is that there has to be adequate wireless coverage in the area.

If someone's in a rural area, that could be a problem. But in my father's area, he's one of the few who doesn't have a cell phone growing out of his ear.

I have found that creating activities, visits and outings in the early afternoon works very well, as Mom begins her delusions around that time if there is nothing else for her to do or if she has no company. Creating something for her to do between 1:30 and 4pm is ideal and saves her from experiencing lots of frustration and confusion. In the mornings she is quite clear and likes to rest playing solitaire or watching TV in bed, so I and the MC staff have learned to honor that.

Talk with the facility's social worker--the staffer who interacts with families of caregivers about what's going on. That's what this person is paid to do, so take advantage of it. Those you have hired to take care of your mother might have some good ideas on how to handle this. It's probably a good idea that the unit manager know in advance when your mother has a medical appointment. Most have a van or can arrange appropriate and safe transportation for your mother to and from medical appointments. Most have a primary care provider who cares for residents in the facility. If yours does, you might consider using that person. However, there's a lot to be said for having your mother see the doctors she has been using all this time--they know her and she knows them, which means a lot to someone who is in memory care. Believe me, every situation is different, and this site is chock full of great advise from people who have been there, done that.

Everyones situation is different. My mom was very healthy other than the CHF. She lived at home and had HH. They (HH) were able to do routine blood work without her leaving home. They would fax results to the doctor. Any medication change was called to me and home health. Prescriptions sent to the pharmacy. She only saw her doctors once a year all on the same day for the most part. I didn't tell her we were going until the day before because she would stress about it. Usually she would remember from the previous appointment that it was coming up but we didn't discuss it. I would leave it up to her. If she didn't want to go I would tell her it was her decision. I was always careful to let her know she was able to make her own decisions. I was available to take her but not willing to engage in an argument about it. I would remind her that the doctors wouldn't continue to give her the Lasix and blood thinner if they didn't see her in person at least once a year. Her pace maker couldn't be checked over the phone. We would talk about what that meant. She always decided to go. The day of, I would call her to let her know I was almost at her house. It was a three hour trip one way and we were both always very tired afterwards. She enjoyed the trip for the most part. I can't relate to frequent doctor appointments. But then, she was very compliant with her diet and seldom required a change in medication. I had help twice taking her and I agree there was less acting out when another person went along. (I may have behaved better with another person along as well).  Early on, before he died, my older brother would bring her half way to meet me. Of course, she never gave him a bit of trouble. Lol
So I guess my suggestion would be, little advance warning, few trips, distraction with others in attendance and remind her that it is her decision. You need to mean that by the way. They can tell.

My dad's AL has doctors that will come to them if they consent to having one assigned. Does her place offer this?

jjkmummert: I totally, totally understand your logic. It’s brilliant. But it’s also sad, because now 2 fully-functiong adults need to upend their schedules to get your momma to the doctor. That’s the rub with eldercare. The ever-increasing interventions that are required ....to facilitate mundane tasks. 

Most facilities here have doctors that are on-site. The doctor has a day or two a week that is spent there. Sometimes it may be a PA. That is the easy and obvious answer.

If this facility does not have a house doctor perhaps a private caregiver, or a geriatric care manager would be able to transport.

I'm anticipating times when this task will get worse. I plan to bring back up...a gal pal. Mom usually behaves better around my friends For now our few appointments go well. Staff remind her...i arrive 1 1/2 hours early and we arrive at the appointment early and look at magazines. She just loves getting out and for now we have fun. I know it will change.

My mom does this too and gets so wild I just don't tell her anymore. The calendar and notes used to work and still do but she gets so fired up if she sees them that we just can't tell her anymore. Right now she is still crazy from last week's dentist. It never ends. Next week is her filling appointment. Sigh. Hang in there!

Was just reading this here, for a reason, and thought the answers were very good too!

Dear friends: Thanks so much for your ideas!

Mom is up half the night and has all night to fret about a morning appointment. I'll make sure to ask for afternoon appointments right after lunch, inasmuch as I can.
The message board is a good idea; unfortunately I live 4 hours away so there's no opportunity to get reminders up on Mom's board in time.

But yes! I always take responsibility when things "go wrong," like yesterday: "Mom, I don't remember you giving me your pajama tops to let out the seams; I must have forgotten! I'm so sorry! How forgetful of me! Blah, blah." It's just easier. Let her have the day. Take the blame and the trouble generally diffuses. (I'll go out and buy new pajamas.) She reminds me often that SHE doesn't have dementia, only a "little memory problem," but she "knows SOMEONE that's got a serious problem (her emphasis, not mine) and looks glaringly at me! LOL

Wish I could take her out for ice cream or some other goodie; but she's diabetic! (Sigh) And as for sugar-free alternatives, I'm learning now that artificial sweeteners raise glucose levels much like sugar.... Maybe a cup of Starbucks with cream will have to do!

Thank you guys, you're the best!

Ah, I remember trying to get both of my very elderly parents ready for a doctor appointment. Mom was great, she would be sitting in her kitchen chair all ready, coat and scarf already on, purse in hand, etc.

Dad was the opposite, he would think he was ready but the search began for his cane... then his eye glasses... ok Dad you have your wallet?.... time for a bathroom run.... then the struggle to get into his favorite jacket... now, what baseball cap to wear. Then getting them into the car was no easy feat. I use to tell my parents their appointment was 30 minutes earlier than it was.

Eventually no matter what you do, with memory issues, it just becomes more complex. Lot of trial and error until you find one certain way that works. I had used what MAC above had mentioned, pick a time that works well, when Mom is the easiest to work with.

Could you hang a small message board in her room? The night before an appt, make notes on the board as to the time and nature of the appt, what time you'll be by to get her, etc. It may help her to see it in writing, but then again it may not. Eventually as the dementia worsens, not even notes will make sense. When you arrive to Mom's anger and frustration, just apologize and try to appease her. "I'm so sorry, Mom. I must have misspoken yesterday. I can understand how that would be distressing for you. Will you forgive my mistake? Hey, after our appt, let's stop by your favorite place and get some ice cream! What flavor would you like?" Try to enter her delusional reality (meet her when/where she is), then see if you can help guide her to a safer place. Hugs to you!! You've got this!!