I'm curious as we start to head down this path (hopefully). With FIL this is such a snail's pace - as we are kind of at his mercy on when we will be able to actually move him to a skilled nursing facility. For the most part he is still competent and is incredibly immobile. He is able to get himself physically out of the bed and using his walker transfer to the bathroom and back, and with the help of his bath aide he is bathing. But beyond that he is depending on the 4 family members (adult children and spouses) for everything else. Primarily SIL who lives in his home and her husband, with myself and his son assisting as we can around our jobs. Many of you have heard our story frequently so I won't bore with the details but long story short we are in the 'waiting for the next big fall" stage with the "unsafe discharge" plan at this point.
Anyway, my point is a question - how do skilled nursing facilities handle doctor visits? I think I had heard that they seriously get scaled back. He thinks of doctor visits as mini-vacations - his social outlet - and schedules them like he is scheduling outings with friends - because he has alienated all of his friends at this point with his behavior (but that's another story). I think at last calculation by year end we will have tag teamed (because his transport to the doctor requires at least 2 of us for safety reasons) him to over 30 doctor's appointments this year. And I would say that if I had to hazard a guess, probably at least 30-40% of those were not necessary. He has three just this week - that require at least on person to take time off of work to assist SIL in transporting him each time.
We are don't have insight into how SNF's work with doctors. Do they eliminate outside doctors in favor of one internal primary? Do they have family continue to manage outside doctor appointments? Does the facility manage appointments and transport? Do they scale down down and eliminate all but the necessary specialists? How does that all work?
However, if he does need to see a doctor outside of the facility, the NH will (should) make the appointment and provide transportation.
When my mom entered the SNF from the hospital, it was for a broken leg. They never contacted the orthopedic surgeon for follow-up care and staple removal. They failed to make a follow-up with the orthopedic surgeon within the time he wanted to see her and when they finally did, I was told 2 days prior that transportation wasn't available. We ended up renting a handicapped van & taking her ourselves. Her surgical staples were in for 40 days by that time.
So, in a nutshell, the facility doctor will take care of his basic needs. Given your dads need for 'social visit' doctor appointments, I think his visits to the doctor will be cut down dramatically and they should provide transportation if they deem the visit necessary.
My husband’s roommate had Type 1 diabetes. When roommate finally got to endocrinologist, that doctor put him on scheduled blood test with insulin based on reading, House doctor cancelled because “If we do that for one, we have to do for everyone”. House doctor wanted shot of insulin twice a day done on rounds. No taking time to make targeted dose based on blood sugar.
Like everything, in-house care from doctor depends on doctor. They are hired by administrator. And fired if they crefate too much fuss. And like ll nursing home staff, turnover is high. They seem. To rotate out about every 2 year.
The better NH facilities generally are both Medicare and Medicaid qualified as those federal rules then require many things (RN on staff all the time, "care plan meetings," COVID-related data reporting, qualify of care requirements and reporting, discharge rules, on and on). Most higher-quality NH facilities will have physicians on contract -- or on staff -- of differing specialities that are right there at the NH throughout the work week and on call weekends and evenings; making doctor visits simple (they just come to the room and handle it for the most part there). Most also have other providers on staff right there: dietitians, physical therapists, social workers/mental health providers; and visiting providers like podiatrists, audiologists, and dentists. Most quality NH will ask you to pick a "primary physician" from their list to be your LO's primary doctor moving forward while at the NH (even it if is a temporary stay) to coordinate all the care right there at the facility. Worth looking for a facility which has a variety of board certified physicians on contract or staff right there and even better if most/many of those MDs are board certified in geriatrics; but if not give these providers generally work only in the NH facility, they are much more experienced in geriatric-related care than other physicians in regular practice outside of a NH setting.
When something specific is needed -- such as a specialists not on staff/contract or medical tests/procedures that cannot be done at the NH -- the care team at the NH should schedule and coordinate those limited outside doctor visits. Most NH want to limit the outside visits of any kind -- doctor or otherwise -- because of COVID now. They will also coordinate medical transport as needed. NH have contracting pharmacies so any prescriptions are handled through the NH, don't bring any prescription or other medications (including supplements) to your LO at the NH.
Giving your primary physician at the NH and their care team there the role to coordinate care, make any outside doctor visits is the way to go as those folks at the NH are on point for your LO's care while there. As needed/if needed, the primary physician picked to care for you LO at the nursing home -- and the NH's care team -- will order and coordinate care needs with any health care providers outside of the facility.
If your loved one is difficult about this, let the the NH care team explain how things will be done. Also, worth getting any paperwork done before entering, such as a durable power of attorney (POA) so someone else can handle things -- financial or otherwise -- as needed. Not that you need to take over immediately, but to be prepared if and when you or other family members need to step in more. Ditto, for executing an Advanced Directive that spells out your LO's wishes for medical decisions if he cannot do it as well as naming a "Health Agent" who is the primary person (family member) the NH facility needs to inform if/when there is a "change in status" and the person the facility needs to communicate/coordinate with (family) on behalf of your LO.
Need ambulance or other transport, 2 ways, either charged to insurance, and what insurance does not pay is charged to the resident, or the full cost is paid upfront in full or no transport.
This is also a good time to scale back on the specialists. The PCP at the facility should be able to coordinate care and prescriptions without endless office visits to orthopedists, pulmonologists, and cardiologists. It's time to refocus on quality of life rather than trying to cure every ailment that in the end is incurable.
The facility is supposed to manage transport and even send an aide with the person who has the appointment. Most of them just send the person to their doctor in an ambulance then leave it to the EMT's to escort them and stay with them during the appointment.
It is up to the nursing home to make sure the resident gets to the doctor though.
I think it depends on the SNF and if your on Medicaid. Moms PCP did not take Medicaid so I had to choose from the Drs affilated with the facility.
I appreciate you asking this question, as I have wondered about the Dr. appointments as well.
Facilities do have an "in house" doctor that is called in and orders meds, may see someone if needed. (I suspect most of it is just chart review, signatures that need to be done. I think in many cases the Nurse will order a med after consulting with the doctor, for something standard, and the doctor signs off when he/she comes in.) And the house Dr. would renew any continuing meds. Also they would order any lab work that needs to be done.
If a resident is seeing a specialist the facility would arrange transport if the family can not safely take them.
Anything out of the ordinary the facility will call 911 for transport to the local ER