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I have a dilemma that I need input on. Mom is bedridden with Alzheimer's, Dementia, COPD, and Parkinson and one of her legs is a bit contracted. What do you do when she has to go to the doctor and they will not permit a stretcher, but even with wheelchair they will not work on her unless she is on their table; BUT they will not assist you at all to get her from the wheelchair to their table!! This is just for a podiatry visit to look at some nail fungus! To make matters worse I have to hire a private ambulance to make this visit work.


The bigger issue is when mom says she doesn't feel good but when you inquire where it hurts, she is unable to tell you exactly. At what time do you call an ambulance to take her to the ER as that would be easier then arranging for a doctors visit?

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I would try to find a podiatrist that does house calls, they do exist. But I would check out Google and see if you can treat it without a doctor.

As we age we have days that we feel punky, nothing specific just generally not feeling good. I would watch for symptoms before I called an ambulance. Unfortunately the older we get and the less mobile we are the more we tend to feel not well.

Have you talked to hospice yet? It may be time.
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Your mom has many challenges. My mom has Parkinson’s too. With Parkinson’s you can’t second guess either. Mom’s neurologist and primary care doctor always says not to hesitate to take an ambulance to the ER with different or new symptoms. I recently had to do this. She did stay in the hospital for several days for observation and tests, then moved to the nursing home for skilled nursing rehab. Now on home health. Mom’s roommate was wheelchair bound and was doing a rehab program too. You never want to second guess and have the situation become worse. The elderly are always dealing with new issues that have to be addressed by medical professionals. When my mom went to the hospital she couldn’t walk.

My mom uses a walker and can no longer get on exam table either. Can’t they elevate her legs onto a stool of some sort?

My mom had the fungus thing before. What about home health? Ask if it will be covered under home health and if it is something a nurse can treat. The nurse mom had with home health treated certain skin issues. They may not but worth asking about. Medicare pays for home health.

There is a cream for it. Ask your pharmacist also.

Best wishes for you and your mom.
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I have found with my MIL who has short-term memory loss and cognitive issues, she often will tell me she has a pain one minute and then not the next. I'm not familiar with Parkinsons but good comments below.
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Yes that is definitely an issue as office staff will not help to get them on the exam table if your mother is unable to. They may minimally assist but I wouldn’t count on it.

Some people by necessity must be transported via stretcher.

Are there any visiting doctor agencies in your area? That may be an option for you as the ambulance cost for transport is expensive & I believe, an out of pocket expense.

As far as when to call an ambulance when she isn’t feeling well that’s not as clear cut. Err on the side of caution & call them if you need to.

I remember when this began to be implemented, maybe a decade ago, when office staff proclaimed they will lift no more. I guess I understand why - the possibility of employee injury.
But again, it’s yet another obstacle the CG has to navigate through that takes physical strength & puts the CG at risk. On the other hand, there are many immobile obese people in wheelchairs these days and most of the time the ancillary support staff in MD offices are MA’s or CNA’s who weren’t taught proper body mechanics and maybe in an office setting they are not required to lift to keep insurance and liability costs down.

But I so agree with you in being upset that you are responsible to get your mother up on an exam table. Another reason office staff also don’t have the time it takes to transfer someone as they are constantly seeing patients all day.
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I took my mom to podiatrist she was also pretty much bedridden she was definitely a two person assist,She had bedsores to the bone on her toes , great care when my sister had her,NOT. She was able to go in wheelchair,sorry your mom can’t. My mom was in No so sometimes we rode in Nh bus or the data on demand .She also had hammer toe severe. My doctor was happy to treat in wheelchair she got right down and examined her feet. Went a few more times I can’t believe how tiring it was for me and her.As she became worse I had wound nurse take care of it . Nurses at NH made sure they were wrapped etc . Long story but my point is call another doctor that can and will bend over no need to be on table. Bless you for being a great caregiver and I really pray that you and mom .
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Before mom went into the NH we found a podiatrist who made house calls. Medicare didn’t cover it since she wasn’t diabetic, so I just paid for it. I think it was about $60 per visit but Priceless to me. If your jerk of a doctor won’t even examine her in a wheelchair ( like the NH podiatrists do!) I’d get a different one.
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Medicare covers a visiting nurse if she is homebound. . But the podiatrist needs to agree to the home visit. Not easy.
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Shane1124 Aug 2019
No physician or podiatrist will write orders for homecare skilled nursing visits due to a toenail fungus. Medicare would definitely scoff at paying for this. Toenail/feet fungus can be treated at home. It’s definitely an issue as far as transporting you mother. Respectfully, I ask that you consider palliative care for your mother - that’s probably the easiest way for her to be followed by providers. Conditions such as toenail fungus are NOT a medical emergency, and Palliative Care programs will NOT provide 24/7 care for your mother. But they would visit (even if it’s a NP) & prescribe a med if appropriate. And prevent your poor contracted mother a lot of discomfort.

At 93, God Bless her. Doing everything medically aggressive for her may cause more harm than good.

Consider Palliative Care for your mother. Also, Look up visiting podiatrists in your area as many, many areas have podiatrists that will go to the home to treat & Medicare pays for it (quarterly or semiannually perhaps if the person has a diabetic ulcer).

Why put mother through all the trauma of getting up and dressed and then transported via litter/ambulance outside in whatever the weather may be, exposing mother to the elements as well as contact with people who may be ill?
Palliative Care would be a great resource to pursue.
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I'm only asking this out of curiosity - what do the staff at this *fantastically* useless doctors' practice suggest you do? Really, are they just literally standing there like cans of corn saying 'we can't help with that'? Unbelievable. Or at least I wish it was unbelievable.

Find a doctors' service that will make house calls and fire that lot. Meanwhile, take a good picture of your mother's nail on your phone, take it your friendly local pharmacist, and ask.

By the time my mother was literally bedridden only two things would have made me force her out of the house: one was an echocardiogram, which still seemed like a good idea at the time (though looking back I'm not so sure); and the other would have been, but by the grace of God this didn't happen, any injury requiring sutures or reduction. For anything else, I'd have asked them to come to us; and I'm more grateful than I can say for all the dedicated and resourceful people we had to call on.

But! - don't give up :) If you'd like any help with finding resources, try your local Area Agency on Aging or do very specific online searches. Remember, you are *never* the only one who needs the kind of help or service you're looking for, and the odds are good that some practitioner will have spotted the demand.
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Tothill Aug 2019
Country Mouse, I worked for podiatrists for 10+ years and for Physios for 15 years.

Some of the things I was asked to do:

Help tie the shoes of a women whose shoes were covered in horse manure.

Help a patient with Hep C and personal hygiene issues dress, when I was obviously pregnant. I refused this one. Nope, nadda, I am not touching you if you have a communicable disease and I do not know when you last washed your hands.

Help morbidly obese patients up and down from exam tables and treatment beds. How is one person supposed to help someone who cannot lift their own leg 4 inches off the ground?

I did help a when I could without risk to my well being. But I put my foot down at other times.

My job was to book appointments, take patients to treatment rooms, clean the rooms between patients and do the billing. I was not hired to touch patients, put my health and my unborn child's at risk, nor risk personal injury.

We had and still have in our community PT's and Foot Care Nurses that do home visits.
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First off, toe nail fungus is rarely an issue. Yes the toenails look nasty, but it is not life threatening. So why are you worrying about getting her to the Podiatrist?

Second, the treatment for toenail fungus is oral or topical Rx medicine. The topical does not work well at all, it is more of a placebo. The oral ones is very expensive has to be taken for a long time to be effective and likely would not be appropriate for your mother based on other health concerns.

Yes, I worked for a group of Podiatrists for about 10 years. I am not a medical professional, but you do pick up knowledge from the pros.

Do you have Foot Care Nurses in your community? We are lucky to have them in many Canadian communities and they are far more likely to do house calls. The Podiatrists I knew did some house calls too.

The doctors often worked with patients who could not get out of their wheelchair and although it was not ideal (wheelchairs are not sanitary), they would work on their knees to trim nails etc.

Some swear by Tea Tree oil to help clear up fungal infections, there are other 'home remedies', nut when you have an elder with multiple medical issues, generally it is best to leave it alone. You could cause more issues trying to clear it up, than the fungus ever will.
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Harpcat Aug 2019
I have to agree with this. Toenail fungus is the least of your mom's concerns. It’s not going to kill her but taking her to the podiatrist seems almost to be cruel.
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Redroseman,

My 86 yr old mom also has Alzheimer's, plus one broken right hip, a left partial hip replacement, and severe contracture in both legs, so no walking, but she's wheelchair bound. Her doctor's network had a house calls branch which I got her switched to once she broke her right hip and could no longer walk to get to MD office visits. They helped me get her into the hospice program which she qualified for and we used for a time based on her ailments, but she got better and we were dropped.

So, we went back to the house calls program, which offers MD or NP home visits from anywhere between every 4 weeks to 3 months, depending on the case. I found a good house calls podiatrist from a social worker, and he comes every 8 weeks, which is covered by Medicare. And I've had several home visiting PTs & OTs that have come since '16 when she had the initial hip replacement. (We're in NYC, by the way.)

Definitely check with her current medical professionals and social work folks as well as the local office on the aging, your caregiver support groups, and local Alz. Assocation chapter for referrals to house call docs & home visiting podiatrists, PTs etc, because they are out there. My Alz Assoc. chapter & house call doc. both were also helpful in giving me the names of dentists and hygenists that do home visits too!

Best wishes for you and your mom!!
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My mother can NEVER tell you what's wrong with her, exactly, or where it hurts, or what she wants, or doesn't want, etc. etc. So I let her be. I figure if things are REALLY bad and she's REALLY hurting or in need of medical attention, she will be able to verbalize what's wrong. She has dementia, but she's not that bad.........trust me when I tell you she can verbalize everything ELSE that's on her mind, just not what she's ASKED to verbalize.

Toenail fungus is NOT something I would worry about or schedule a doctor's visit for. Palliative care is called for at this stage of life, in my opinion, and the only time mother needs to see a doctor is if she's very ill, obviously so. She lives in Memory Care and I've hired the in house doctors to care for her. If/when she needs more urgent care, I have an ambulance sent for her to take her to the ER, and an ambulance to take her back to Memory Care. She's wheelchair bound, I should add. When my dad was wheelchair bound & I had to take him to the urologist, they pulled the same nonsense with me about only taking out his staples (from hip surgery) if he was on the table, and gee whiz, we sure CAN'T help you get him ON said table. We don't even have a walker for him to use!! I swear I almost had a heart attack that day from the sheer stress of that doctor's visit. From that point on, there were ONLY in house (in ALF) doctor visits for Dad, and now the same for mom.

When Dad was alive & they both lived in Independent Living, I hired a geriatric doctor that made house calls. It was SO MUCH easier......they'd even order traveling xray companies to come out if needed, and the same with nurses to draw blood. It's just TOO MUCH to try and transport your mother anywhere in the condition she's in. The other thing I've done (recently) is hire a wheelchair van to take my mother from the rehab facility to the Memory Care facility on the day she was moved in. It cost me $100 to have her driven 4.0 miles, but hey, I thought it was worth it b/c it was 100% stress free.

I would choose my battles here........in other words, use your own good judgment to determine when your mother truly needs ER attention and when she just needs plain old attention. Otherwise, YOU are going to have a heart attack yourself!

Best of luck!!
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My Moms foot doctor went to her AL. Maybe u can find one who will come to the house.
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When doctor visits become so overwhelming and my mother seemed to need every kind of doctor in the world, then I felt it was time for hospice. One day she was panicking and saying she needs this and she needs that from all her doctors and then even added a few more problems that needed medical attention and more doctors, I called her primary care physician and asked him if he felt she could use hospice. We had been in and out of the ER recently and he took all info into consideration and referred us to hospice. With comfort care from hospice, she is doing better, but is still eligible for their services. I just couldn’t keep up with everything anymore. Hospice keeps her good and so far we haven’t had to go out of her house for any doctors except the audiologist and skin doctor. She is not on hospice for skin cancer. (But she should be). That’s another day. Hospice supplies all medications and all equipment t my mother needs to help her.

Please inquire about hospice or at least palliative care.
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nymima,

I still don’t understand the difference between palliative care and hospice. Is palliative the same across the board everywhere? I know there are different hospice companies and it is a ‘business’. Is palliative care similar? All of us as caregivers need to know these things. Could you explain in detail what you know about it? I’m in Louisiana. Is it different in different states? Forgive my ignorance on the topic. I’d like to be better informed about it in case I need this service for my mom.

We had hospice for my brother but I have no experience with palliative care. Is it less restrictive than hospice?
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Tothill Aug 2019
The difference between Palliative Care and Hospice will vary by jurisdiction.

Here Hospice provides support to the dying and their families. There has been an ongoing fundwaising campaign to raise money to build a Hospice House, which will have rooms in which residents can receive Palliative Care. Locally we used to have Hospice volunteers who would sit with the dying so their family could get a break. They did not provide any medical or care giving, just company, perhaps reading a book, watching a show, playing cards. Currently they had programs for the dying and their families. Mum has been going to a grief support group sponsored by Hospice since David died. It has been a great support to her.

Palliative Care in this part of Canada, refers to keeping a patient comfortable, but not providing any further life supporting treatment. No feeding tubes, no dialysis, or chemo. My step dad received Palliative Care in the hospital as there was no way for Mum to care for him at home.
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Medicare will pay for a podiatrist to come to the house. I use a visiting nurse and physicians service for my mom's care.
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I tried to get phone or Skype consultation with Drs office for mother. Every time, they would tell me to "bring her in" (cuz of liability fears). Also, "house-calls" (by Drs or nurses) should be provided by every insurance company, for elderly urgencies. With our aging population, its downright stupid the way services are provided in the U.S. it would save money to help us avoid unnecessary transport or E.R. visits. (My mom frequently needed hydration, which could have been done by I.V. at home, saving thousands). There's no reason labs ect, can't be done at home, if patients are deemed eligible. Maybe I just had the wrong insurance co.
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JoAnn29 Aug 2019
When it comes to Dr office visits the patient needs to be there for the doctor to be able to bill Medicare. Thats why I stopped Moms specialist. The required her to be there for test results even though she had no idea what they were talking about.
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There comes a time when we have to look at our Doctors and see if we still need them.

On a hospital visit itcwas found Mom had a thickening in her upper stomach. Had to see a specialist to determine if it was cancer. No, probably caused by her acid reflux. But we went every six months and then a year. When there seemed to be no change, her Dementia was getting worse and she was in an AL, I stopped seeing him. She had graves disease. Again a specialist. After a couple of years it seemed to be under control. By this time she was in LTC. Specialist said as long as the facilities dr. Tested her ever so often and her numbers were good he wasn't needed. He was also 45 min from her NH. Then there was her urologist. She had bladder cancer at 80. He was still at 87 doing scopes on her oncevavyear. With her Dementia we would never had put her thru the Chemo u need to go thru. So, I chose to stop him. There are things u need specialist for but after ur stabilized I think a PCP can continue monitoring.
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I take my mother to the pediatrist every nine weeks, and she stays in her w/c. The w/c reclines to 50 degrees. I tilt her about 30 degree.. I place a bulky pillow under her legs. The doctor is ok with this. He does not have to struggle to cut her toenails and he saves his back.
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Goodness, many professionals in our health care system seem to have lost empathy for patients!
I would think there would be extra people to be called for help in moving patients onto tables etc. Of course I also know many times they are worried about liability.
I have no advice for you. Just wanted to say how disappointing it is to see a profession that is supposedly human oriented w little care about patients.
BTW, I teach preschool and many times have had to deal w bodily fluids. I put on gloves and deal with it.
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You didn't mention your mother's medical directives or wishes. My mother who has advancing dementia and lives in a memory care facility was hating every time she went to a doctor visit or had to go to the hospital. During her last hospital visit she was biting the nurses as a way of expressing that she didn't want them to bother her. We decided to switch her to hospice care with a medical directive of no hospitalization. The concept is that she gets "comfort care" just things to make her comfortable. Hospice helped me contact her doctors to renew her prescriptions automatically (without a doctor visit). The doctor comes to her facility for her annual check-up for her to stay in the facility. Some people even put into their medical directives that they don't want to be fed if they can't feed themselves. My mother didn't do this, and now she is at the stage where she has to be fed. As mentioned in another response, if you have medical POA you can decide which doctors she should visit and when it is necessary to do so.
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This was a huge dilema for me with my mom until she was on hospice. When she was more mobile, I was dismayed that doctor's offices had these stationary tables that were impossible for her, or many elderly people to climb onto. The need to have drawers in the table to store paper gowns seem more important than patient needs. At least her doctor then would examine her in the wheelchair. Dentist chairs go up and down, why can't doctor's exam tables???!!
The problem of getting my bed bound mom to the doctor in a wheelchair and hiring a van all went away when she was on hospice. The time before that was terribly rough, so I fully understand where you are coming from.
If anyone is listening that could invent an exam table that goes up and down, please do so! You could make a bundle as this is badly needed!
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Ash1984 Aug 2019
I just went to a doctor last week who had a table that started out super-low! She had be sit down and then raised it. Also, there was still a drawer at the end! I'm able to get up and down, but now that I know these tables exist, I don't know why offices that deal with elderly patients and/or disabled patients don't all have these. I'm guessing it has to do with expense. Plus, the table was more comfortable when I needed to lay down, which would be so great for older patients.
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I don't understand why someone would not allow a stretcher unless it is due to the size of the exam rooms and hallways. I would ask for clarification on that point with the doctor - not the staff. Ambulance personnel do not leave without their stretcher which means they are always available (in the waiting area) for lifting if necessary.
Perhaps there is someone who would make a house call in your circumstance. Again, I would ask the physician if this is possible. Or if your mother is in a facility, is there a podiatrist on the staff?
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After my dad had surgery on his femur and hip, we had him transported to the surgeon's office on gurney via a company that provides rides for medical appointments. Here locally it’s called MedRide. It was not cheap but necessary in his case. They also provided wheelchair rides. The drivers would help with assisting him on the table when necessary. And even the doctor helped. Your podiatrist needs to be fired. But personally I think worrying about a nail fungus at this stage of your mom's condition is not necessary. It’s ugly but hard to cure and it will not affect the quality of her life. Plus you have to throw away any shoes she wears as it will just reinfect her. Give it up and move on to more serious matters. And don’t feel guilty.
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I was able to locate a wonderful doctor that a nurse from a visiting nursing company suggested. This doctor came to the house once a month and more often if urgent. She took care of all my moms needs, Levy bodies dementia with Parkinson’s and mom was unable to walk. I was also told that the local hospital would give recommendations for doctors that treat only the home bound. She accepted Medicare and we had to pay no additional costs. Blood work and xrays both came to the house. Best thing we ever did concerning moms care.
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There are also many podiatrists who make house calls. Check with the ones who visit local nursing homes. Ours accepts Medicare
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cetude Aug 2019
Medicare does not cover nursing homes, unless it is for rehab (for a limited time) and only after hospitalization. Most podiatrists do NOT make house calls.
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This happened to my father, so he had to switch doctors...and for his radiation treatments had to do it at the hospital versus the cancer center. as far as podiatry goes, we had one come out to the house, as well as the rehab center, and they had no problem cutting his nails from the bed or wheelchair. So ask around...maybe there are better podiatrists who will work with a wheel chair bound person. Us too with the ambulance to get him there, as he wouldn't walk down the stairs...The ER? Possibly, but you know how the ER goes, you'll be there for Hours.
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With the conditions you list she would be eligible for Hospice. Then you would have a Nurse that comes to you. If a Doctor would be needed they would come to you, or they would arrange transport to their facility or to the hospital if that would be necessary.
With Hospice you would also get a CNA that would come in and help bathe, dress, order supplies....And you would also get a Social Worker, Chaplain if you wish as well as other services.

Oh, the nail fungus...don't worry about it it does not cause pain and most "cures" either take a year to work or they don't work well and if it is the oral medication it is toxic to the liver and she would probably be required to have blood tests every few months.
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It sounds like you need to put her on hospice. They can supply all the routine medications. My mom is on hospice and I get her all her routine meds through them; now her insulin and insulin needles are regular prescriptions through Express Scripts, but hospice filled that as well. Should you ever get your mom in the ER or hospital, a hospice consult can be made. You may want to try CALLING your mom's primary doctor and ask for hospice.

I don't know how old your mom is, but nobody has ever died of toenail fungus. I treated mom's toenail fungus with over the counter topical stuff -- it took about 10 to 12 months of daily treatments twice a day but it went away.
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see if your area has visiting physicians. we have that for my mom and they come to see her at her home
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It's unfortunate that podiatrist's offices don't have a hydraulic lift--a small version of what the auto mechanics use. Then the wheelchair could be raised a few feet so the podiatrist wouldn't need to work at floor level, and it would obviate the need to transfer the patient.
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