yourhousekeepers

Picking a New Primary Physician

As my mother’s legal and medical advocate, I get to pick her new Primary Physician. The old one was getting out of medicare, so we can either pay big bucks or go with another doctor. My mother doesn’t have a complicated medical history. She broke her hip two years ago, has manageable high blood pressure and has some dementia.  At 97, she needs  monitoring and basic care. So how do I hook up a lady born in the horse and buggy days with a new doctor in this internet age.

Doctor reviews are hard to come by. There are best physician editions of papers and magazines which look suspiciously like ads. There are reports from licensing agencies telling whether a doctor has been censured for questionable practices  but no equivalent to say… Amazon’s review of books, epinions reviews of household appliances or Consumer Reports review of cars.

My plan starts with a sample of 20 doctors within 30 minutes accepting her current Medicare + insurance.  I call to make sure these doctors are accepting new patients and still accept the insurance as listed on the website. I’m down to 14.  Next is a location check. I look for easy access. I take her in a transport chair that has four 5″ wheels. I want a nice neighborhood, good parking and a ground floor office or inside elevator access. I look for non-medical signs of smarts, cleanliness and order. Office personnel with common sense and common courtesy mean a doctor who knows how to run  a practice. Records aren’t lost, tests are recorded properly, equipment is calibrated and maintained. I’m down to 10 now.  I look through their bio, schools, specialties, experience. My sister used to be a nurse. I have her put them in order. Now I schedule a short phone call.  We talk. If I feel, I have a competent caring pro, I can work with, I sign mom up. After three calls, I settle on the 32 year old Internist from Shanghai who did her residency at the hospital that did Mom’s hip surgery.Oh…Mom likes her too.

Home

My mother has mild dementia which began about 10 years ago. It began with confusion when she walked in the mall or got lost in the aisles of the supermarket. The Neurologist says she has an old lady’s brain. Small damage in many parts of the brain has been caused by minor strokes. It is likely that one of these strokes led to the fall that  broke her  hip two years ago.She exhibits what medical people call sundowning.  When it starts to get dark, she is apprehensive and lost.

She sometimes announces that she wants to go home, when sitting in her living room or lying in her bed. She has lived in many different homes so once, very late at  night I asked her where home was.  I thought she might  be going back in time to thoughts of her home in Brooklyn (NY) or Dromod ( Ireland ).  She was very quiet and thought awhile before speaking.  ” Home is where I can do things myself ” she replied.  That was the “home” she really missed.  It is heartening to realize that when we grow old and frail, what we long for aren’t things or even youth.  We long for the important things like freedom and independence.

Getting Organized

Although, everyone benefits from it, people who deal with crises and emergencies must be extremely organized. Firemen always return their trucks ready to go out to the next fire. ER surgical teams always leave the operating room set up for the next  accident. In elder care you need to do similar things on a smaller scale.  I have two small bags packed with a change of comfortable clothes, shoes and toiletries. One stays in the trunk of my car.  One stays in the hall closet to go with the ambulance if my backups are with my mother in an emergency.  Her doctor’s numbers are on the top of my cell.

I have kits of bedclothes arranged for quick replacement at night. Mom has prescribed medicines, vitamins, laxatives that she takes regularly. I also serve her a soy protein/vegetable juice  concoctions when her appetite disappears.  Occasionally her electrolytes are off so we  keep  salt, potassium and magnesium supplements in the house.

All of these measures were put in place over the years after I had gone through some  emergency unprepared.  The second time around, I’m prepared and feel like an expert. My equipment is at hand and the emergency looks quite normal.  All in a days work.

Simple Equipment

After my mother’s hip surgery, her doctor prescribed rehab and several pieces of medical equipment.  By far, the most useful is the walker. Mom’s has two 4.5 inch wheels on the front legs. The back  pair have no wheels to provide stability.  Unlike younger people who might break a leg or a hip, the elderly have balance problems unrelated to the new or weak limb.  These gadgets have been around for years and are an engineering work of art.  There are two buttons on the top crossbeam. When pressed the walker side fold in so the walker can be stored in a car trunk or in the back seat. They are also extremely maneuverable in tight corners like the stalls of public restrooms.

Most elders can use them to get up from a seated position. At 97, mom has little upper body strength  so she requires help.  Even so, I find the walker a help to me in getting her up due to the many places and different heights for hands. The walker’s legs were fitted to my mother by the rehab therapist. Different leg heights were tried out watching my mother walk, sit and get up.  If it were not for this little gadget, I’m not sure my mother would be approaching her second year post hip replacement.

We’re Irish

My parents were born in Ireland and  both came to NY in the thirties. They met through contacts with relatives and friends at one of the many local get togethers that were run by all immigrant groups.  My brother got this in the mail from a friend so I’ll pass it on.

Irish Dancing Bears

Going Beyond Expectations

I make sure my mother’s day to day needs are taken care of.  Usually she is pretty happy with this. I get her up in the morning and change her into her outfit dejour.  After breakfast is reading or on a nice day a short trip out side for a stroller ( walker with a seat and four wheels )  assisted walk for a few blocks. Not much for the old Margaret who used to go for two miles in her seventies and early eighties, but these days this is what she can manage.

My sister was here this week and decided to give mom the full beauty treatment, - manicure, shampoo, cut and blow dry. This really put a spring in her step. She laughed when we told her  how nice her hair turned out but I think it made her feel special that we took the time to make her feel special and fussed over.

Not out of Sight

About 6 months ago, we discovered the free video phone service offered by Skype.  My sister had just gotten a new laptop with a built in web cam and I already had one.  We hookup once a day when she is not visiting and my mom gets to see and talk with every night.  Our equipment is far from fancy or pricey.  The Laptops are cheap ($499 + tax) Acers and the web cam is bottom of the line but we can see and talk clearly. Occasionally heavy traffic creates tinny sounds,  echos and screeches and sometimes we are cutoff.  I see a great future for this service with older people, especially the frail. These users may have no interest in the rest of the computer, but the video phone and perhaps low cost security hookups would be welcome both for the elderly and their families.

Backup Crew

Everyone in the elder care world needs backup people.  You should definitely make sure to include them in your care plan. Here are my sister, mom, my brother and my sister in-law. They make sure I  get breaks, can get out for customer service (  hanging on to the old job but I work more from home than in the past ).  Having them has made life easier for me and mom and gives her the social interaction that she needs as much as physical care.  A few friends and people I have met at hospitals and senior center have had a more difficult time in getting family support for an aging parents but we are very close and I know I can depend on them… on short notice for job related problems and yes, even on those 3am calls after the ambulance has arrived.  I hope you never feel taken for granted.  Thank you, crew.