Note that a concierge doc may have some restrictions on contact as they have other patients (and presumably a life). They are not actually available 24/7 and may have restrictions on the number of calls/emails. This will differ doctor to doctor. She would definitely get more one on one attention but it’s not a cure-all.
7 Likes
Also the concierge doc has to decide whether or not to accept the patient and the patient gas to agree to pay the extra fee for the doc. They are not all equal so evaluate carefully if you go this route.
Concierge docs have a small a caseload of patients and can be particular about which ones they’ll accept.
1 Like
All of the cheapo Medicare Advantage plans I’ve been in have 24/7 access to a call with a nurse. And my hospital network has access to unlimited video visits with an ER doctor around 18 hours/day, for free.
3 Likes
We have access to a nurse helpline at no charge. We can also make reservations for urgent care and there is space to describe the issue. A nurse will call back and you can talk to him/her about the issue and they will advise you as to whether Urgent Care of ER is better for the issue. They have been helpful with H’s frequent issues and saved us an unnecessary stop at UC because we really needed equipment only in ER.
2 Likes
I’m a patient in a concierge practice that is owned by a large regional hospital system.
DH got in to the practice just before he was diagnosed with diabetes. The care was very responsive and he could even go to their office for lab draws ordered by any of the specialists they sent him to. (But we found out he could not just walk in for draws — he needed to schedule an appointment, which might be the next day).
The doc was a significant help when DH was diagnosed with pancreatic cancer.
After DH died, I transferred my care to the same group. After hours, my calls are received by a service and passed to the group’s on call doc. Calls are returned promptly. They will advise ER or next day appointment.
If I get labs done on a day that is my doctor’s day off, another doc in the group will send a message advising if there are concerns or not with my labs.
It’s definitely high touch.
4 Likes
My sister who has many health problems has a concierge doctor. It’s been great for her to have someone who is on top of all the different medical issues and is easily accessible.
My father-in-law tried a gerontologist but he didn’t care for the doctor and felt he wasn’t easily reachable. He switched to a concierge doctor at age 90. While I don’t think the doctor is anything great I think the ease of getting into the doctor and being able to be seen in their community is well worth the cost. This is in an area where I think most patients who use the concierge practice are seniors. That doctor is slowing down his practice and has brought in another doctor to the practice. My MIL was pursued to also switch. She feels this new doctor is better. They can call and get in on the same day. They also love the ER at the small local hospital. They go there for a lot of concerns. They found that the Urgent Care center seemed to always tell them to go to the hospital.
Their previous primary doctors were 45 minutes away and at 95 years old not the smartest drive. The concierge is local to them helping to lessen the driving trips to the doctor. Unfortunately most specialists are 45 minutes away.
4 Likes
My dad was around 90 or 91 when we engaged a concierge physician on his behalf. We live in an area with lots and lots of senior citizens, and his prior doctor had 2000 patients, and the concierge doctor was said to have only 400. It made booking appointments so much easier. In the last year of his life, the service was much more high-touch. I will seriously consider it when I get older, but not yet.
5 Likes
It’s interesting how times (her on CC and in the real world) that I’ve recently heard about concierge doctors. hose practices serve a good purpose.
But… it really does make me hope that someday our medical system will find a way to integrate more PA/NP etc (and maybe even some way of leveraging AI/human expert collaboration) to become more efficient. In conjunction with this thread topic, my wish is that if even if it can’t happen to help our parents… that it will happen before my kids need to be coordinating my care. And if not, my wish will be to have enough funds left in later years to be able to afford a concierge option. I see way too many families scurrying around trying to deal with their parents’ interlocking specialist visits.
I just went to the NP this morning, and she had a student observing our meeting. When I said something about it being good that young people are getting educated in these fields, my NP acknowledged that their patient numbers were increasing, creating the need for new NPs. We hired the concierge doctor to eliminate the “scurrying”, and it really did. There was other drama present, so it didn’t solve everything, but it was one improvement.
1 Like
I have a bad outcome story from a wealthy person (I personally know his wife) whose concierge MD partner was on call, and with his hospital admission didn’t probe enough (on the phone with ER MD) on his medical conditions prior to the current pneumonia he had that his wife took him to the ER for; the man sent his wife home once he was settled in his hospital room - for her to come back the next day with personal items like his shaving kit (she should have hired a sitter to stay or insisted on staying, and also more medical precautions, NC oxygen, head of bed elevated 30 degrees). But her husband was a CEO retired head of a Fortune 500 company he cofounded, self-made man - and she didn’t see the danger - if something happened to him and he couldn’t ring his call light, or if the call response was late. He was on a regular medical unit and had something happen medically to him that night - the hospital staff found him unresponsive, and after being on life support for a few days, he died. I told my friend that if she ever is in medical need, she can call me 24/7 - one needs a medical advocate at their side. The concierge MD later asked her “why didn’t you call me?” - but of course there was his partner MD that was on call. He had throat/mouth issues from oral cancer in the past - and IDK if that caused an issue during the night. But his respiratory system was compromised beyond just pneumonia, and more caution definitely was needed.
Sometimes one doesn’t know what one doesn’t know.
The medical paradigm is changing. Understand what one can about the care you need and you can get, and understand about the care you might possibly need. Asking a lot of questions to current care providers, asking questions to others you know that might have more knowledge/experience in the situation as well as know the resources available/options available in current community.
In Switzerland, everyone has their medical coverage through the country (retirees pay in the same as if employed but it is at a level steady throughout) but you can pay ‘extra’ when you are in the hospital and desire the same MD following you (like concierge). In Switzerland, they also have trained people that are the homeopathic medical kind of track, and you can have some remedies outside of traditional medicine.
Those confounding parents.
I’m perseverating over a friend’s situation with her 90+ year old mother. There are three adult kids in their late 50s early 60s. One lives in the nearish to Mom in the same major Midwest city. Two are on the east coast with complicated lives and special needs, and not an abundance of money.
All three “kids” are still working. The local is the grandmother of infant twins.
The 90 yo is one of the least-nice people I’ve ever known and I’ve heard a lot of stories. She won’t accept help, lives alone, etc. You’ve heard the stories.
Mom fell a few weeks ago and I really tried to gently discourage letting mom go home after rehab. Broken hip. She has just gotten home and the first two weeks of round the clock care will be over $8000.
Also, the kids found out that other than a paid off house and car, Mom only has $10k to her name, Make that $2k after the first two weeks.
While my quick answer was “it’s time for Medicaid” and a consult with an elder care attorney, I’m sort of angry at Mom for never letting the kids know this could use some planning.
It’s so hard that these older folks think they are going to die in their own beds without falling, breaking hips, getting pneumonia, or anything else that might happen.
Selling the car is the only thing that is likely to happen quickly, but that won’t buy much care or time.
From what I know there are several ADLs she can’t do, but she will fight the idea of going to a facility.
This will be interesting to watch to see how they can get services, what’s next, and if anyone moves home to care for her.
It all makes me sad. And angry.
7 Likes
1 Like
MIL had a Jitterbug. It was actually not simple to use at all. And I am convinced that the people who sell Jitterbugs to old folks also sell their names to spammers. I swear, MIL got constant spam calls and texts after she got a Jitterbug. YMMV, but that’s our experience.
2 Likes
Dad has a Lively jitterbug flip phone. The interface seems clunky to me, but he is accustomed to it. He had the text feature disabled after a scam text somehow resulted in charges. Too bad since his hearing is so bad.
Social services in the rehab possibly has the power to ‘block’ what mom wants because she can’t afford care to be able to go home. The county aging - or whatever it is called there.
The rehab facility might have long term/skilled facility - bed available, and if she can stay and use up/spend down some of her money (it won’t take long) and keep a skilled care bed there moving seamlessly into Medicaid (if they have a bed available). IDK what the Medicaid requirements are for a single person - if they do have to sell their home. The facility will have people who know.
Facilities balance the patient load fiscally.
1 Like
Our happiest day was when Mom gave up her cell phone. The spam and scam were relentless, and it just ginned up anxiety every single day. Her AL provided a landline; we just found her a super simple phone and she is so much happier.
Her AL is losing staff in anticipation of the 2027 medicare funding cuts, and the local hospital is also looking at further reducing services. It’s a bad time to be elderly in rural America.
11 Likes
Thank you always.
From my perspective, the problem is they (the adult children) let her come home. This may be a case where she has to be admitted again to get someone to make a different decision.
She’s long divorced and lives alone. I don’t know what it will take to get the Medicaid acceptance done — and an assessment for Medicaid-paid care.
My frustration is they waited so late, there’s no time to make “better” plans.
3 Likes
I feel like I’m juggling, jumping through hoops and trying to reason with a toddler who knows they can make their own decisions. All at the same time.
I think it’s not uncommon. I think there is a ton of magical thinking and that there will be time to figure it all out. When in fact, there’s no time to fully comprehend the complexity involved.
Add to that no money to have choices and it’s even more difficult
Even though the elders in my neighborhood have the advantage of having funds, I see this all the time. We have a neighbor who is home, shouldn’t be home and is resisting all common sense. Because they like their house? I’m sure they do.
I swear I think the plan is to drop over dead one day. No other for thought other than none.
8 Likes
The Best Tech Gear to Help Aging in Place
https://www.nytimes.com/wirecutter/reviews/smart-home-for-seniors/
2 Likes
From the article:
It goes without saying a smartphone is an essential tool of modern life, and most of the devices in this guide require access to and frequent use of one. For instance, you may need a smartphone for setting up devices and connecting them to the internet, or for controlling smart-home devices via touch or voice commands. A phone that is as simple to use as it is reliable is a worthy investment, and that typically means the phone has a large, finger-friendly display that is easy to control and use.
1 Like