En español | Allen Neylon lives in Brick Township, New Jersey, with his wife, Mary Beth, who has Alzheimer's. Last spring, when New Jersey COVID-19 hospitalizations were spiking, Neylon took his wife to the hospital to get some worrying symptoms checked. “I wasn't allowed to go in with her,” he says, so a nurse met him outside to get information. Neylon told the hospital staff that Mary Beth had dementia. But once she was inside the facility, “they took everything she said as gospel,” he says — and did not verify what she said with him. “Later, they said they didn't know my wife had dementia. They thought it was vertigo.” It was traumatic for his wife, Neylon says, “and it was ripping my heart out because I [couldn't] do anything” for her.
Restrictions for visitors, including caregivers, have eased since the spring, and exceptions are made more readily, according to doctors around the country. Still, helping older loved ones navigate their health care under COVID-19 precautions and restrictions can be complicated.
The first order of business? “Know the rules. Don't show up at the door surprised," stresses J. Allen Meadows, an allergist in Montgomery, Alabama, and president of the American College of Allergy, Asthma, and Immunology.
Here are four other things to keep in mind as you plan doctors’ appointments.
Is the appointment needed right now?
As many doctors’ offices reopen, some caregivers of older Americans may be tempted to schedule a slate of routine appointments. But while health care practitioners struggle to return to normal, even with precautions in place, many of them are holding off on scheduling nonurgent visits. At present, “most doctors don't advise patients to come into their office for routine follow-ups,” Meadows says. But, he adds, “If you have an urgent issue, go see your doctor."
What is urgent? If your loved one is experiencing life-threatening or harmful symptoms that need to be immediately addressed — difficulty breathing, acute injury or chest pain — bring them to an ER or urgent care center at once. For concerning symptoms that don't require a visit to the ER, call their health care provider, who can decide if the patient should be seen. “Depending on [the patient's] risk factors such as age and comorbidities, a discussion with [their] physician is critical before delaying any treatment,” says Ramin Fathi, a Phoenix dermatologist and Mohs surgeon at Phoenix Surgical Dermatology Group, who treats skin cancer patients. “Some skin cancers are slow-growing and asymptomatic,” he says, “and others are aggressive and life-threatening and need to be addressed sooner rather than later.”
The doctor makes the call on how quickly to attend to an issue. Last spring, dentist Arthur Yeh, who runs his own practice in Bloomfield, New Jersey, saw only patients who “were experiencing swelling, pain, or difficulty eating or chewing,” he says. He would treat them alone in his office to limit the risk of COVID-19 infection. The American College of Surgeons has issued a useful guide for more details on what to see the doctor about and what can wait.
What is the office's visitor policy?
If the doctor suggests you bring your loved one to the office, check its visitor policy before you go. In the time of COVID, policies are stricter. “Currently, we only [allow] scheduled patients in the office,” Yeh says. “With older patients, we make exceptions for their caregivers as needed, but we also ask that, once the patient is seated, the caregiver go back to wait in the car.” At the Montclair Breast Center in Montclair, New Jersey, policy changes include keeping friends or family outside the building. It's the same at the Santa Barbara Women's Imaging Center in Santa Barbara, California, which “discourages non-patient people from entering the office.” Says Brian Jenkins, director of marketing at the center, “We recommend that caregivers wait in the car or outside the building” while the patient is in the waiting or exam room.
Hospitals also tightened their regulations for visiting caregivers. “Early on [in the pandemic], there was a concern that caregivers could be a source of transmission into the hospital, which meant they couldn't accompany sick family members,” says Sam Torbati, an emergency care physician and co-medical director of the Ruth and Harry Roman Emergency Department at Cedars-Sinai in Los Angeles. “Now that we have a better understanding of COVID-19 and [personal protective equipment], and we have universal guidelines around screenings, we're in a better place to allow for more visitation and family."
Carol Jones, chief nursing officer at Morristown Medical Center in Morristown, New Jersey, part of the Atlantic Health System, says that when caregivers were required to wait in the car at her hospital, the center's medical team took over to provide extra care for both admitted patients and outpatients. “[We] had to become the eyes and ears of the patient and communicate with family,” Jones says.
Still, many medical facilities, Morristown included, made exceptions for caregivers who could not be replaced, Jones says. “The medical team would ask, ‘Is this [caregiver] needed by the patient?’ When a caregiver felt strongly, we would weigh the pros and cons and make a decision. Some adults or adult children who are caregivers to a compromised patient … if they're caring for [their older loved one] around the clock at home, they can be with us as long as they're respectful of our rules."
How is the office or center taking precautions against COVID-19?
Right now, in most health care facilities, including imaging centers, doctors’ offices, hospitals with outpatient services, ERs and labs, vigorous facility cleaning and sanitizing, universal masking, physical distancing and hand sanitizing are the norm. Patients are almost always met at the door with a thermometer and a COVID-19 questionnaire. Preregistering for appointments is encouraged at the Santa Barbara Women's Imaging Center, a practice that cuts down on time spent in the waiting room. Special precautions used at other medical facilities include removing magazines, as Fathi's dermatology office has done, to protect against the risk of virus transmission, and asking that all patients use a special rinse before their dental exams, as does Yeh. He wears an N-95 mask, usually with another surgical mask on top of it, a full-face shield and a full protective gown, and his staff is protectively dressed as well.
In addition to installing medical-grade air purifiers in the office, Yeh uses a fogging machine that sprays a compound of salt and vinegar called hypochlorous acid into the air. The compound bonds to viral particles in the air and destroys them, says the dentist, who mists the ceiling of every room with it himself.
How should you prepare for an in-person appointment?
Both caregiver and patient should wear a mask and arrive on time. When you call to make the appointment, ask this simple question: If the visit is a preamble to a scheduled surgery or procedure, does the patient need a COVID-19 test? Today, a test is often required two to four days before the procedure and is usually administered in the office.
If your older loved one's present health care need is not urgent but pressing, it will help everyone to bring along a couple of important documents. One, a list of medications — names, dosages and frequencies, Jones says. (You should also note the number of refills left.) Second, a medical history that includes symptoms, dates and durations can also be useful, not only in filling out the COVID-19 questionnaire but also to get more value out of the appointment. A list of questions for the doctor is also useful.
In addition, “the caregiver should know the names and numbers of the patient's other health care providers,” Meadows says. “Especially for a patient with, say, memory problems, it's important that the caregiver have on hand the contact information for, say, a dermatologist or gastroenterologist.”
What to leave with when the appointment is over? Fathi recommends that you 1) make sure all of your or the patient's questions have been answered, 2) review the instructions for home care provided in the treatment plan, and 3) schedule the next appointment if a follow-up is required. Cedars-Sinai hospital has an informational sheet that suggests how to prep for an appointment and what to expect at your next one.