When is it reasonable to request a home visit?

[SpidersAreShitheads]

Hi,

I’m just trying to gauge when it’s reasonable to expect a home visit by a nurse for blood tests etc. This might be long - apologies.

DM is 78, and has cerebral palsy and mild/moderate dementia (amongst many other things). She can walk short distances but only if there is someone she can hold onto. She can’t walk alone with a walking frame etc and can’t use a mobility scooter. She can’t even get out of the front door to her bin on her own.

She also has lymphoedema so her feet/ankles are very swollen. She is awaiting an appointment with Podiatry. She currently doesn’t have any shoes that she can get on her feet. Also, it’s very dangerous for her to walk with ill-fitting shoes as she can’t lift her feet fully and if she trips, she doesn’t have reflexes to save herself. Over the years, even a small trip has landed her in hospital with multiple stitches, severe injuries etc (not helped by the fact she’s on blood thinners now too).

She’s developed numbness in her hands and has no feeling in her feet. She’s diabetic. So last week I managed to persuade her to come with me to the surgery to see the GP. They have diagnosed diabetic neuropathy - she needs blood tests and a review with the diabetic nurse.

She will only walk with me, no one else. Her husband is doddery on his feet and even I’d agree not able to safely support her. She only leaves the house on very rare medical appointments that can’t be carried out at home. Even then, she frequently just cancels them - she’s cancelled a hysteroscopy and CT scan in the last three months.

She struggled with the GP appointment last week. We parked in the nearest disabled spot and she had to stop several times before we made it through the door. She was in loads of pain afterwards. She managed to jam some sandals on her feet but they weren’t done up at the back and have cut her feet due to the swelling (obviously not ideal with the diabetes). It was also a massive trip hazard - although as I’ve grown up supporting my DM’s disability, there’s a chance I might be able to catch her/hold her before she hits the ground (but she’s a large lady).

I will ALWAYS try and juggle things to take DM wherever she needs. We moved three years ago so I could help her more - she’s in the annexe and I’m in the main house so I’m right there. But it’s not easy - I have 16 yr old twins who are both disabled. Neither will ever live independently- they are at home or with me 24/7. Extra complication - I currently have a torn rotator cuff muscle and tendinopathy in my hamstring so I am finding it excruciating to walk. Physio has given me very gentle exercises but told me I need to rest (hahahahahahaha). I also work - but I’m self-employed so I can manage it around my caring responsibilities.

Fuck me, this is long. Sorry. It’s just the circumstances are quite complicated to explain!

DM has to have a steroid injection in her shoulder in July - she HAS to go to the GP surgery for that as they won’t come out. She complains bitterly about this to me regularly . She is threatening to cancel this.

The GP surgery are now saying that as she got there last week with me, that they will no longer do any home visits for her. At all. She doesn’t see the GP at home - it’s the nurse visits and paramedics that the GP surgery employ. They have always been happy to send out nurses to do vaccinations, blood tests, and dementia reviews in the home. She only came to the surgery last week as I begged her to get the numbness checked out and they don’t send GPs to the house.

We are at an impasse - the GP surgery say she has to come to the surgery for her much-needed blood test. DM is refusing to go - she says it’s too difficult/painful leaving the house and they’ve always done them at home for her.

I’ve lost sight of what’s reasonable to be honest. There are no neighbours/friends who can help - it’s only me who can get her there (when she agrees). It causes distress to my DS (he panics that I might die if I leave the house). It’s uncomfortable/borderline unsafe for DM - and she suffers physically later (she was totally bed bound for six weeks in January because she had inflamed nerves in her back and she’s still healing - walking aggravates it again).

Weirdly though, they sent the nurse out to do her COVID jab at home today and the Podiatrist is down for a home visit.

I think it’s a combination of physical/psychological factors that makes it so hard for her to leave the house, even with support from me - with the dementia/cerebral palsy/lymphoedema/diabetic neuropathy/back pain.

Does this sound reasonable for a home nurse visit for the blood test ? I just don’t think I can convince her to go to the surgery as they’ve always done her blood tests at home. What counts as preference and what counts as being “housebound”?

I’m so knackered I can’t really think straight, truth be told.

You are not being at all unreasonable.

I don't know how you would go about it - but I'd complain about the Surgery's failure to meet your DM's needs.

Edited to add: You might want to come along to the Elderly Parents board - it's under the Other Stuff heading.

I think it is reasonable to ask them to continue to come to the house. You have already given the reasons here, so copy and paste to the gp. Ask them what they plan on happening if she can't make it.

Separate to this is what you mention about your son. Is he getting professional help? You being housebound as he doesn't want you to go out is very challenging for you. He clearly needs some kind of exposure therapy. Take care of yourself.

Not at all unreasonable. Please ask.

You sound at the end of your tether, OP. Caring for elderly parents is fucking hard. I hope you are OK.

I suggest writing formally the practice manager outlining the issues for your dm…. Don’t include your health issues but focus on her frailties and falls risk.
you could ask chatgpt to help you frame a compelling factual case.
And please join the long running cockroach cafe threads on the elderlies board…. Lifesavers.

YANBU but if they refuse to play ball, could you hire a wheel chair (if you are able to push it)?

I was a GP. I also have a 93 year old father. I think when people get to an age or physical state where things aren't easy then you can't say yes, they're housebound, no they're not.
My dad can get to his local tea room for cake but would not manage a taxi to his GP in case something went wrong. He would panic and not be able to correct a difficult situation. He's on anticonvulsants and they have severely impaired his mental processing.

With your mum. It's a fluid situation for her. To be honest I'd visit without question as it's clearly very challenging to get her out. District nurses are stricter on their guidelines so they might not be as flexible. They used to say their caseload was full, I could never do that as a GP.

ALSO when people are unwell when older it affects their ability to do things.

I did used to have issues with people who could get out easily and readily to the hairdresser but wouldn't come to the GP. I used to ask them when their appointment was and get them to come in before or after.

It shouldn't be a hard and fast rule. Your mum is a human and they fluctuate in their abilities. Good luck OP.

Definitely time for a wheelchair. FB marketplace sometimes have them. red cross and other places hire them out

Sounds like she needs an OT assessment, a wheelchair for outdoors and a care package so she can be assisted to appointments. If there are social prescribers linked to her GP practice they may be able to assist with referrals/sign posting/reasonable adjustments at the practice to get her to appointments.

There is a mobility place in my town that hires wheelchairs that fold and fit in my small car boot for £15 a day.

You need to speak to an actual GP or nurse - not the Receptionist or Practice Manager - if you can but it is not easy. If the Podiatrist does come to the house you could ask them to support you. Hope you are getting all the allowances you should be claiming - sounds very tough for you.

Yes, do this.

My mum has blood tests done at home ,the community nurse comes out.

It needs to be on your notes that treatment needs to be done at home in the future so formally writing in is probably your best bet so you don't have to go through explaining it all every time.

Focus on fraility, danger of falling, pain, inability to get in the car etc.

She really needs an ot assessment and potentially a wheelchair plus fitted for suitable shoes. You are not unreasonable to request a home visit under current circumstances but suitable footwear and a wheelchair would mean she could be taken to the surgery safely (with electric assist if you are unable to push yourself). Remember a blood test takes 10 minutes (or less) but if they come to you they will need to allow 45 minutes or so plus there’s the safety element of going to private houses.

When I was unwell earlier this year they did offer to visit so home visits do still exist but I refused it and went to the surgery with help.

My mother was automatically offered a home visit for bloods as she has dementia with no physical difficulties. I think you are being very sensible asking for a home visit.

Wheelchair?

i have neuropathy in my feet. It’s only a social convention to wear shoes it’s not actually compulsory.

presume the dementia etc is why she can’t drive a mobility scooter.

Thank you all so much for reading my epically long post!

I was actually writing it while editing for my physio appt and I’m on my way home now so will reply properly to everyone later.

Quick points though - she has a wheelchair. I can’t lift it in and out of the car though - because of the torn rotator cuff muscle. And as she’s always walked - when she was told she’d never be able to walk - DM is very very reluctant to use it. Plus ideally she’d still need to be wearing shoes because cold/loss of sensation etc.

We had a recent OT appt that I arranged - they’ve fitted raises on her toilet seat, extra poles, and a seat lift thing for the sofa as she can’t stand up by herself any more. She can’t use electronic raises because of her balance difficulties. We already have bed rails, hand rails etc everywhere. DM refuses a care package - and OT aren’t that fussed because I’m on site to do whatever needed.

We’ve had OT over the years for DS and they have always been wonderful. Unfortunately the one who comes out for DM isn’t that sympathetic - I can’t really work out why. They get very huffy for some reason - I had to fight to get the adaptations for the toilet seat and shower!

I’m hoping the podiatrist will enable her to be fitted for shoes. Her legs/feet are horrendous unfortunately.

I’m just so divided on whether it’s unreasonable to expect home visits for blood tests etc. I worry that she’s just likely not to bother (dementia really affects her reasoning).

Also might be pertinent- I’m AuDHD and imo, there’s a very, very good chance my DM is too. It isn’t helping her willingness to even consider a change to what’s always been offered before.

I’m just stuck on where the line is between technically able to get there with lots and lots of support and pain later in the day and saying not able to get there because it’s too much… 😩

Manual or electric?

either way yes they are heavy to get out of the car (not too bad) and get back in (bloody nightmare).

if she has an electric then is it possible to just use that to go to the GPs? Obviously if you are in a village and it’s three miles or whatever then no.

ime the gp surgery are happy to send someone out if it’s something they want done but less happy if it’s something you want done. So to tick a box in terms of getting her reviewed etc they’ll come out to patients near me but if someone is actually ill they’ll want to see in person.

(I’m disabled and have a number of friends who are also disabled and cannot walk at all).

I think you're not unreasonable at all to expect home visits for blood tests. If they can come out to do covid jabs they can surely come out to take bloods, it takes 2 minutes! I have a friend who's a district nurse and a large part of her job is visiting elderly patients, often with dementia, for a variety of reasons. I'd put it in writing to the practice and list all the reasons you've shared with us here. Good luck OP 💐

I think you need to insist on carers op. It’s not right that your mum is refusing them. You need to look after yourself.