Caring for an elderly parent at home

There is a moment most families arrive at eventually. The appointment itself lasts fifteen minutes; getting to it takes half a day, a car, somebody’s leave, and a parent who arrives exhausted and goes home more tired than when they set out. The medicine was never the hard part.

A good deal of what an older person needs from a doctor can now be done in their own chair. Not all of it, but enough that the journey no longer has to be the default.

What can be done at the house

All of the following is carried out at the patient’s address, with what the doctor brings:

• A full consultation, unhurried
• Injections and intravenous therapy
• Nebulisation for breathing difficulty
• Fluids for dehydration
• Wound cleaning and dressing
• Blood tests, taken at home
• Minor procedures
• A review of every regular medicine

What cannot be done at home is imaging, surgery, and anything requiring a hospital’s monitoring. A doctor who has examined your parent at home will say plainly when that line has been reached, which is more useful than a journey made on the chance.

The changes families tend to explain away

Adult children see a parent often enough that gradual change becomes invisible, and rarely enough that they notice it all at once. These are the ones worth acting on rather than putting down to age:

New confusion

Confusion that arrives over a day or two, in someone who was perfectly clear last week, is a symptom and not a stage. In practice it is very often an infection, urinary or chest, or dehydration, or a medicine recently started. It should be seen, not watched.

A fall

A fall is an event with a cause: blood pressure that drops on standing, a medicine, an infection, failing vision, an irregular heartbeat. ‘She just slipped’ is worth examining, particularly after a second one. The cause is usually treatable, and the next fall is usually the more serious one.

Eating and drinking less

Older people feel thirst poorly and can dehydrate on a hot Mauritian afternoon without noticing. Appetite that has fallen away over weeks, and weight loss nobody planned, both belong in a consultation rather than in the category of things that simply happen.

The medicines drawer

Prescriptions accumulate: one from the cardiologist, one from the clinic, one from a specialist two years ago, one bought over the counter for a knee. Each may be sensible on its own. Together they can produce dizziness, falls, confusion and stomach bleeding. Nobody looks at the drawer as a whole unless somebody is asked to.

Keep one sheet of paper listing every medicine your parent takes, the dose, and who prescribed it. Update it whenever anything changes, and keep it where a visiting doctor can see it. It is the single most useful object in most households, and it costs nothing.

When it is not a home visit

Go straight to hospital, or call SAMU on 114, for: chest pain or pressure; sudden weakness on one side, a drooping face, or loss of speech; breathlessness at rest; a fall with a head injury, particularly in anyone taking blood thinners; a person who cannot be roused. In a stroke or a heart attack the first hour is the one that decides the outcome, and waiting at home spends it.

The money question, plainly

Families ask, and it is a fair thing to ask out loud. A day consultation between 7am and 7pm is Rs 2,000; a night consultation between 7pm and 7am is Rs 3,000. The rate is the same in Grand Baie, in Curepipe and in Mahébourg.

There is no separate rate for older patients and nothing to join. Each visit is charged at the standard day or night rate, whether it is the first of the year or the tenth. Treatment given during the visit, dressings, tests and materials are charged on top, explained and priced with you before anything is done.

The person doing the caring

One short note, and then we will leave it alone. The family member who manages the medicines, the appointments and the nights is usually the one who has not seen a doctor themselves in two years. A home visit can be booked for them just as easily. It is worth doing.

Frequently asked questions

Can blood tests be done at home for an elderly patient?

Yes. Blood is taken at the address and sent for analysis, which removes the early-morning trip to a laboratory that many older patients find the hardest part of the whole business.

Can a home visit doctor review medicines prescribed by a specialist?

Yes, and it is worth asking for. The doctor looks at everything being taken together, flags interactions and duplication, and advises on contacting the specialist where a change is needed rather than making it unilaterally.

Is a home visit suitable for someone with dementia?

Usually yes. Familiar surroundings make the consultation calmer and more accurate, since people with dementia are frequently at their worst in an unfamiliar waiting room. Specialist care continues separately, but routine reviews and acute illness suit the home well.

What does a home visit cost for an elderly parent in Mauritius?

A day consultation between 7am and 7pm is Rs 2,000 and a night consultation between 7pm and 7am is Rs 3,000, at the same rate anywhere on the island.

When should an older person go to hospital instead of calling for a home visit?

For chest pain or pressure, sudden one-sided weakness, a drooping face or loss of speech, breathlessness at rest, a fall with a head injury, or a person who cannot be roused. Go to hospital or call SAMU on 114.