Dad’s anxiety has increased tremendously during Covid. Since I can’t go inside as often as I used to, we talk every day, but other than that, there’s minimal going on there - so it’s almost impossible for me to try and help him stay calm. I called his GP (affiliated with the LTC facility) and inquired if he should see a psychologist. The GP said it could be beneficial and she would contact the LTC facility to call in an order. I told the GP that as my father's POA, I wanted to speak with the psychologist first so I can give some background on his current medical status, as well as what changes I’ve noticed in dad.
A week Later the LTC facility contacted me and said they would set up the appointment. I reiterated to them exactly what I told the GP - that I needed to speak with the psychologist BEFORE my dad's appointment (and told them why). The facility said they would relay my request to the psych and let me know when the appointment was scheduled for.
As the weeks pass, I hear nothing (from the facility or the psychologist). I call the facility and ask if the appointment was made because again, I needEd to speak with the psychologist before he meets with dad. I’m assured by the facility that the message was passed along to the psychologist.
A week later, I have my indoor visit with dad (yay! ) While I’m there, I see a piece of paper in dads nightstand with the psychologist’s name, phone #, and affiliation (in LARGE print). Clearly he had already seen my dad (and I was never contacted and had no idea). I contacted dad's facility first and they said they left several messages for the psychologist stating that I wanted to know when the appt was, and I needed to speak with him before he saw dad. Then I contacted the psychologist (now that I had his info on that piece of paper I found in dads room - in large print!) I told the psychologist that I was my father's POA and I wanted a copy of the medical evaluation he did, as well as any notes from their meeting. Psychologist told me that he would need to have dad sign a consent form first. I explained that I was my dad's POA and I did not want him to do this - not to mention it wasn’t necessary because I AM POA. Psychologist suggested we have a telephone conversation to discuss the visit instead - If I didnt want him to have dad sign a consent. I didn’t know what else to do so I agreed to the telephone conversations. After the 2nd visit, the psychologist called me to discuss the visit (as promised). He told me that even though we were have a telephone conversation, he would still have to get dad's consent (Even though initially he told me that the phone call was so he didn’t have to get dads consent). I replied that this was crazy and as POA, I have never had an issue getting medical records for my father before. I was very upset by the psychologist’s blatant disregard for my role as POA, and our call that day was cut short. The next day, I received another call from the psychologist. NOW, he said that he spoke to his regional director, and the calls he would be making to me (the ones he suggested we have after dads appointments)) would be billed as a family counseling session. I said what?! These calls were his (the psychologist’s) idea - not mine. I just wanted the medical notes (and am entitled to them btw since I’m guardian, POA, and dad's health directive). He said the calls take time and they are a form of counseling. I said I didn’t need counseling for myself nor did I ask for it. He told me to think about it. Needless to say, I thought about it and sent an email to the facility, as well as the psychologist, that the visits should stop immediately. I’m so upset by this and feel that business practices of the psychologist should be investigated. Besides this, I hate to say it, but I feel that the LTC facility should be held accountable for this nightmare as well. Does the LTC facility make $ from these visits as well? What actions can I take to get to the bottom of this.
"Psychotherapy notes, also called process or private notes, are notes taken by a mental health professional during a session with a patient. ... These notes are kept separate from medical records and billing information, and providers are not permitted to share psychotherapy notes without a patient's authorization.Jun 8, 2018"
There is much more information about privacy rights and rules on the government site.
So would guess that the licensing board for the psychologist would support him in his decision on how to handle this. But that of course would only be my guess. You may wish to contact them.
Is there a reason that Dad cannot simply sign the form giving this psychologist the right to share private and personal information about a psychological exam? IF Dad is not capable of understanding and signing such a think I wonder if he is in a condition to be actually helped by consults with a psychologist.
As to the LTC and what stipends they may provide to Medical persons serving facilities, that is a good question to ask the Admin. on Monday with a phone call.
Covid is causing such dreadful problems for seniors and families. Wishing you good luck and hoping you will update us. It is too bad they didn't communicate their policies and reasoning upfront earlier. It could have prevented a lot of frustration.
And yes, Doctor cannot charge your "talks" to Dads Medicare because Dad was not present. Its fraud. Anytime a doctor talks to you, he can charge for his time.
Came back in with the hipaa link so you could access the differences in the privacy rights of regular physician versus mental health care.
They differ.
I am afraid that the only way this psychologist could get AROUND Dad not signing is to consider it family counseling.
Wishing you luck.
Medical records of anything psych wise (psychiatric, counseling, psychotherapy) are doubly protected under HIPPA. Alva provided the actual wording.
Why not just have your dad sign the consent himself to avoid all the hoopla?
We’re in the middle of a pandemic. Mental health is suffering. Suicides have increased in number. People are getting severe depression from fear of the virus, financial distress, having to teach their kids at home while working full time. The healthcare world has been impacted. Nobody got hurt here. Maybe take a deep breath & realize things could be a lot worse.
Plus now in my area no (or very few) therapists are actually seeing patients in person due to Covid. The therapists don’t want to risk a face to face visit due to Covid. It’s billed the same as a telephonic visit you may have with your PCP for something minor like a sinus infection. MD’s don’t have to physically see patients for simple problems to be diagnosed.
Counselling now is done via a laptop or phone with a camera. The PCP offices have the software and give the patient log in instructions. Ditto with mental health professionals.
From what I read, your dad is an alcoholic and your parents divorced when you were very young. Your dad maintained a once a week sort of relationship with you over the years and things were cordial. But you feel that he regrets how he has spent his life.
You are dad's POA (that is about financials, yes?) and guardian?
You appear to have some insight into dad's issues, but might I suggest that that the psychologist wanted to see her/his client first before getting the adult child's take on what was going on? And if the conversations that you are having with this person go beyond a quick "check in" as to how you perceive dad (I did this on occasion with mom's geriatric psychs, but they were never more than 5 minutes) then yes, they are family counseling and need to be thought of and billed as such.
Anna, any person who is the child of an alcoholic needs Al-Anon/counseling and ongoing support. I'm quite surprised that you are so resistent to it. Please re-think how you are reacting and make peace with the idea that some help for you may ultimately be help for dad.
https://www.hhs.gov/hipaa/index.html
The shrink saw her w/o anyone telling us when he would visit. Since my sister worked as a psychiatric nurse in a mental health hospital, she wanted to be aware of what was going on. That didn't happen. What we did discover was the shrink was seeing Mom and we were unaware of the visits, and Mom said he just stopped by and asked how she was.
So we worked out a daily schedule by which one of us (me, my sister or my father) was available at all times, although we gave Mom plenty of private and down time. I was fortunately there one day when he came in, said hi, asked how Mom was feeling today and left. That's it!
Monitoring the Medicare notices, I saw he had the audacity to bill for a consult! So off goes a letter to Medicare advising that he appears to be billing for services not rendered. And I documented, obviously, with dates and times. Eventually Medicare investigated and advised they would be investigating further and taking action.
See below link. Hipaa works differently for mental consults and physical. There are increased protections.
https://www.hhs.gov/hipaa/index.html