The majority of the practice is dedicated to patients aged 65 and older. These patients have additional needs and are more likely to experience difficulties with health issues, loss and grief, isolation, changes in living arrangements, and loss of independence. We have expertise in diagnosing and treating mental illness in the geriatric population and visit the individual at their place of residence such as a nursing home, assisted-living facility, or private home (by special arrangement).
The majority of our patients have cognitive impairment due to conditions such as Alzheimer's Disease/other Dementias and Parkinson's Disease and may be experiencing related behavioral and psychological symptoms such as confusion, depression, anxiety, mood swings, aggression/uncooperative behaviors, sleep or appetite disturbance, apathy, wandering, and inappropriate sexual behavior. We are often contacted regarding impaired individuals who do not understand that they are having difficulties and require assistance caring for themselves but are refusing to allow it.
For all of our patients we work closely with the family as well as with facilities, physicians, and other care providers, including Geriatric Care Managers, to make sure that all aspects of the individual are evaluated and addressed. Our approach is tailored to the individual needs of each patient and takes into consideration multiple aspects of each. We examine effects that the biology of underlying medical conditions may play in each patient as well as that of individual temperament, behavior, and personal life experiences.
Initial Evaluations consist of several parts. First, we obtain extensive information from family members, Primary Care Physicians and other involved medical specialists; this includes reviewing medical records, labs, and other tests. If the patient resides in an Assisted Living, Nursing Home, or other Long-Term Care Facility, we speak with the staff at the facility and review their medical chart. We then meet with the patient and do a comprehensive assessment including looking for symptoms of depression, anxiety, psychosis, behavioral problems, and perform memory testing. If the patient has not been evaluated by a neurologist, we will perform a neurologic examination as well. Afterward, we discuss our findings and recommendations with the family and other physicians and answer any questions they may have. The evaluation typically takes four to six hours in total; the portion of this time spent with the patient varies depending upon their ability to participate, but is often one to two hours. The fee for this evaluation is $1,800.
As part of our initial evaluation, we have been utilizing specialized testing (collected via painless cheek swab) to analyze the individual liver metabolism of medications for each patient. This tells us whether they metabolize each medication they are taking and any we would consider prescribing, quickly, slowly, or normally. This does not tell us the "right" medications for each patient but does help to inform dosing and possibly avoid medications that may be more likely to cause unwanted side effects. Most insurance plans, including basic Medicare, will cover the cost of the testing in full, however, some plans may require a co-pay.
Follow-up evaluations follow the same process of obtaining outside information and meeting with the patient as the initial evaluation, focusing on how the patient has been doing since the previous visit. Follow up visits are $350 per visit with Dr. Schor and $300 per visit with Nurse Practitioners Andrea Kohn or Jessica Abrams.
Since Dementia is a progressive condition, the treatments that work well for a while may become less effective as the disease advances. Typically, we follow up with our patients about every 4 weeks. Some patients who are very stable may only need to be seen every two to three months. Sometimes at the onset of treatment, adjustments may be needed more frequently, so visits may be spaced closer together at first. We have found that this model of scheduling is helpful in identifying problems early, so we may work to address them before becoming emergencies.
Geriatric Legal Services
Dr. Schor is available to assist with legal evaluations to help family members obtain Power of Attorney or Guardianship for their relatives who are not able to care for themselves safely as well as to advise about treatment needs. These services are similar to the Geriatric Evaluations described above. Dr. Schor works closely with Elder Law Attorneys and is able to make referrals to one if needed. Legal services are billed at $500 per hour.
Please do not hesitate to contact us with any questions about these services.