March 1st, 2010

Geriatric program meets community need

An inpatient geriatric psychiatry program at Saint Anne’s Hospital in Fall River, Mass., launched last Sept. is filling a void in care for older adults in southeastern Mass. facing acute emotional or cognitive problems and highlighting the value of providing specialized, integrated care for these adults.

The 16-bed unit serves patients, most ages 65 and older, who show signs of dementia with behavioral disturbance, significant depression or anxiety or other marked changes in behavior. The patients are assessed and treated by a team including a psychiatrist, neuropsychologist, clinical social workers, nurses and an occupational therapist, with the goal of helping them return to their “baseline” so that they can return home or to another living arrangement.

“We go over the cases together and decide on a course of treatment,” says Rebecca Slean, MSW, LCSW, a social worker in the program. Recommendations for each patient are highly individualized, she adds. Family involvement and group therapy are both a significant part of the patient’s stay. Medical specialists and dietitians may also be involved in a patient’s course of treatment, depending on the nature of the problem.

Before the program began, older adults with psychiatric problems had to travel up toward Boston or into Rhode Island for inpatient services. “We’d been hearing from families and colleagues in the long-term care industry and in family services [that this program was needed],” says Carole Billington, RN, MSN, NEA-BC. “Geriatrics is a specialty; care of elders is a specialty. Many of our patients were being admitted to adult psychiatric units and that’s a different approach.”

According to the Massachusetts Health Data Consortium, 254 Fall River residents ages 60 and older were admitted for inpatient psychiatric care in fiscal year 2007. Just over a third were admitted to hospitals without a psychiatric unit because of a lack of available appropriate psychiatric services. (Many of these patients had accompanying medical conditions).

Patients are referred to Saint Anne’s program through referrals from families, elder service organizations, nursing homes, assisted living programs and area hospitals. Admission is available 24 hours a day.

In discharge planning, all aspects of care are addressed, which may include primary care and psychiatry appointments, visiting nurses and adult day health programs. For patients returning home, the team must determine that they would be safe there. Patients returning to a nursing home or assisted living must be able to return to those surroundings.

“When we’re sending someone back into the community, we go for a very tight discharge plan,” Slean says. Sometimes, the problem leading to admission “could have been medically induced and once that problem is resolved, the patient’s behavior goes back to baseline.”

Patients requiring more structured support after they’re discharged may be referred to a partial hospitalization program or intensive outpatient program through Saint Anne’s Center for Behavioral Medicine.

According to the American Association of Geriatric Psychiatry, one in five older adults in the U.S. will experience a psychiatric disorder, whether due to physical decline, medical illness, neurological deficits or psychosocial stressors.

By Ami Albernaz

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