THE PSYCHIATRIC ELEMENT PROGRAM
A psychiatrist and staff provide regular team presence at the care facility, bringing a variety of treatment approaches to increase the quality of life among your residents, reduce your staff’s stress and give time needed to manage patients through activities and visibility in the community. This is a vital component in early diagnosis, treatment and prevention. In order to provide optimum care, it is essential to collaborate and receive input from all individuals and professionals who interact with the resident on a daily basis. This also gives recognition for your home to family members and professionals and other caregivers who have a need for referral to a quality nursing home. Our diagnostic plans become a part of the chart available for audits as well as for staff and physicians to review and discuss the ongoing status and resolution regarding recurring or chronic difficulties. We maintain active contact with physicians and staff about psychotropic medications, diagnostic services, psychosocial treatment, and medical and psychological changes in patient status.
There are models for best treatment. First, models that are least effective include those in which a consultant makes a one-time visit when an emergency occurs and simply writes recommendations in a chart consultation without talking to the staff or providing staff education. We know from research that chart recommendations alone are only followed one third of the time (A one-time consultation is problematic with respect to follow-up).
The best treatment is known as “The Integrated Model of Geriatric Psychiatric Care.” This plan includes follow-up visits to ensure that prescribed medication or behavioral treatment is implemented appropriately and that the resident is responding without side effects or problems.
Six Components of Geriatric Psychiatric Services Consistent with Best Practices by AAGP:
(Source: Mintzer, JE, Kennedy, GJ, Reichman, WE, & Daiello, LA. (2002). Care of the psychiatric patient in the nursing home: Challenges and opportunities. American Association for Geriatric Psychiatry, 1(3), 1-19.)
- A multidisciplinary team approach
- Specific geriatric expertise and competence
- Individualized assessment and treatment planning with routine follow-up, ideally using standardized outcome measures
- Collaborative treatment planning between the consultant and the nursing home staff and primary care physician
- A strong educational component
- Family involvement
The six components listed above are particularly important with the resident with dementia because the symptoms fluctuate and the medication effects can vary as the dementia progresses. Therefore, it is crucial to detect symptoms early, and increase, decrease, or initiate a change of dose in the medication if needed.
We provide a full range of services to assist residents, family members, physicians, and staff in recognizing existing and potential problems. We formulate solutions for residents who are mildly depressed or with previous severe psychiatric illnesses, such as bipolar episodes and those who become severely isolated and withdrawn regardless of the cause (whether it is stroke, Alzheimer’s, medication interaction, or adverse reactions) which results in marked apathy, comprehensive psychiatric programs for intervention are developed after an evaluation of the resident. This effort involves the family, staff, and primary physician interaction with other mental health professionals. Due to the variety of impaired cognition, we believe and strongly encourage the development of bonding relationships which requires frequent contact as necessary with the resident. In addition, it is essential to collaborate and have input of all individuals and professionals who interact with them to provide optimum care including psychiatric services.
In addition, we take pride in using medications sparingly, conservatively and judiciously that are used in sufficient dosage to gain the desired improvement as well as for extended periods of time to assess the gradual benefit that is often not dramatic. This is confounded by undesired side effects the resident cannot adequately communicate, or changes consistently observed by the staff. Evaluating the impact of medication frequently is important because there is a tendency to minimize positive results because of disruption or focus on other more severe or pressing medical problems, lack of knowledge, and/or lack of specialized training. Thus, we provide psychiatric expertise as well as awareness and information on the latest capabilities of the newer psychotropic medication as well as the more specialized role of the older tried and true tranquilizers and sleeping adjuncts.
We are available as a resource to the facility staff when crises arise with residents and families. The medical professional can attend the care plan meetings, offer notes and documentation to substantiate the levels of care needed for residents who are depressed, demented, isolated, delusional, wandering, aggressive, and so forth. Additionally, we provide the liaison with the resident’s family from the home satisfying various quality assurance parameters. We are available to staff and family for training sessions. These are open to the public as a means of enhancing the facility’s recognition in the community (See: “Dementia Care Specialist Training”).
PSYCHIATRY, MENTAL HEALTH, QUALITY OF LIFE AND BENEFITS
The Role of the Family – Family Involvement & Family Therapy:
Residents of nursing homes are referred to SPC for psychological/psychiatric services by the patient’s primary care physician. The reason for referral can be due to memory loss, difficulty adjusting to the facility and staff, behavioral issues, depression, anxiety, wandering, delusions, hallucinations, resistance to care, grief/loss issues, etc. SPC provides a full range of services to help residents, family members, physicians and staff recognize existing and potential problems. We formulate solutions for residents who are mildly depressed, those who have had previous severe psychiatric illnesses such as bipolar episodes, and those who have become severely isolated and withdrawn regardless of the cause.
Family members are a crucial part of a successful diagnosis and treatment. Any family input, recommendations, feedback, etc. are very welcome by our staff, and we encourage full participation in family therapy sessions whether or not the patient is involved in the session. Family members’ knowledge of the social, behavioral, and emotional habits of the resident can be very helpful to plan treatment objectives and goals. It also helps confirm the underlying reasons for certain behaviors and other mental health issues. Families can help the therapist explore the patient’s feelings and help in finding solutions to problems. Family members know what has and hasn’t worked in the past.
More often than not, a family chooses a facility based on input they have received from family members/friends who have had both positive and negative experiences with specific LTC facilities. Family satisfaction with a facility is the most vital determining factor that influences the decision.
Studies show that the below specific areas tend to influence a family’s satisfaction:
- The degree of empathy the LTC facility staff demonstrates while providing direct and personal care to a resident, coupled with promptness of care.
- A sense that the LTC facility staff members genuinely listen to the resident’s or family members’ concerns
- Direct care1
- Family-Staff Interaction1
- A sense that the LTC facility provide care to the resident in a sensitive, respectful, and timely fashion.
- Accurate and consistent communication between family members and staff. Families feel satisfied when they are permitted to be closely involved in care planning. Scheduling care planning meetings at times when family members are available or allowing an employed family member to participate in the meeting via a conference call during the workday increases the level of a family’s satisfaction with a facility.1
- The family members’ experience when they visit the facility. The satisfaction of family members is often based only on what they see and hear while they are visiting. A facility leader who is aware of that might structure the whole organization so that all staff members are wise to what makes the facility welcoming to the family. SPC can aid the administrator develop and publish a document that clearly outlines what is expected from individual staff members as they interact with family members.2
All staff members of the facility (admissions, nursing, activities, therapy, housekeeping, grounds crew) have an impact on how the family feels about the facility. SPC can help an LTC facility make their experience positive.2 SPC takes pride in educating the resident, the staff, and the family about the patient’s diagnosis, medication side effects, aggressive behavior and how to deal with it, memory loss, adjustment problems, etc. We value the opportunity to work with the family. We want the family to choose your facility for their loved one.
The Family Meeting
Family meetings are important for clinicians in order to share information and discuss prognosis and treatments. The goal of the meeting is to establish a forum for communication among the resident, family, and healthcare team so that together they can work to improve the resident’s outcome. Effective family meetings also lead to resident and family satisfaction and the development of a plan of care that is consistent with resident and family goals and values.3
SPC can provide information about the structure and process of conducting family meetings, and strategies to promote effective family meetings, such as: (1) timing of family meetings; (2) use of a step-by-step process; and (3) communication techniques to support families and facilitate shared decision making.