Summary of New Directions in Geriatric Behavioral Health for Long Term Care
Conference held at Belmont Center for Comprehensive Treatment on October 16, 2003
What do we know about mental health and long-term care?
Ira Katz, M.D., Ph.D., of the University of Pennsylvania, a professor of psychiatry and director of geriatric psychiatry at the University of Pennsylvania Medical Center as well as director of the Mental Illness Research Education and Clinical Center of the Philadelphia VA Medical Center gave the keynote presentation. Notes from presentation.
"We know that things have gotten much better over the past decade, but there is still a long way to go," Katz said. "Mental health problems like depression occur in long-stay residents with medical or neurological conditions, and in short-stay convalescent or rehabilitation patients. They occur as new problems in people who have brain disease related to medical illness, or psychological difficulties in adjusting to chronic disease and disability, as well as in those who have previous histories of mental illnesses. No matter where they occur, they lead to suffering, disability, and problems in bouncing back after medical events."
Dr. Katz stressed the importance of treating depression in older adults who are in nursing homes. He indicated that more than 40 percent of all nursing home residents are taking anti-depressants. They also need other mental health services besides medications, and improvement in the quality of nursing home care, he said.
How is the long-term care system working or not working for older adults with mental health needs?
Panel Discussion: Moderator, Cynthia Zubritsky, Ph.D., University of Pennsylvania; Paul Goldenberg, M.S.W., Willowcrest Nursing Home; Linda Kunst, M.D.; Dr. Ira Katz, University of Pennsylvania; Wayne Pendleton, M.S.W.,Long-Term Care Options, Philadelphia Corporation of Aging; Hikmah Gardiner, Senior Advocacy Team; Sandra Smith, B.S., COMHAR, Community Mental Health Center
Panelist Paul Goldenberg, administrator of Willowcrest, a long-term-care (LTC) facility, pointed out that it is difficult to get older adults with mental health needs admitted to a nursing home. He said that the whole reimbursement system must be changed to accommodate the extra care that older adults with behavioral health needs present. Dr Katz talked about new Medicare initiatives related to depression, including quality improvement projects in cardiac rehabilitation and nursing home settings. The lively discussion emphasized that the current system often overlooks the mental health problems of residents in long term care settings and the consequences of that neglect are serious. Any reforms must address the need for an educated staff and treatment.
Domingo Nieves gave the perspective of a family member whose mother is in a long term care facility. He told of the need for the staff to understand his mother as a person with feelings and who needs to be respected and valued.
New insights for helping older adults with disturbing behavior: Recreational Therapy Dementia Practice Guidelines
Glenn W. Thompson, M.Ed.,C.T.R.S., began the afternoon with a presentation on recreational therapy. Mr. Thompson, president of the American Therapeutic Association, suggested ways to help older adults with disturbing behavior that are suffering from dementia and living in nursing homes. He said recreational therapy - which uses recreational interventions to change behavior or improve function; is individualized to meet people's needs; and is outcome-based, physician-ordered, and time-limited - could improve their health and well-being and be designed to change their behavior. "Activity is a basic human need," Thompson said, adding that recreational therapy also improves the behavior of older adults with dementia living at home and helps them remain at home longer. Notes from presentation.
What are some models for improving behavioral health services for older adults in long-term care?
Panel: Moderator, Linda Shumaker,R.N., Hershey Medical Center; Neil Beresin, M.S.W., Pennsylvania Restraint Reduction Initiative; Pat Hartzell, B.S., R.N.C., Masonic Lodge Home; Joyce Hanna, M.S.S., L.C.S.W., Senior Outreach Services, Northwestern Human Services; Dale Laninga, M.S.W., PA Intra-Governmental Council on Long-Term Care
The panel showed a variety of examples of programs that work. Neil Beresin spoke about a statewide initiative to end restraints, both chemical and physical. He suggested that nursing homes need to be small, personal, and attractive to older adults. Pat Hartzell talked about the need to change staff perceptions as a key to improve care. Joyce Hanna spoke of developing support groups as a way to get older adults talking about their lives and issues. Dale Laninga spoke of new initiatives that are geared to improve life in long term settings.
Throughout the day, participants were invited to submit suggestions for improving behavioral health services for older adults. Suggestions ranged from companion radios, pets and the company of children, to improved recruiting, training, and retaining of better health care workers and "changing the culture" at nursing homes and personal care homes. Another progressive idea was ensuring that the money follows the clients into the nursing home. You can view the suggestions from the day by clicking here.
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