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Discussion

Gero psychs

Increase in number of nursing home admissions for gero psych requests.

I kinda laugh sometimes because I wonder what exactly the pt is doing in the nh to warrant a geropsych admit.

Had an issue yesterday, the nh was mad when I was calling back to give report that the pt was returning. Pt was at her baseline, pleasantly confused. Pt becomes agitated for personal care... Mechanical lift transfer due to a recent fx.. Pain controlled with Tylenol. I don't have the gal like they do but I'd think maybe she needs something stronger for pain with a fresh fx? Not a geropsych admit.

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    It does seem that the nursing homes do not pursue other avenues before declaring the need for a psych admit.

    Maybe if they did, indeed, work on better pain control (in this case) maybe they would find the resident to be more manageable.

    Also, do we really know how well the care staff is able to work with the residents to find what soothes them individually?

    Something else I often think about is how much care in nursing homes has changed.

    Used to be that no one was sent to psych and we had to learn how to manage the resident on our own.

    I know that I have called report to nursing homes and they have expressed irritation that the pt still refuses to take their meds or still yells out... or whatever. They don't understand that we can't cure anything, but-- hopefully-- make it more manageable (or bearable).

    Sometimes, it's not really the meds but the fact that we had more time to learn what non-pharm interventions work best, but if they cannot follow through with that at the nursing home, then that resident will, again, possibly begin to act out again.

    They also don't give the resident a chance to reacclimate to the environment change of going back to the nursing home. They should understand that every time you change their environment, there is a potential for increased confusion and acting out. However, the nursing home declares the resident's psych treatment a "failure" and they want to ship them right back to us.

    Geeze! Work with them a little and give them time to adjust.

    I don't necessarily blame the nursing home staff.

    I blame penny-pinching and short staffing... the nursing home staff is pushed beyond there limits and I don't think they can always manage trouble behaviors with so much going on.

    You know how agitation can be part of the dying process? Well, we've had pts brought to us who were taken off of hospice to become inpts on our unit!

    What can we do???

    :down:

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    I dread these patients! Unless they're sick with legitimate AMS compared to their baseline, I honestly don't know what they want us to do about the irritated sundowning patient.

    Sometimes it seems they just don't want to deal with the patient so they send them to the ETD.

    One NH sent me in a "combative" dementia patient. They had given him Ativan just before the ambulance arrived. By the time he got to us he was sleepy and completely cooperative. What the heck? Why wouldn't you medicate and then reevaluate!?

    Or the caregivers/children who literally drop off their poor mother with Alzheimers so they can get a little vacation. Ugh don't get me started on that...

    I actually fear that one day I will have to be a caregiver for my mother. Then your stuck at the crossroads because it can be a full-time job yet I would never want to send her to a NH after all the trainwreck or seemingly neglected patients I have received in the ER.

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    I have sent residents to the ER for sepsis, cva, chest pain, and other medical ailments....never have sent one for behavior. Only once has the night shift sent someone for behaviors. We deal with a lot, but sending them to the ER for behaviors is like putting a bandaid on a laceration needing stitches. ER's aren't going to magically make the behaviors better. They may rule out UTI or other causes for the behaviors, but not fix that specific behavior.

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    We always had to do our own medical clears for gero psych. And it would take weeks of lots of documentation to warrant.. Like we tried different techniques to redirect behavior. Ect.

    We have at least 2 geropsych pts a shift. I haven't seen even 1 pt yet that was anything like the ones I used to deal with in ltc.

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