Where Do They Go?

Marysjrfan · May 7, 2008

I am wondering, for those people who have psych disorders and cannot live on their own, when they are discharged from the hospital, where do they go? Are there places for these patients to live? In my area we have a few assisted living facilities that are especially designed for the mentally ill but once they no longer qualify for assisted living status, they are left to go to a nursing home. There is one nursing home in particular that takes all of them. The problem that I see is that in a nursing home you are not able to physically or chemically restrain a person even if they are being physically abusive to others. You are not allowed to send them to their room for a time out. I know that in mental facilities these things are allowed. It seems to me that there must be places that these people can go besides a nursing home. I am just wondering if there are places designed especially for them in other parts of the country or do they always end up in the general nursing home population?

I don't know about everywhere, but in my community, there is respite care that keeps them until they regain sufficient skills to live out in public. By suffiucient sils, I mean being responsible for taking thir medciation at the right time and in the right dosags, taking care of their personal hygiene, being able to reember their appointments...tings like that. There are also group homes in the community where the can live with supervision. Some of them do end up gong to assisted living situations, but not many. ome o back to live with family member, but the mental health agency here stresses independent living for anyone who is capable.

elkpark · May 7, 2008

Nursing homes, group homes for the mentally ill, "halfway houses," homeless shelters, independent living with intensive outpatient services. And, of course, a lot of them just end up on the streets ... In my state (I don't know about any others), the state hospitals still have some long-term units for people who just can't function at a lower level of care -- people live on those units for years at a time (in some cases, for the rest of their lives). The number of beds in those divisions is much lower than it used to be, but that option is still available on a limited basis.

green12, BSN, RN · May 7, 2008

We have everything that elkpark mentioned except for nursing homes. I've seen a person or two sent to a nursing home but they have been ruled out for psych problems and are more likely organic (ie dementia). We more often send people to group homes or apartments with wrap-around services if they cannot live on their own. Can you clarify what you mean by:

"in my area we have a few assisted living facilities that are especially designed for the mentally ill but once they no longer qualify for assisted living status, they are left to go to a nursing home. "

I can't imagine sending a person with BorderlinePD and severe self-harming behavior to a nursing home! or even our psychotic people who live in very smelly apartments with intensive outpt services...

RN2begin · May 9, 2008

I am wondering, for those people who have psych disorders and cannot live on their own, when they are discharged from the hospital, where do they go? Are there places for these patients to live? In my area we have a few assisted living facilities that are especially designed for the mentally ill but once they no longer qualify for assisted living status, they are left to go to a nursing home. There is one nursing home in particular that takes all of them. The problem that I see is that in a nursing home you are not able to physically or chemically restrain a person even if they are being physically abusive to others. You are not allowed to send them to their room for a time out. I know that in mental facilities these things are allowed. It seems to me that there must be places that these people can go besides a nursing home. I am just wondering if there are places designed especially for them in other parts of the country or do they always end up in the general nursing home population?

They are discharged to a group home...go off their meds (because it is their choice)...become psychotic again...get kicked out of the group home...live on the streets until they do something that upsets a local citizen...re-admitted to the hospital/sent to jail...stabilized on meds (hopefully)...discharge to a group home...repeat cycle...repeat cycle...repeat cycle...

handyrn · May 9, 2008

To clarify what I meant, there are a few specialty assisted living facilities for people with psychiatric disorders with staff that are trained to deal with their behaviors. The problem is that they must be independent with their toileting needs and showering needs and personal hygiene. Once they are no longer able to do these on their own, they no longer quailfy for the assisted living facilities. The only place left is a nursing home. Therefore, we are left with a nursing home which is filled with psych patients. The one I work in has many psych patients, and yes, many behaviors. Of our 38 residents, 2 are actually elderly, the rest are psych. MANY behaviors! Some are self harmers, some are abusive, many water intox! Very hard to deal with them on nursing home staff numbers. In fact, I work night shift and it is just me as charge nurse and one cna. These people do not sleep at night! I get so frustrated! It is hard for me to understand how a person can be 45 years old, look like you and me, college educated, be perfectly capable of smoking a cigarette, eating a meal, asking for his bread to be toasted, but yet pee his pants, don't know how to tie his shoes, don't understand that it is not appropriate to come up to you and get right in your face or walk down the hall naked.

cjones68 · May 14, 2008

Wow! :eek: Can't imagine strictly psych in a NH!!!

I work in Community based MH--and follow the ACT model. I went from working in our clinic to now working as the RN for our Intensive Intervention Center-IIC-(aka Respite) as well as the RN for our HOST (Homelesss Outreach Specialized Treatment) Program. When I've had consumers move to a NH setting, they were then discharged from our services. The only time we ever had consumers in a NH were instances where they medical issues prevented their ability to care for themselves.

Our consumers reside in group homes, boarding homes, apartments, and sadly also on the streets. If least restrictive isn't possible-i.e., IIC or our CSU, then ultimately the result is hospitalization. Like elpark-we too have a local hospital which has some residents/patients who have been there for many years d/t mental illness. Just can't imagine our pervasively mentally ill consumers all together in a NH! Really, they are there without a medical condition contributing to the need of an ICF or SNF bed?

Mish56, BSN, RN · May 15, 2008

God help them, they go wherever they can. In CT where I work, the state facilities have years long waiting lists; somehow "they" have decided that nursing homes are not appropriate for psych patients, although we have a few that still take them.

In one of the richest states in the country, mental health consumers have become what I call the "Invisible Nation". The chronically mentally ill have no voice, no vote, no power. NAMI tries to help, but they are not powerful enough yet.

Sorry, I'll get off my soapbox now.

wonderbee, BSN, RN · May 24, 2008

Many go to transitional facilities, personal care homes, etc. The lucky ones go to their own homes where they are followed by community treatment teams. A lot of them try to make it with few resources only to lose it all again... kids, home, jobs, relationships. So terribly sad. Of course there are the homeless mentally ill. No one wants them. They find shelter under a highway overpass or wind up in jail. Some try to get better, some don't. Either way you look at it, it's just sad.

nerdtonurse?, BSN, RN · May 24, 2008

I'm in a rural area, and we usually have at least 2-3 pts on our telemetry floor who have significant psych issues; right now, we've got a pt I'll call "Wolfman" who was brought in by the local PD for attacking a pizza delivery person. He kicks, he screams, he bites, he's busted out of 4 pt restraints 2x, and it's taking 2/3s of the folks on the floor to maintain his safety (and ours!) just to bathe him -- seriously, one person per arm/leg, one person bathing him and one administering IV push meds and one person holding his forehead and keeping a pillow case ready to shield us when he spits or tries to bite. Somehow he managed to get twisted around and pulled out his IV with his teeth and we barely managed to get it back out of his mouth before he swallowed the catheter. We tried to feed him and he bit the plastic spoon in half, and cut his lip; we give him sandwiches, half of which he throws across the room screaming we're poisoning him. Homeless, no history, no knowledge of what he might be allergic to, so minimal meds. When he came in, he was covered in ticks and we think he'd been sleeping in the woods somewhere. Hair like an old testament prophet, fingernails like claws, and his toe nails were so long, he can't have been wearing shoes.

Problem is, there's no where local that will take this guy; we don't have the community resources, the local nursing homes won't touch him because he's so dangerous. And he's on the telemetry/ICU stepdown unit because for all we know, this guy could have who knows what underlying medical conditions besides being dangerously aggressive. We can't get him calm enough to CT/MRI, he's got scars all over, and we even had the local cops come take his prints to see if he's ever been arrested/in the military/etc. (and wasn't that a fun 30 minutes, the cops wanted to hit him with pepper spray, and it was hard for us not to agree). No positive ID yet. He had a hand written id in his wallet, but for all we know, he could have found the wallet. You ask him his name, and he starts screaming, cussing, and snapping at you like a snapping turtle. I wish I was exaggerating, but I'm not. We finally got an order for chlor. hydrate to calm him down enough to bathe him, but it took him biting one of the nursing assistants just to get that -- he just burned thru adivan like we were giving him water.

Sorry, venting. But all I can think of is if this guy gets loose, he's going to really hurt someone. He can't live with us, and he can't be released.

Mish56, BSN, RN · May 26, 2008

Holy Cow!!! Has a psych consult been called? This guy is floridly psychotic and paranoid (he thinks you are poisening him). He doesn't need placement, he needs acute care psych treatment!! I hate to break it to your docs, but ativan, chloryl, whatever might make him sleep, but it isn't gonna treat psychosis. Haldol IM, may take a few days of repeated dosing(please give the guy cogentin with it-or benedryl dystonia can be ugly), but it should at least give you a glimpse of the human inside. From what you describe, he has been without treatment for months if not years.

I KNOW it is horrific trying to treat someone who is attacking you left and right, causing real understandable fear and anger, but schizophrenia is a treatable illness. I work in CT, and every state has their own laws and rules, but he needs involuntary treatment. Call the judge, the independent docs whatever...but he needs commitment.

Better yet, call the attending MD and tell him/her to do their job and call the consult, or let the doc feed/bath the guy just once!

Let me put it to you this way, can you imagine if I had one of my psych patients complain of chest pain, perhaps radiating, and my psych MD didn't call medicine/cardiology to eval? Now there is a lovely malpratrice case.

So, transfer to a psych facility....placement and treatment done for you!

nerdtonurse?, BSN, RN · May 26, 2008

Oh, yeah he definately needs to go to the state hopital, or at least somewhere that can handle this kind of patient safely; I mean, we're winging it. They're doing the guardian ad litem thing, judge is coming Wednesday. I don't know the legal side of the house for psych; maybe they can't place him because they can't confirm he's a state resident or confirm his ID? Dunno.

I know our psych doc came and saw him, and they keep fiddling with his meds, but he's seriously dangerous. I just hope we can get him somewhere where he can get help before anyone else gets hurt.