The demographics of Mental Illness and Dementia in LTC centersApproximately 28,000 in skilled nursing and long term care centers inVirginia Approximately 80% of residents with a mental illness diagnosis, including depression 64% of Medicare beneficiaries age 65 and older living in a nursing home have Alzheimer’s disease and other dementias.*39% of Medicare beneficiaries in Virginia in 2009 had moderate tosevere Alzheimer’s or other dementias.* * 2012 Alzheimer’s Disease Facts and Figures, Alzheimer’s Association.
Dementia is a general term for a decline in mental ability severe enough to interfere with daily life. Dementia is not a specific disease. Its an overall term that describes a wide range of symptoms associated with a decline in memory or other thinking skills severe enough to reduce a persons ability to perform everyday activities. Alzheimers disease accounts for 60 to 80 percent of cases. Vascular dementia, which occurs after a stroke, is the second most common dementia type. Other conditions that can cause symptoms of dementia, including some that are reversible, such as thyroid problems and vitamin deficiencies.
Catastrophic Reactions Rummaging/ Uncooperative Hoarding / Resistant To Care Social Aggression/ Withdrawal/ Agitation Apathy IllustrationsSuspicious- Wandering/ ness/ Pacing Delusions Hallucinations/ Illusions Delirium Yelling/ Mood Calling Out/ Problems Screaming
Co-morbidities Dementia diagnosis Age PolypharmacyBarriers Acceptance by family or support systems Geropsychiatrists and other mental health professionals Community resources Lack of Resources IP geropsych beds Staff training
F 223 ◦ The resident has the right to be free from verbal, sexual, physical, and mental abuse, corporal punishment, and involuntary seclusion. F 329 ◦ Each resident’s drug regimen must be free from unnecessary drugs.
Return to the skilled nursing/long term care center ForEmergencyEvaluation Referral and Admission
• Diagnosis • History and Physical • Medications • Length of time on medicationsInformation • Co-morbidities needed • Course of current hospitalization during the • Follow up appointments referral • Family/community support process • Behaviors • What decreases behaviors • What increases behaviors • Possibility of trial admission • Resources in case of exacerbations
Preparing for admission to skilled nursing/long term care center Discussion with Review of care coordinator Hospital visit information regarding care modalities Provision of needed Discussion with Development of education regarding primary physician interim care plan for care for skilled who will follow after skilled nursing/long nursing/long term admission term care center care center staff Develop a plan for Determine and response to schedule any follow exacerbation of up appointments, symptoms counseling, etc.
Involve the family or support system as much as possible Assure medication Review the reconciliation has predetermined The occurred andcare plan with the Admission medications will team caring for Process be available upon the resident admission Utilize a team- based approach for admission assessment
Develop apartnership with local emergencydepartments Before EmergencyDevelop apartnership withemergency services personnel
Let them know the types of skills your nurses/staff have re: IV’s, pain management, care of residents/ patients with dementia or mental illness Do a brief overview of governing regulations Discuss your for long term care patient/resident which affects the types population of residents you are able to care for Who we are Meet with the ED and Agree on definition ofmanager/physician “stable” What can we do?
Communicate things that calm Use a standard resident and transfer form things that cause familiar to thestress (bright lights, receivingloud noises, sirens, center.lots of people, etc.) Give adequate description of Include reason for medications’ list evaluation; along with time behaviors, medical of last doseexacerbation, fall, etc.
Return to the skilled nursing/long term care center
Length of time “stabilized” Are either physical or chemical Site visit restraints in place or part of discharge Medications orders and length of time on medications Any new educationFinal diagnosis needed to safely care for the resident
THANK YOU! Lora Epperly, MSN, RN CCR, Inc. - Roanoke, VA LEpperly@commonwealth-care.com