Presentation made March 27, 2012 by Lora Epperly - all rights reserved. http://worldeventsforum.blogspot.com/

1. Lora Epperly, MSN RN
CCR, Inc. - Roanoke, VA

2. The demographics of Mental Illness and
Dementia in LTC centers
Approximately 28,000 in skilled nursing and long term care centers in
Virginia
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 to
severe Alzheimer’s or other dementias.*
* 2012 Alzheimer’s Disease Facts and Figures, Alzheimer’s Association.

3.  Dementia is a general term for a decline in mental ability
severe enough to interfere with daily life.
 Dementia is not a specific disease. It's 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
person's ability to perform everyday activities.
 Alzheimer's 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.

5. Catastrophic
Reactions
Rummaging/ Uncooperative
Hoarding / Resistant To
Care
Social Aggression/
Withdrawal/ Agitation
Apathy
Illustrations
Suspicious- Wandering/
ness/ Pacing
Delusions
Hallucinations/
Illusions Delirium
Yelling/
Mood
Calling Out/
Problems
Screaming

7. Co-morbidities
Dementia diagnosis
Age
Polypharmacy
Barriers
Acceptance by family or
support systems
Geropsychiatrists and other
mental health professionals
Community resources
Lack of
Resources
IP geropsych beds
Staff training

8.  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.

9. Return to
the skilled
nursing/long
term care
center
For
Emergency
Evaluation
Referral and
Admission

10. Referral and Admission

11. • Diagnosis
• History and Physical
• Medications
• Length of time on medications
Information • 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

12. 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.

13. Involve the family
or support system
as much as
possible
Assure medication
Review the
reconciliation has
predetermined The
occurred and
care plan with the Admission
medications will
team caring for Process
be available upon
the resident
admission
Utilize a team-
based approach
for admission
assessment

14. For Emergency Evaluation

15. Develop a
partnership
with local
emergency
departments
Before
Emergency
Develop a
partnership
with
emergency
services
personnel

16. 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 of
manager/physician “stable”
What can
we do?

17. Communicate
things that calm Use a standard
resident and transfer form
things that cause familiar to the
stress (bright lights, receiving
loud noises, sirens, center.
lots of people, etc.)
Give adequate
description of Include
reason for medications’ list
evaluation; along with time
behaviors,
medical of last dose
exacerbation, fall,
etc.

18. Return to the skilled nursing/
long term care center

19. 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
education
Final diagnosis needed to
safely care for
the resident

20. THANK YOU!
Lora Epperly, MSN, RN
CCR, Inc. - Roanoke, VA
LEpperly@commonwealth-care.com