Nursing Home Crisis!!!

[MDhasbeen]

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... or not. Here's an article about the mentally ill living in nursing homes and supposedly killing everyone in their sight while there. Geez. If they're that worried, maybe states should look more carefully at re-opening their long-term hospitals?

 

[chameleonknight]

If they're that worried, maybe states should look more carefully at re-opening their long-term hospitals?

Absolutely they should. Sadly, the only way to get things done in this day and age is to sensationalize as much as possible. Call it "Ivory's law" or something like that, and get public support for it. I'm sure the vast majority of the public has no idea how many chronically mentally ill people are dumped not just in nursing homes but back into the general public life where they will simply decompensate from the stress. *sigh*

Probably the most underappreciated public health issue at the moment. Up to us to get the word out and get the mental health facilities and resources this country needs.

 

[whopper]

Something I've noticed from anectdotal experience is several psyche units are now trying to discharge psyche patients to nursing homes.

The good thing is several psychiatric patients are appropriate for nursing homes under the rules. E.g. a medically compromised psychiatric patient.

However if that patient is psychotic, yes that person can become agitated due to psychosis. Would that nursing home be equiped to handle such a patient should that situation happen?

Another thing is I've seen some units try to "dump" patients. For example my own unit is not equiped to handle medically compromised patients. We have 2-3 nurses in charge of 28 patients--because those nurses are supposed to handle the psychiatric, not medical problems. A medical nurse to patient ratio usually 4 to 1 by several standards (yes I know it can go more, but several 3rd party agencies use the 4 to 1 ratio as a marker of higher quality).

And guess what? The local hospital gave my unit a post surgical patient who needed frequent medical intervention, with exposed tubes going into her peritoneum, and exposed fascia. Another unit in my hospital was given a total care patient--that patient requires bed turning every hour.

The people that should have been acting as gatekeepers to have prevented that-well the gatekeeping didn't happen. I don't know exactly how it happened because I was not involved in that process.

And I'm sure some nursing homes have gotten psychiatric patients "dumped" on them that were not appropriate.

Its unfortunately due to lack of communication or intentionally misleading efforts on the part of the unit trying to get rid of the patient because managed care will no longer pay for their stay--so they rush to get rid of that patient, and when another place takes the patient, now that place is responsible.

This is part of the problem of the dual problem patient, and I'm not talking substance abuse/mental illness. The patient has more than 1 problem that is not handled by the same field such as surgical & psychiatric or medical & psychiatric. Most facilities are designed to only take one kind and aren't equiped to handle the other. That leaves the facility that has the patient in a bad situation when trying to discharge the patient. Very few facilities are designed to handle both.

 

[Regnvejr]

... or not. Here's an article about the mentally ill living in nursing homes and supposedly killing everyone in their sight while there. Geez. If they're that worried, maybe states should look more carefully at re-opening their long-term hospitals?

No kidding. The hardest work on a Senior-inpatient unit is the discharge plan. NH dumpjobs are legion. And for good reason. Eventually, the only place left is the state hospital senior units.

Long-term group homes, psychiatric nursing homes, all that good stuff is all in short supply. Mental Health is the red-haired stepchild of nursing care. Especially now where antipsychotics are cast seriously in question (better get used to depakote in the unruly patients 😉 ).


Not all bad, though. I can't count how many NH patients I have been consulted on, and find to be utterly snowed on seroquel to the point they don't know where and when they are- of course then navigating life less and thus becoming more anxious and aggressive.🙄

 

[kugel]

Hey, the only other one in my family with red hair is the milkman.

Anyway....
the reverse dumping is also going on - and getting worse
Every week, we get supposed "psych" patients from nursing homes. The alzheimer patient who is wheelchair bound grabbed someone's bum and the NH called the police and had the patient brought in as a "danger to others due to mental disorder." When we determine that there is nothing a psych admit is going to do to change the problem, the NH screams bloody murder and tries to "refuse" to accept the pt back.

 

[Doc Samson]

Hey, the only other one in my family with red hair is the milkman.

Anyway....
the reverse dumping is also going on - and getting worse
Every week, we get supposed "psych" patients from nursing homes. The alzheimer patient who is wheelchair bound grabbed someone's bum and the NH called the police and had the patient brought in as a "danger to others due to mental disorder." When we determine that there is nothing a psych admit is going to do to change the problem, the NH screams bloody murder and tries to "refuse" to accept the pt back.

Absolutely agree. The NHs also have psychiatrists on contract who'll diagnose a "Mood DO NOS" or "Psychosis NOS" at the drop of a hat on a demented or brain injured patient to make sure that the dump sticks. I've had admissions longer than 100 days where the patient is essentially at their demented/TBI baseline, but unable to place because now they have a "psychiatric diagnosis."

 

[whopper]

My own unit just discharged a schizophrenic & brittle diabetic patient. She was psychiatrically stable the entire time, and the previous short term psyche unit couldn't find a disposition for her, so they "dumped" her onto us. However she was something of a cantankerous curmudgeon who sometimes didn't cooperate with her insulin--due to nonpsychotic reasons.

Her diabetes was under very poor control and her blood sugar shifted from levels of 30-400 within the same day.

In fact when the previous unit was doing the nurse to nurse report, the nurse from the previous unit even admitted that they were giving us the patient becuase they couldn't find a disposition, and that billing became an issue.

So for about 5 weeks, we had a patient where the only real problem was her blood sugars. Her psychosis was under control from day 1 of her admission onto our unit.

 

[Regnvejr]

So for about 5 weeks, we had a patient where the only real problem was her blood sugars. Her psychosis was under control from day 1 of her admission onto our unit.

Social workers and their rolodex are your friend. 😍