2 week geriatric psychiatric stay. Any experience?

a quick update: MC nursing director is insisting that MIL must see a geripsych but she dropped the 2 week inpatient requirement. MC nursing director still insists that MIL sees a geripsych and if the geripsych can state that the patient is stable then they’ll admit her.

we are now trying to get a referral from the GP to get her an office appointment for a geripsych evaluation.

My MIL was in GeriPsych for 2 weeks. It wasn't pretty. The blessing was that her doctor was really good and they tweaked her Parkinson's meds to stabilize her moods which prior to, was making us all crazy. It wasn't a fun hospital stay for her. And yes, there were several days she was restrained because she flat out wasn't behaving herself. The part that was hard was some of the other patients. They were wailing, wandering in and out of each other's rooms, some were openly masturbating, it was awkward. It was very motivating for her to do what the doctor said and take her meds. We noticed a big change the first week The second week she was threatening to never forgive us if we didn't get her out NOW.

We’ve not heard back from the original poster but I want to share my continued experience. One nursing home is willing to accept dad right away (their numbers are high for use of antipsychotic drugs according to health.usnews) but of course, dad told them no.

The second nursing home, which I kind of like more, wants more records to find out if there were more behavior issues besides lack of sleep. They're questioning the home health agency and primary doctor. I hear they are also questioning him being on the Seroquel (their numbers are low for use of antipsychotic drugs according to health.usnews).

So that may be another reason.

Are there other facilities you could consider? My concern is what if she develops some behavioral issues once admitted. Will they kick her out? I would ask them that.

My mom began hallucinating with a uti. ER. Rehab. Then rehab psych put her on Aricept and Nimenda. Her primary was not sold on these and took her off the NimendaI took over her med care in ALF and stopped the Aricept after 3 days bc of bad dreams. I think less is more of these concoctions. It was for my mom. She has dementia and memory issues but without a uti to send her to crazy land, she is grounded in this world. Moves confuse her. And since we’ve been at my house (last 5 days) I have yo keep explaining where we are. But no behaviors, hallucinations or delusions.

And no. I have no experience with geriatric psych stay.

Good luck! And good for you for trying to make mil’s life as good as it can be in a more active facility.

Gosh no. Just like any hospital but hopefully more supervision!

I sort of can understand the MC reasoning to see a GeriPsych.. they are the experts in this area - elderly grey matter - & can re assess a person's whole medication plan.

Some folk probably have a gigantic collection of drugs: from primary Doctor + Neurolgist + other Specialists = a giant cocktail. A reassess & cull may be needed.

Withdrawal/change of meds may be unpleasant, cause behavour issues, hallucinations etc so I am guessing the MC feel it would better done as inpatient.

Ludmila: Imho, they do not tie a patient down to a chair or bed.

An MD needs to order the admission to a geriatric psychiatry unit. It is a locked unit, not appropriate for all patients. Generally care is provided by levels - there is no indication that your mother is currently out of control and risks harming self and others.
Has the memory care outreach person met you and your mother at her current care home, and talked with those CGs about her past and current behaviors?

A geripsych admission is usually 'treatment of last resort" when less restrictive measures have failed - such as adjusting meds in community without any improvement and behavior continuing to deteriorate.

Might want to look at other memory care facilities....this is a very unusual request as a prerequisite to admission. Good luck.

My husband was admitted to the hospital for combative behavior and then sent to a psyc eval , where they would not let me see him , the doctor's were awesome in keeping me updated (it was covered by Medicare)n he only stayed there two days and was sent back to MC facility so maybe it won't be 2 weeks

If she is stable for months, her behavior should not be an issue. I agree that her behavior should be managed by a geriatric psychiatrist. Maybe MC would be more amenable if she was evaluated and managed by a geriatric psychiatrist. If the psychiatrist sees that she is stable and writes an evaluation to that effect, your mom shouldn't have to go to an inpatient psych unit before admission.

First I don’t think patients locked in their rooms and bound to their beds alone is the “norm” anymore. But I would certainly ask to visit the facility where she would do this in patient psyc eval, I’m assuming it’s in patient, to put your mind at ease and ask any questions you have to get a clear picture of what they will do. The term Psyc eval sounds scary and I think can be a broad term. My mom has had 2 geriatric psyc evaluations since her stroke, I wish she had one prior for a better baseline and they weren’t at all what they sound like. Grueling, yes and they know it so the do it over time, days sometimes weeks because their damaged brain is working so hard during the evaluation. Dementia patients are admitted all the time for these evaluations, particularly when on medications for mood and mind, to find the proper dosing and mix of medications because our bodies and the way they process and react to medications changes. Even when they we have been on medications for a while, maybe even especially when it’s been a while, the way it works for us can change just like anything else we put in our bodies.

Im not sure it’s a bad or suspicious thing that the MC wants this before she moves in, though it sounds odd given her mood has been stable requiring this now rather than having to send her after she is settled in because some combination doesn’t work in her body might be the responsible thing to do on their part. MC facilities have a lot of experience with all of this, we have experience with our LO and they can be more objective than we are they also are responsible for the other residents there so there might be some comfort in the idea that they will be as protective of Mom once she is there.

The insurance question is a good one and I would verify that Medicare will cover what they are asking for, it’s a good measure of wether or not it needs to be done. Someone is probably going to have to have it pre approved in some way and it may be that what they mean when they say 2 weeks is that it could be up to 2 weeks but I can see why they might want to be cautious about a patient on several mood altering medications who hasn’t been evaluated by a geriatric psychiatrist. Neurologists are the doctors who typically prescribe these at first and are the ones dementia patients are sent to but there can be a fine line between their specialty and a geriatric psychiatrists specialty, I can see a point where they should be working together with a patient. I mean if you want to the geriatric psychiatrist first and they were prescribing medications and treating for dementia it would be responsible to get a neurology consult as well as a neuro psych evaluation.

Don’t be afraid of the terms just make sure you ask all the questions and do everything you need to to feel comfortable and informed about what’s going on. Again I go back to, you know your mother best and her comfort and ability to get through the changes is what you need to offer to these decisions. Don’t be afraid to express those concerns and assert your value to everyone involved either.

I went through a similar process a year ago. DW had become aggressive at the ALF so she was sent to Geripsych. Ten days turned into six weeks. When she got out, she was much more stable. As others have said, the dementia was still there, but the aggression was gone.

The geripsych facility did her a lot of good. The one we used specialized in dementia cases (my first question to the doc was if he had ever hear of Lewy Body-at least he got that one right.) They got her, for lack of a better term, "dried out" from all the meds the various psychos had been prescribing. Additionally, since they specialize in dementia, and they see the patient more, they are better able to assess the whole patient and create a comprehensive plan.

This is just one man's experience, but if you can get them into GS and medicare will pay for it, I would go in a moment.

If she is combative with staff and particularly with other residents, tries to walk out, etc, the living center can make the request part of the the requirement to stay. I'd check with your family doctor. But here is my experience. My sister was being taken care of by her son, which turned out to be a bad thing. Savings gone, credit cards maxed. He died suddenly age 40 of a heart attack as a result of drug usage. I had been cut off from her for about two years and when I came back to take charge, she had been diagnosed with "cognitive impairment". I moved her to assisted living, nice apartment. But she became combative, abusive to staff and tried to walk out several times. As a condition to stay, they wanted her evaluated which I allowed. Ten days later it was like a different person. She still of course had the memory issue but was stable. MC paid all her bills but each situation could be different. I'd check with her MC provider first. She is still in the assisted living center but no longer has the privilege of coming and going. Outside time is restricted unfortunately to areas where she can't wander off. She is free to leave her apartment, go outside. As far as the hospital treatment, she will be assigned a team to evaluate the path of treatment. She most likely will not be able to leave her room on her own. No they won't tie her to a chair or bed. Hopefully she isn't trying to harm herself. But the result is they can determine the extent of her dementia, the progression and adjust meds that work best together for her. When the hospital called me after ten days, they asked if I wanted to pick her up or have her transported. I asked will she be ok to ride, not try to open the door or be combative. They said I might be surprised at the results and I can tell you I was very much surprised. She had previously accused me of things, called me names and said she didn't want me around. Now its "baby brother". But check with Medicare just to make sure they approved such a move which almost certainly they will.

Sounds like another way of making money? I wdmstill go ahead with this but only if there is a two-way mirror so I could watch to see what actually happens.

Ludmila

Would love to hear the outcome if you decide to continue with this memory care unit.

I have not heard of a MC facility requiring a psychiatric evaluation for admittance. Your MIL's symptoms (hallucinations, combativeness, and difficulty redirecting) are typical behaviors for someone with dementia. Any MC facility worth their salt knows how to respond to these behaviors.

That said, my wife was admitted to a psych ward for her unruly, damaging behavior. Shortly after her admittance, she tore the thermostat off the wall, damaged the venetian blinds, and smashed the family pictures in her room. She was essentially incorrigible. The facility asked for our OK to place her temporarily in psych ward. Obviously, destroying the place wasn't an option, so we OK's the move. The facility made the arrangements. Before being admitted to the ward, she had to be admitted to the ER for some screening. This only took about an hour. In the ward, she was in a small area with maybe 6 others. The staff met with me and my daughter to map out her plan and discuss my wife's background. Each resident had their own room (no doors), a bed, a small cabinet for their belongings, a private shower and toilet. She was only there for 12 days, not the 2 weeks your facility is requesting. She didn't return to MC all doped up, but properly medicated to eliminate any further disruptions. Her remaining 14 months in MC were of a model resident.

So don't equate today's psych wards with the terrible insane asylums of the past. If you OK the move, and it's your decision, make sure the psych staff meets with you and doesn't keep you in the dark. Also, make sure you can visit her. My visits were filled with angst until I arrived and found the situation well under control. So if they can't guarantee a meeting and visits, seek another MC facility.

I too had that concern of them doing awful things to dad when he went into a behavior unit. Too much television I guess. When he went to the behavior unit for the possible two weeks, they did not do the MRI or neurology consult. So you may want to call ahead of time and see if that is even a possibility. All they did in a matter of one week was load him up on meds and discharged him back to our home.

I don’t know who mentioned it on my post a while back, but you may want to be careful with having that on record. Now that we are interviewing nursing homes, one nursing home admin, just this week, said they had to do an actual visit with dad about the very issues you mentioned that are now under control. They are still willing to accept him but dad said no. I'm also concerned because this nursing home has a high percentage of using antipsychotic medications.

It's a shame that something that may be helpful or provide reassurance could possibly hurt our loved ones when it comes time for placement.

Should be covered by Medicare. Will include several psychiatric interviews and evaluations. I’ve worked in two state hospitals and two private psych facilities. She’s not going to be tied to anything. That may have occurred a long time ago but not current practice. It may also include a MRI and neurology consult. If she is combative or trying to elope, she may be in a half door locked room; or
her hands may be restrained and/or her legs.

If you are not comfortable with having her have this psych evaluation. Find another MC.

I would find a different facility. They obviously are ill equipped to deal with behavioral issues and that is the point of MC.