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A Senior With Psychiatric Issues Will Present Special Placement Challenges

I have been receiving a fair number of requests to assist families with the placement of loved ones who have psychiatric issues. Many of them have had episodes with violent behaviors. Unfortunately, there are no easy solutions to these types of placement problems, and under no circumstances do these placements resemble a typical nursing home placement. A nursing home is simply not a dumping ground for a senior who exhibits psychiatric behaviors. If you call a nursing home to inquire about a bed for someone who has bipolar manic depression, schizophrenia, or Alzheimer’s disease with disruptive behavior disorder, it is likely the response you receive won’t be positive. That is because there is a real lack of Geriatric-Psychiatric (“Gero-psych”) care available for seniors around Cook, Du Page, Will, and Lake Counties in Illinois. For instance, there are only about 6 nursing homes in Du Page County that can handle psychiatric illness effectively. There are more in Cook County. Most nursing homes don’t have the staff with training to accommodate the one-on-one type of attention seniors with mental health issues require. They may be a danger to themselves and their fellow residents.

Here’s what you can expect if you enter the senior psychiatric arena in the Chicago metropolitan area:

1. Most of the homes that handle mental illnesses (Institutions for Mental Disease or IMDs) are at the intermediate care level. The residents are often ambulatory and many are not elderly. The residents need their medications administered to them and sometimes need help with some of their activities of daily living. Depending upon the seriousness of his or her mental condition, the resident may be allowed to check in and out of the facility on a daily basis. There is a lack of locked units that treat psychiatric illnesses that many seniors who wander require.

2. If you are lucky enough to find a locked unit, the residents who have psychiatric illnesses may be mixed with residents who have Alzheimer’s disease, but who don’t necessarily have a psych diagnosis.

3. I have been in nursing homes where I have seen psych residents living with the general population. (Those with dementia and those without it.) Beware of nursing homes that say they can handle mental illness but are not qualified to do so. The staff may be trying to fill the beds in a home that has a low census. If they cannot handle your loved one’s behaviors, it may involve another move to a different nursing home. This can be devastating to the senior, and a precursor to more behavioral problems.

4. Do not judge the communities that can handle psychiatric illnesses effectively according to their aesthetics. Their decor may be less than desirable, but it doesn’t mean they can’t deliver good care to your loved one. (Indeed, a simple or even spartan decor is often required for patient safety, as such may be necessary to avoid slips, trips and falls, person-object collisions and so forth.)

Psych placements can be extremely complicated. Although I can guide you toward the communities that are equipped to handle psychiatric cases, I would rather give you the following advice. If your loved one has been admitted to the behavioral unit of a hospital after an episode, it is truthfully better to ask the psychiatrist who is treating him/her if the doctor sees residents at any of the nursing homes where they accept psychiatric cases. That way, the psychiatrist who knows your loved one’s medical history can suggest an appropriate community and follow them. The discharge planner should work with the psychiatrist and arrange the appropriate referral. Otherwise, you will be setting yourself up for endless phone calls to nursing homes without a positive outcome. Try my suggestion first. If that doesn’t work, I will be more than happy to assist you. And, if you observe that your loved one is having behavioral issues on a non-emergency basis, call his or her primary care physician and get a referral for a psychiatrist.