Psychiatric Care or the Right Care?

Shot of a young doctor comforting a sad senior man in a nursing houseIn my 25 years of practice with geriatric populations suffering from dementia, I have learned that patience, proper timing of medications, close observation of immediate needs and an individualized approach are the keys to success in managing difficult cases of dementia. Families often ask me how we can manage 16 residents in one home, especially with so many having advanced dementia and exhibiting challenging behavior, when the family can’t even manage one person at their own homes. That question was answered through direct experiences with such cases over the last several years.

Four years ago, when I had started a small community designed specifically for people with dementia, I thought that it was simply going to be a home for residents who need assistance with care and safety. But then I began receiving more and more calls from families who were stressed and horrified that their love ones with behavioral dementia were being abruptly removed from their current facilities and sent to psychiatric hospitals. The caregivers were given two choices in those situations: either they needed to hire one-on-one care, or their loved ones would be sent to a psychiatric hospital for stabilization. That is when I made the decision to start taking those residents into our facility, thereby preventing unnecessary psychiatric hospitalizations.

Neither I nor the caregivers could imagine how successful this would be. With my individualized approach, these patients adjusted quickly and adapted to their new home quite well, all without strong and addictive medications. I came to understand that this is the best possible approach as it offers an alternative to psychiatric care, which in turn often leads to overmedicated patients and other problems like dehydration, inactivity and of course, a lack of quality care.

So I must offer the following thoughts to caregivers. If your loved one’s current facility suggests that you need to hire one-on-one care, this might really be a red flag indicating that the facility might not be the right place for your loved one. The luxurious communities with ice cream parlors, movie theaters and restaurant style dinning are all great and attractive on the surface. But each caregiver needs to ask themselves: “Is this really what my love one needs?” Perhaps they would be better served in a small, therapeutic, caring environment where their needs are met and they are not unnecessarily sent to hospitals. For example, from my experience with people with behavioral dementia, something as simple as sitting a resident on a stationary exercise bike can help channel his/her energy and eliminate behavioral episodes caused by anxiety or excess energy.

Families and caregivers need to be aware of those red flags and not to rush allow transfer of their loved ones to psychiatric hospitals, especially when it most likely can be avoided. They need to pay close attention when a facility tells them to hire one-on-one care, or when they tell the family that their loved one needs to go to a psychiatric hospital for medication management. What this may really mean is that their loved ones simply are not in the right type of facility for their best care.

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