[StBernard] mental illness in nursing homes

[Westley Annis]

Just a point to add to this interesting discussion about people with mental
illness in and out of nursing homes:
Nursing homes were not intended for people with 'severe mental illness' nor
is staff properly trained for such residents. They are trained to care for
people with physical and cognitive disabilities (Dementia), but not
psychiatric conditions with some very, uhm, unusual and extraordinary
behaviors.

I remember clearly the sudden deluge of people with schizophrenia,
psychosis, borderline manipulative and bipolar depression disorders to be
kicked out of their mental institutions where they stayed for many years,
even decades,  (and no one yelled then that it was wrong) into the various
nursing homes, suddenly living with UNLOCKED doors, NO restrictions on
activity schedules, smoking wherever, no behavior plans, NO trained staff to
deal with this. These were people who functioned ok in a strict structured
environment, yet nursing homes were supposed to be home like, are NOT
allowed to tell people what to do, when to do, not to leave, nursing homes
are NOT prisons and few have 'locked' units, which are difficult to justify
with the current Resident's Rights. 
No, nursing homes can NOT legally lock someone up, can NOT legally stop
someone from leaving.
 
Therefore a new admission step was added before admission, by DHH. A two
step psych screening.
People with mental illness MUST have a physical disability (or co-diagnosis
of dementia) to even are allowed to be admitted. Then they need to go
through a psych eval via the state assigned psychiatrist. This is a back
log, so many get in without this eval and are still waiting for the eval.
 
In the eighties, when this two step level assessment began, many many many
were IN nursing homes WITHOUT any other diagnosis than the psychosis, and
nursing homes were forced to find discharge alternatives for them.
Remember, these people came from East Louisiana and South Louisiana State
Hospitals (Jackson, Mandeville) and lived in a much stricter environment,
many not being able to function safely in the more unrestricted nursing
home, and many of these now had NO choice but to move into the community,
either with family, alone, or group homes. Then they functioned even less,
but the nursing home got the blame for inappropriate discharge, on the other
hand was expected to KEEP them WITHOUT pay until appropriate discharge was
found BY THE NURSING HOME. THis was so unfair, discharge planning is usually
only done for those elderly who underwent rehab and could go back home with
family, but never on this scale, with such difficulties in finding
placement. 
 
Even today when a person in a nursing home cycles through a period of active
psychosis and hurts another resident or staff, the nursing home is blamed
(even though psychosis does tend to cycle), can NOT discharge that resident
unless nursing home finds placement, and DHH is NOT helping at all. 
These people must stay (or return after a short stint in an acute psych
place) back to the nursing home, continue to pose a threat to others.
I have seen it time and time again. Cannot forcibly discharge, but do so to
protect the elderly.
Then get hit with deficiencies and thousands of dollars of fines, denial of
payment for other residents etc, and lots of headaches, because 
either the home failed to protect other residents for letting the mentally
ill person stay 
or the home inappropriately discharged the guy who needs professional help.
I have also seen that these folks end up getting picked up by police and put
in jail for assault and battery and even murder, because DHH keeps saying to
find another nursing home for them but cant seem to get them back into the
OMH maze into a longterm psychiatric facility. 
 
OMH is not at all involved with nursing homes on this level. 
OMH successfully removed these residents from their responsibility to DHH. 
 
I still believe, once those mental health beds were closed by the hundreds
and people dumped into nursing homes, OMH should have gotten more involved
in following these people
This whole mess with mental illness started when those psych beds were
closed and the people inappropriately discharged into nursing homes. 
Thanks for letting me step on my soap box.
(bowing and stepping down)
 
Gaby
To live only for some future goal is shallow. 
It's the sides of the mountain that sustain life, not the top.

-Robert M. Pirsig