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Bridging Acute and Long Term Care with a Behavioral Health Perspective

Written By : Joe Casciani

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When patients transition from an acute hospital setting to a long term care setting, there are many issues that pose serious risks for these individuals. But the more staff members at both ends of the treatment continuum recognize these risks, and understand how they can mitigate them, the more successful these transitions can become. Among the list of potential risks, patients with any of the following require more specialized approaches from caregivers:

  • dementia and deliriumgeriatrics care
  • depression, anxiety, or adjustment disorder
  • personality disorders
  • sensory deficits
  • resistance to care
  • uninformed and unprepared about management of their care
  • cultural and language barriers

One way to successfully manage these potential risks is to individualize the treatment approach by categorizing the patients into one of three levels, or tracks. This should occur on admission to both the acute and the nursing facility, and ideally will be incorporated into the patient assessment documentation. These tracks are necessary because they allow caregivers to adjust their communication, expectations, and interactions according to the cognitive capacity, psychological status, and motivation level of the patient. Track A is for those who can communicate coherently and understand why they are in the facility, Track B is for those who may be disoriented or disorganized but can be expected to improve with reorientation and reassurance, and Track C is reserved for moderate to advanced dementias. When patients are approached in ways above or below their level of functioning, the stage is set for misunderstanding , frustration, increased dependency, noncompliance, and a host of other behavior problems.

A staff member with a behavioral health perspective and sensitivity helps to bridge these transitions from a hospital to a nursing home setting by complementing the medical care with psychological care. Any of the potential risks listed above can complicate a patient’s plan of care and his or her treatment outcome. A severe personality disorder, a patient with a negative, hopeless outlook, or someone whose dementia is masked by a superficial compliance require adjusting our approaches, our communication, and the hand-off to the next level of care. How much can your patient truly understand about his hospitalization or need for long term care? Is the patient involved in decisions about her discharge? Does he know where he is going, why, and what will happen there? And, have the doctors and nurses answered all of his questions?

Bridging acute and long term care with a behavioral health perspective offers a huge opportunity to provide comprehensive health care for older adults.

Thank you for your interest in the CoHealth Blog series.

 

Filed under: Long Term Care

Written By :

Joseph M. Casciani, PhD, is the founder and President of Concept Healthcare and CoHealth Psychology Services.

has written 5 articles