JEFFERSONVILLE, IN Wellstone Regional Hospital in Jeffersonville, Indiana, offers comprehensive inpatient and outpatient care for seniors who need intensive treatment. Their program addresses the special medical, psychiatric, and emotional needs of older adults who need extensive assessment and management of their illness. Diagnosis and treatment of psychiatric illness and its relationship to possible medical problems is a primary focus.
The hospital was opened in 2003 by a small investment group, and originally did not provide geriatric psychiatric services. However, Chief Executive Officer Greg Stewart says by 2008, Wellstone took a leap of faith and entered into geriatric behavioral health. “It was a fantastic line to move into. It was a very unmet need in our community,” says Stewart. Today, Wellstone has two 12-bed geriatric psychiatry units, one focused on Alzheimer’s and dementia patients, and the other unit for patients with depression or other mental health issues.
Wellstone also provides an intensive outpatient program for seniors utilized by multiple extended care facilities in the area, according to Stewart. “The patients participate in three psychotherapy groups – a functional skills development group, a process psychotherapy group, and an illness management group,” he says. Wellstone also provides wraparound services such as lunch and transportation.
Stewart and other clinicians in the hospital agree that Medical Director Asad Ismail, MD, is at the heart of the geriatric services provided by Wellstone. “He is not only a psychiatrist but also a neurologist and addictionologist,” says Stewart. “People know and respect him in our community. He is very well known for behavioral health in regards to the geriatric population.”
Ismail says geriatric patients need to have a thorough assessment to ensure that they are not being over-medicated. “My approach is that we need to find out the cause of the dementia and determine how advanced it is to best help the patient. There is no treatment to reverse dementia, but we can treat symptoms and try to make sure the patient is not on a lot of medication. We want to make sure they are on vitamins, and we explore making diet changes. We want to help them emotionally and physically, so we are treating them holistically,” says Ismail.
“Geriatric patients are very special and fragile. We have to treat them with love and respect…”– Asad Ismail, MD, medical director
Ismail says this is his message to other providers. “We sometimes forget that geriatric patients can become addicted to drugs,” he says. “We also need to make sure their medications will not interact with other medications to create confusion, agitation, or increased risk of falling. Geriatric patients are very special and fragile. We have to treat them with love and respect and monitor them closely on medications.”
Social services play a key role in the comprehensive geriatric care provided at Wellstone. Becky Gilberts, LCSW, has been a social worker for 28 years, working in community mental health and with chronically mentally ill seniors. She says Wellstone stands out in the individualized care offered for geriatric patients.
“We also have an adult transitional unit for adults and seniors without dementia,” says Gilberts, “because treatment for major depression or other mental illness is very different from dementia treatment.
“Those patients can benefit from our psychotherapy groups because they have the ability for insight and can learn about treatment for mental illness and coping skills. But someone with dementia is typically not able to retain new information, so the focus on the geriatric unit for dementia patients is cognitive stimulation and reminiscing,” explains Gilberts.
“The more you can stimulate memory and cognition, the slower the progress of the disease,” she says. “We might ask dementia patients to reminisce about their first job, or their school, or role models from the past.” Social services are also key in meeting the challenge of finding the right placement and situation for a geriatric patient, whether it be home, assisted living, long-term care, or home health assistance.
Compassionate Care for Patients – and Their Families
Jennifer Firkins RN, has worked on the geriatric dementia unit for 15 years, and says continuity of care is an important issue for her patients. “We have people on the unit who know how to deal with Alzheimer’s and dementia populations, which helps a lot. We have pretty much the same staff here all the time including numerous CNAs, (certified nursing assistants) who understand these patients,” says Firkins.
“Our physicians are very knowledgeable about psychiatric situations,” she says. “I know if we call and tell them what’s going on, they will know exactly what to do and what medication will work for the patient. They really know hands-on who their patients are – and their families.” Firkins says families are an important part of patient care for dementia patients, especially because it’s so emotional for them.
“So many families come here and just bawl their eyes out because they’re not able to take care of their loved one at home any longer. They feel guilty, and that they should not have to go to a nursing home. We try to explain that sometimes it’s the only thing you can do, because it’s not safe for them to be at home,” says Firkins.
Special Challenges of Geriatrics
On the geriatric unit, Firkins says the patient population she deals with can be challenging due to combative, aggressive, and sometimes overly sexualized behavior. Making sure patients’ basic needs are covered often helps to combat agitation, she says. “They can no longer tell you that they’re hungry when they are, so we try to keep their bellies full, and keep them hydrated, which helps them be calmer.” She says family members often don’t understand the changes in their loved one.
Social worker Becky Gilberts explains to families how dementia affects the brain and behaviors of patients. “This disease attacks brain cells which affects functioning and behaviors. Sometimes inhibitions are affected which can lead to inappropriate behaviors or aggression. We support families and educate them, stressing that these symptoms are part of the disease and not a reflection of the person.”
Wellstone clinicians and other staff who work with Ismail say he is exceptional in his dedication to educating families about dementia and the disease’s complexities.
“Dr. Ismail is the most wonderful medical director I’ve ever seen,” says Firkins. “He’s always here for the patients – caring for their needs. Dr. Ismail talks to the nurses directly about our patients and spends two to three hours on the unit. If a family member has a question, he’ll say, ‘Dial the number for me, I’ll talk to them,’ no matter how busy he is that day.”
“He does a great job educating families about what to expect,” says Stewart. “We are proud to have a physician who cares enough to pull families in, to educate them and engage them in the process of their family member’s treatment.”
Special Joys of Geriatrics
With combative and challenging patients and stressful days, why have the physicians and staff dedicated so many years at Wellstone Regional serving geriatric patients?
Gilberts, who has a big, extended family, says she’s been around seniors her whole life and enjoys talking to seniors about their pasts. She loves Wellstone because “we have a great team who work together for the benefit of the patients.”
Firkins says she is fascinated by the stories the seniors tell about their lives, and relates to them. “I feel like one day I may be them. One day I might have to be changed or cleaned. One day I may need to be taken care of.”
Ismail says he also feels a special affinity for the senior population.
“I enjoy geriatric patients,” says the medical director. “They are complicated with multiple issues, and you try to figure out how you can solve their problems. You have to have respect and to have love to treat geriatric patients, because sometimes it is like treating patients who are five years old. They need your help. But what I really like is that you feel like you are treating your own parents. You feel like this is tending to my mom. This is tending to my dad.”