Transcript LTCOP
Bad Reps and Bum Raps Advocacy for Residents with Mental Health Conditions presented by NORC With special guest Susan Wehry, M.D., Geriatric Psychiatrist Consultant, Vermont Department of Disabilities, Aging and Independent Living © S WEHRY 2009 2 What Ombudsmen Bring → Optimism → Conviction/Hope → Energy → Communication skills → Knowledge → Assumptions → Experience 3 What Ombudsmen face Residents rights in conflict with behavior plans Antiquated mental health approaches A resurgence of us and them Aggressive and threatening behaviors Conflicts between physically frail and physically fit 4 What ombudsmen are asking How do ombudsmen proceed? Who needs to participate? What resources may be available? What can be done if the community mental health system refuses to help? How to address the rights of one and rights of all? 5 Reflective exercise 6 See the Difference? The person with DEMENTIA THE PERSON with dementia 7 See the Difference? The person with SCHIZOPHRENIA THE PERSON with schizophrenia 8 Ombudsmen experiences A resident, Miss Lillian, says she was given the wrong medication The nurse says “Oh, she has dementia - she's just confused" 9 Approaching the problem Consider: what is this person telling me Look at root causes Obtain collateral information Consider: what do I know about dementia Re-create or observe the situation Help staff see THE PERSON 10 Miss Lillian Medication practices improved Medication refusal was new Pill was too large to swallow 11 Mr. George 82 years old, widowed Has dementia Makes lewd comments, swears Placed on medication, no change Struck another resident Discharge notice 12 Ombudsman’s Role Advocate seeing the person strength-based, individualized care planning non-pharmacological interventions Utilize root cause approach Facilitate referral 13 The 'truth' about violence Recent Maryland stories Risk factors Age Rarer among seniors Past history Substance abuse (Mental health conditions) Usually intimates 14 Mental Health Problems in Long Term Care Dementia Behavioral disturbances Capacity concerns Delirium Depression Schizophrenia 15 Delirium A medical emergency Frequently missed Characteristics Sudden onset Fluctuating course Impaired attention Disorganized thinking Altered sensorium 16 Delirium Drugs misuse interaction intoxication withdrawal 17 Ombudsman’s Role Raise awareness Advocate Prevention Intervention 18 Depression Depression is… a medical disorder a chronic condition not a normal part of aging a public health issue a worldwide cause of disability preventable, treatable, and common 19 Suicide Growing concern in nursing homes People who threaten to kill themselves DO Asking about suicide does not put the idea in someone's head Thoughts of suicide are a SYMPTOM as well as an expression of CHOICE 20 Ombudsman’s Role Be aware Educate Recognize Arrange screening Listen Ask questions 21 Assumptions about mental illness …People with mental illness are different …Mental health not as important …Mental health is somebody else’s problem 22 Common Encounters A resident, Mr. Davis, refuses his medication. The facility threatens him with an involuntary discharge saying: 'he has schizophrenia and will get out of control if he doesn't take his medications –we can't risk the safety of the other residents' 23 My Assumptions Just because a person has a mental illness, it doesn’t mean it’s responsible for everything. People with mental illness… Have good days Have bad days Just like you and me… 24 Schizophrenia ▪ Delusions ▪ Hallucinations ▪ Disorganization Thought Behavior 25 Schizophrenia Trouble paying attention All behavior interpreted as mental illness Limited reservoir Anxious 26 Mental Health Recovery YES Individuals with schizophrenia recover from the illness 27 Ombudsman’s Role Challenge assumptions Support recovery Advocate Services 28 Communication Skills Talking with Residents Who Have Cognitive Impairment ▪ memory loss ▪ disorientation ▪ aphasia 29 Communication Skills Talking with Residents Who Have: Hallucinations Delusions Severe Anxiety or are… Not making sense Verbally abusive 30 Set the Stage Consider ▪sensory deficits ▪level of understanding Face-to-face ▪perceived lack of power ▪fear, anger sadness Commit to listening Communicate respect ▪allow time ▪be patient ▪private ▪quiet ▪Tone, posture, gestures 31 Communication Tips Depression What Helps: ▪Active Listening ▪Empathy/Hope “I know you feel this way now, but you won’t always” 32 Communication Tips Schizophrenia ▪Be patient ▪Signal confidence in recovery ▪Maintain attitude of hope, empowerment ▪Listen actively 33 Communication Tips Fearfulness ▪ Do not use gestures which threaten ▪ Take care with touch 34 Assessing Capacity Capacity and Competency: what's the difference? Standards and Thresholds Impact on autonomy, self-esteem 35 Capacity Capacity is Task specific, not global Situational Contextual Capacity can fluctuate Determining capacity in older adults with complex impairments can be difficult 36 Context What decision needs to be made? What is interfering with decision-making? Is capacity likely to change? Issues of undue influence? 37 Capacity Can Fluctuate Lucid and confused days Fluctuations make it difficult to discern capacity May result in misleading conclusions Ombudsmen experiences Share your stories 39 Closing ► Mental health problems are common ► Recognize, refer, advocate for services ► Determining capacity can be difficult and crucial 40 Ombudsman Resources Advocating for Residents with Mental Health Needs: Engaging and Changing the System http://www.ltcombudsman.org//uploads/File/Advocating-for-Residentswith-Mental-Health-Needs.pdf Mental Health Ombudsman Training Manual I'm Glad You Asked Help for the Ombudsman: Assisting the Adult Home Resident http://www.ltcombudsman.org Mental Health Advocacy for Ombudsmen DVD and Self-Study Guide Distributed in 2006