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Behavioral and Psychiatric Challenges in SNFS

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“Bonnie” was admitted to the skilled nursing facility following surgery for a right hip fracture. Prior to her fall, she said she was living by herself, fully independent. Although she claimed she wanted to return to her apartment following rehabilitation, she was slow to make gains in her therapy, often complaining of great pain and isolating herself in bed.

Because Bonnie’s voiced desires appeared to be in contrast to her behavior, and her condition was weakening, I was asked to meet with her for a psychological consultation. I found Bonnie to be unhappy and fearful. And she revealed for the first time a recognition of her frailty, her several earlier falls and a fear that she might need to move into long-term care.

Behavioral and psychiatric concerns like Bonnie’s are extremely common in post-acute care and offer a difficult challenge to facilities. Up to 70% of skilled nursing facility residents have a psychiatric diagnosis upon admission, most commonly: adjustment disorder, major depression, bipolar disorder, personality disorders, schizophrenia, dementia and anxiety disorder. An acute change in medical condition — like a stroke, hip fracture, loss of limb or peripheral neuropathy — or an exacerbation of a chronic condition can produce a secondary psychiatric disorder.

There are no easy solutions, but it is vital that SNF leaders come to understand how these various conditions can affect each resident’s daily functioning and, when concerning behaviors and symptoms manifest, that they endeavor to identify and address the underlying cause. This can best be accomplished by integrating psychological care into the SNF’s comprehensive treatment programs.

For the full text of this article by Mitchell Gelber, Ed.D, PC, click here to visit McKnight’s Long-Term Care News.