When to take away the gun?
While we spend a lot of time talking about depression and loneliness in long-term care, we spend less time talking about suicidal seniors.
This week the Joint Commission made a point of flagging suicide in healthcare settings after receiving a report noting more than 1,000 suicides from 2010 to 2014. The most common root cause documented was related to shortcomings in assessment, specifically psychiatric assessment.
To be fair, the guidance in the Joint Commission's' Sentinel Alert is more focused on behavioral health centers. It's a little vague for nursing care centers, only noting that the organization should “have a process that addresses transitions in the patient's or resident's care.”
“Healthcare organizations are encouraged to develop clinical environment readiness by identifying, developing and integrating comprehensive behavioral health, primary and community care resources to assure the continuity of care for at-risk individuals,” said Ana Pujols McKee, M.D., executive vice president and chief medical officer at The Joint Commission.
What does that mean from a practical perspective long-term care providers?
The Joint Commission has several points everyone agrees with, and one that will be controversial to some. The first is that suicidal residents and family members should be given the number to the National Suicide Prevention Lifeline, (800) 273-TALK, as well as local crisis contacts. Second, there needs to be a safety plan, which includes the person identifying images or thoughts and making a list of family and friends that are available to talk.
The part that will chafe some residents — and family members — is restricting access to lethal means. In older adults who commit suicide, 67% used a firearm.
We could debate our thoughts about gun control at length, but that's not my point. It's instead how we are in an unprecedented era of access to firearms, as well as a thought that it's a private issue. For example, there's a bill being debated in Iowa that would allow children under age 14 to use a handgun with parental supervision, and the National Rifle Association pushed back against a American Academy of Pediatrics recommendation that physicians ask families whether there was a firearm being kept in the home. In a debate over a Florida bill, the NRA eventually agreed physicians could intervene if it were directly related to the patient's safety. It's unclear whether that would include not only the suicidal, but those being bullied and/or planning to harm others. It's impossible to know whether physicians treating seniors in Florida feel they can ask about firearm safety.
It's also hard to know how many senior living communities have questions about firearms as part of their initial assessments, not only for residents moving into long-term care, but for those being discharged home. Additionally, nursing homes must evaluate their state's concealed carry laws to determine their policy. This isn't solely about preventing suicide among staff or residents, but whether lethal weapons can be in a healthcare setting.
For some residents, taking away a firearm or other weapon may feel as painful as losing their car keys. With the senior population, we can acknowledge the balance between individual and community safety and a right to end one's life with dignity. Many would be hard-pressed to attack those seniors who choose to end a terminal illness journey early, whether their weapon be pills, a noose or a gun.
I am empathetic to those seniors who want to keep their family rifle or handgun out of concern for their safety. But I return to the statistic of 67%, and the belief that whether a resident has dementia, chronic illness, is suicidal, or harboring thoughts of a “mercy killing” for a loved one, it's time to take away the firearm.
Elizabeth Newman is Senior Editor at McKnight's. Follow her @TigerELN.