Long-term care psychologists often can help prevent rehospitalizations
Eleanor Feldman Barbera, Ph.D.
Long-term care psychologists are a valuable resource for facilities looking to reduce their hospital readmission rates. As the only team member whose role it is to sit and talk with the residents for an extended period of time on a regular basis, psychologists are privy to a relationship that can help address root causes of readmission such as medication noncompliance and the recognition and timely reporting of symptoms, as well as follow-through with medical appointments after discharge.
1. Notice mental status changes before other staff members. Because interactions are based on extended conversations with residents, psychologists are frequently able to spot subtle alterations in cognition that wouldn't be noticed during a med pass or routine caregiving.
2. Discover previously unreported symptoms. Due to the amount of time psychologists spend with the residents and the level of trust that develops in the psychotherapeutic relationship, residents often reveal important symptoms of their illnesses they might not share with medical staff.
3. Gather information from communication-challenged residents. Psychologists can gather info from residents who speak slowly or need to use communication devices and then share it with the team, saving staff time and providing important details.
4. Identify health-related psychotic symptoms. Because psychologists have extensive mental health training, they can identify psychotic symptoms that might reflect a medical problem rather than a mental health problem (for example, hallucinations due to pain medications).
5. Prevent psychiatric rehospitalizations through keeping residents emotionally stable and working with the psychiatrist to adjust meds.
6. Address factors underlying medication noncompliance. While nursing and other medical staff can offer medications and explain why they are needed, psychologists can work with noncompliant residents on the issues underlying noncompliance. These can range from addressing a bad experience with medications in the past to identifying faulty logic (“I'm better now so I don't have to take this pill any more”) to resolving interpersonal conflicts with nursing staff.
7. Attend to falls prevention through detailed analysis of a fall, identifying preventive measures for the future, and through discussion of issues of dependence versus independence that often lead to premature attempts to ambulate.
8. Enhance cooperation with rehab, determining areas of resistance and encouraging attendance, thus reducing the likelihood of inactivity and its concomitant medical problems.
9. Increase dietary compliance by addressing eating disorders and other obstacles to following nutrition recommendations, working in tandem with the dietary department to maximize follow through.
10. Reduce stress, enhancing residents' ability to cope with the enormous changes associated with a LTC admission, thus reducing the likelihood of rehospitalization due to high blood pressure, TIAs, heart attacks, etc.
11. Address discharge planning issues such as ensuring residents understand medication management and have necessary outpatient mental health and emotional support. Psychologists can also help residents recognize and problem-solve around potential barriers to keeping medical appointments upon discharge, such as discomfort around asking for help to travel to and from appointments or trouble keeping track of office visits.
Facilities interested in reducing hospital readmission rates through enhanced collaboration between their mental and physical health services can start by:
- Considering psychology referrals for cognitively intact new admissions.
- Keeping psychologists in the information loop regarding medical issues, treatment noncompliance, discharge plans, etc. This can be accomplished through establishing psychology as another nursing home department (rather than as consultant/outsiders) and giving them tools to facilitate communication with other team members such as email addresses, phone lines, a mailbox to receive CCs of relevant memos, etc.
Eleanor Feldman Barbera, Ph.D., is a speaker and consultant on psychological issues in long-term care, and author of The Savvy Resident's Guide: Everything You Wanted to Know About Your Nursing Home Stay But Were Afraid to Ask, now available on Amazon. For more information, visit her at www.mybetternursinghome.com.