CHVH BEHAVIOR FORUMAPRIL 22, 2014

PRESENTED BY: RENEE NORDSTROM, MHC

& MAURA PIEPER, MSW

http://www.youtube.com/watch?v=YyZ9b4My6NU&feature=em-share_video_user

RECAP FROM LAST BEHAVIOR FORUMAUG. 19, 2O13

Topics discussed:

1. Changes in population- younger, more psych, more substance abuse

2. Training – need more in depth, more frequent

3. Activities – need more individualized, more staff

4. Mental Health – more complex psych dx, insurance issues

Happenings since last meeting:

1. Martinsburg VAMC tour

2. Mental Health Summit

3. NCCDP classes

4. Mental Health First Aid classes

5. Alzheimer’s Assoc. Caregivers Support Group

6. Culture change group re-established

OUR GOALTO DECREASE

BEHAVIOR PROBLEMS AND

IMPROVE THE DAILY LIVES OF THE RESIDENTS

Resident’s quality of life is directly affected by their moods; and their moods are usually identified by their behaviors

TODAY’S TOPICS FOR DISCUSSION:

1. PSYCH/BEHAVIOR RELATED FACILITY DATA & CHALLENGES

2. CULTURE CHANGE AND BEHAVIORS

3. WHAT ARE WE DOING TO MEET OUR GOAL?

4. WHAT TOOLS/RESOURCES DO WE CONTINUE TO NEED?

THE NUMBER OF VA USERS WITH A MENTAL ILLNESS INCREASED BY 45% BETWEEN 2005 AND 2012

2006 2008 2010 20120

200,000

400,000

600,000

800,000

1,000,000

1,200,000

1,400,000

1,600,000

1,800,000

2,000,000Number of VA Users with Mental

Illness

PSYCHOACTIVE MEDICATION USAGE STATISTICS

SNF Antipsychotic usage AL Antipsychotic usage

1st qtr 2012 – 28.7% 1st qtr 2012 – 15.4%

1st qtr 2013 – 29.6% 1st qtr 2013 – 12.7%

1st qtr 2014 – 22.0% 1st qtr 2014 – 8.6%

SNF Antidepressant usage AL Antidepressant usage

1st qtr 2012 – 61.9% 1st qtr 2012 – 48.5%

1st qtr 2013 – 68.5% 1st qtr 2013 – 49.3%

1st qtr 2014 – 67.2% 1st qtr 2014 – 47.7%

ALTERCATIONS AUG ‘13

SEPT ‘13

OCT ‘13

NOV ‘13

DEC ‘13

JAN ‘14

FEB ‘14

MAR ‘14

VERBAL ALTERCATIONS: RESIDENT ON RESIDENT

0 1 1 1 1 0 0 0

PHYSICAL ALTERCATIONS: RESIDENT ON RESIDENT

0 0 1 1 0 0 2 0

Altercation w/Injury 0 0 0 1* 0 0 0 0

Altercation w/o Injury 0 0 1 0 0 0 2 0

Altercation involving resident with Dementia

0 0 1 0 0 0 2** 0

PHYSICAL ALTERCATIONS: RESIDENT ON STAFF

0 0 0 0 1 1 1 0

Altercation w/Injury 0 0 0 0 0 0 0 0

Altercation w/o Injury 0 0 0 0 1 1 1 0

Altercation involving resident with Dementia

0 0 0 0 1** 1** 1 0

TOTAL # ALTERCATIONS 0 1 2 2 2 1 3 0

*Resident hurt own hand when attempted to hit other resident, missed, and hit wall.**3 incidents of physical altercation involved the same resident with dementia.

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After you complete the exercise ask yourself these questions:

1. How did it make you feel when you were the resident?

2. How did it make you feel when you were the one talking to the resident?

3. What can you take from this exercise?

4. Thoughts, feedback, discuss!!!

PSYCHIATRIC CARE OF OUR RESIDENTS

MedOptions Psychologist 2x/week

Possible vendorization of MedOptions to see VA psych patients who are not appropriate for Telemental

Crisis intervention training for all 1C staff

Barriers to psychiatric care due to insurance

Barriers to psychiatric inpatient transfer due to Dementia as primary dx

Only one psychiatric medication provider for both AL & SNF

No VA psychiatrist on site at CBOC

GDR requirements Delay in treatment

issues(appt times, lack of second MD availability)

Progress Challenges

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Questions for discussion:

1. Why the increase in younger veterans?

2. Why the increase in applicants with psych issues?

3. How can we change if the population is changing?

4. Is our criteria for admission truly conducive to our services?

5. Thoughts, feedback, discuss!!!

Current applicants (60year old, SNF, 1C) Alzheimer’s, anxiety/bipolar disorder.

Aggressive at home with wife, so she admitted him to an AL facility, then sent to ER same day due to becoming combative with staff, assaulting numerous employees, currently on 1:1, hospital recommending psych facility

(68year old, SNF) 100%SC for Schizophrenia, admitted to psych unit due to thoughts of hurting others he believes are stealing from him, has history of altercations at other nursing homes, police involved after trying to strike nurses, paraplegic in wheelchair

(57year old, SNF) Aphasic, paranoia, outbursts, past criminal record for drug distribution, theft, robbery with a deadly weapon, recurrent CVAs due to drug use

(57year old, AL) Positive Mental Illness ID Screen, left side upper and lower paralysis, social worker having difficulty because veteran refuses to do anything for himself

(58year old, SNF) Previously denied to AL due to criminal charges, psych admissions for suicidal ideation, intoxication, alcohol abuse current(1-2pints liquor/day), previously in rehab at Baltimore and Perry Point, no longer mentally capable of completing alcohol rehab, homeless, no Medicare, no bank accounts

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It's estimated by the year 2020, nearly 12 million people will need long-term care, and this number is sure to grow with the aging baby boomer population

Non-Denials(67year old, AL) – History of assault charges 1992-

2008, Alcoholism, alcohol-related admissions to Martinsburg, no longer mentally capable of completing rehab

Denials(62year old) – drug charges 2013

(89year old) – psychiatric issues

(53year old) – failed criminal background

(66year old) – psychiatric issues

(61year old) – psychiatric issues

(76year old) – alcohol, psychiatric issues

(57year old) – psychiatric issues

HOW IS OUR CHANGING POPULATION(BABY BOOMER VETS) CHANGING HOW WE CARE FOR THEM?

Boomers are changing long-term health care by not preparing for it while it's still affordable. Since the cost of long-term care increases with age, purchasing insurance for it is most affordable before retirement -- a time when boomers aren't typically focused on making that purchase. AMONG PEOPLE IN THEIR 40S, ONLY 10 PERCENT HAVE SECURED AN INSURANCE PLAN. If more people are unprepared for the costs associated with aging, funds in need-based programs such as Medicaid are expected to be depleted in coming years.

CULTURE CHANGE AND BEHAVIORS

What are some of the benefits from Culture Change?

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Questions for discussion:

1. How will culture change curb behaviors?

2. Why do some people resist culture change?

3. How can we change their perception?

4. How can we make culture change contagious?

5. Thoughts, feedback, discussion!!!

Resident Benefits: reduces loneliness, helplessness and boredom; improves physical and mental health (e.g. reduces depression and behavioral problems); reduces unanticipated weight loss; reduces mortality

Staffing Benefits: reduces employee turnover; reduces overtime; reduces workers’ compensation claims/costs

Additional Benefits: significantly improves employee, resident, and family satisfaction; increases involvement with the outside community including clubs, students, religious organizations, children, etc

INSTITUTIONS TEND TO PRESERVE THE

PROBLEMS FOR WHICH THEY ARE THE SOLUTION

-CLAY SHIRKY

https://www.youtube.com/watch?v=SUifqX11ZDY

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WHAT ARE WE DOING TO MEET OUR GOAL?Culture Change

Training

Ongoing collaboration with other facilities

WHAT TOOLS/RESOURCES DO WE CONTINUE TO NEED?

Turn a designated unit into a locked dementia and/or psychiatric unit?

Do we need a substance abuse rehab unit?

Better collaboration with hospitals re: psych admissions?

Use Culture Change to help reduce behavior problems?

More psychiatric medication management staff?

CNA/GNA Leader program?

More staff accountability?

EMPOWER AND EDUCATE STAFF AND YOU WILL SEE A CHANGE!!!

REFERENCES English, Marianne.  "5 Ways Baby Boomers

Are Changing Long-term Care"  17 May 2011.  HowStuffWorks.com. <http://health.howstuffworks.com/wellness/aging/baby-boomers/5-ways-baby-boomers-are-changing-long-term-care.htm>  16 April 2014.

Eilier,Victoria(2013,September)Welcome to the Perry Point Va Medical Center. Mental Health Summit. Lecture conducted from Donaldson Brown Center at Port Deposit, Maryland.