Nursing Homes Seeking Psychiatric Consultants

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SALT LAKE CITY -- Geriatric psychiatrist consultants can relieve some of the burden on nursing homes and help provide optimal care, the medical director of a large system of senior-living facilities said.

Good geriatric psychiatrists are hard to find, but it's important to convince administrators that timely psychiatric consultations and appropriate recommendations may reduce litigation risks and help nursing homes with risk management, Dr. Jeffrey B. Burl, medical director of Overlook Masonic Health System in Charlton, Mass., said at the annual symposium of the American Medical Directors Association.

Today, up to 70% of residents in nursing homes have dementia or a dementia-related diagnosis. "We're all seeing these types of patients admitted to our facilities [from] assisted living programs," Dr. Burl said. "They nurture these people until it finally reaches the point where the behavior is so untenable that they are admitted to a nursing home."

He noted that mental health issues are some of the most difficult problems in the nursing home setting. Lack of good research, potential adverse effects of medications such as atypical antipsychotics, and difficult-to-quantify end points for progress with patients "make care of these issues problematic," he said. "Provider and staffing issues may complicate the picture."

Dr. Burl said he is aware of a few skilled nursing facilities that offer a stipend to consultant psychiatrists and assign them the title of associate director of dementia units. Duties include educating staff about behavioral problems, reviewing policies, and developing behavior plans for residents.

"It took a little bit of effort to convince these nursing homes to pay for the stipend, but once they saw the number of antipsychotic medications going down and the number of psychoactive medications going down [after psychiatrists' interventions], that got their attention," said Dr. Burl, whose system offers a continuum of services that includes independent housing, assisted living, a skilled nursing facility, subacute care, a visiting nurse association, and hospice care. …