Is ER trip necessary to enter Geri-psych unit?

Brittygirl

Today we were told that my dad’s agitated and verbally abusive behavior at the MC he’s been in for seven weeks is beyond the care the facility can provide and they recommend we admit him to a geriatric-psychiatric unit where staff there can figure out meds that will manage his behaviors. In reading on this forum about geri-psych units, it seems everyone had to first take their LO to the ER and wait there for the LO to be admitted to geri-psych. Can’t we just take Dad directly to the geri-psych unit?

loveskitties

Does the MC where your dad is have a visiting doctor who can facilitate this for you?  

Or can't the MC take action of sending to ER when his behavior is beyond their control?

Not sure, but it would seem to me that geri-psych unit would need some type of referral.

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M1

If they have a relationship with nearby facilities they may be able to arrange a direct admission that bypasses the ER. Id talk to the nursing supervisor, and use that phrase specifically: "is there a way we can arrange a direct admission?" You'll sound knowledgeable and sometimes that helps.

NatA77

It's interesting I stumbled upon your post.  In our situation we can't get anybody to accept my mom as a new patient in MC without a geri-psych evaluation.  And to get this done I'm told  we need to take her to ER.  Right now I am struggling with what day I need to pull the plug and call 911 to have her taken by ambulance or if I can voluntarily get her to go in car I'll drive her myself to ER.  Here are all the people I have talked to.  Primary Geriatric Dr says to call 911 and have ambulance take mom to ER.  Social Worker from Allina gave me a number to call which would put me in touch with "the best geri-psych" in my area and after calling that number I found out it was only an after hours number and it got me connected to the Allina Mental Health line where I was reprimanded for actually calling the direct number to search out availability for beds in this unit.  I explained that the social worker gave me the phone number and was only trying to help.  So here we are.  I too haven't found anybody to elaborate any more on other than drive your loved one yourself to the ER or call an ambulance and have them transport them.  In our case we have guardianship and all other things that are needed.   I was told one good piece of advice.  Make sure you bring all your documentation that you have with you to the hospital cause you are going to need it.  So I have a bag that is with me at all times that contains guardianship papers, in home health care documentations, Neuropsych evaluations (most recent testing), doctors phone numbers and names, MC Facilities we've been rejected from, etc.  Nobody has in anyway told me if there is a procedure to follow or anything.  I hate flying blind on this.  But I'm just going to trust that once we get there they will help me with the process, get a care plan together, get our mom on meds (which she has refused all along when offered) and help us get her into a MC facility that will actually deal with her behaviors.   So to answer your question all info points to taking your LO to ER and letting them take over.  In our case our city only has 3 hospitals that have Geri-psych wards.  And if it works like it does for others if they don't have availability they would transfer or make you go to another hospital that would have room.  Hope this info helps.  I feel for you as we are in same boat.  But am being told it's for the best.

Olly_Bake

Hubby and I were not able to carry dad (my dad) directly to the geri-psych unit. At the time, he was on hospice and we were trying desperately to get him calm enough for sleep at night. Meds hospice tried were not successful. We were instructed to call the ambulance and have him sent to the hospital in our area and what to say to have him medically clear for geri-psych unit.  We did, only to have him sent home.

Hospice had us try a hospital a town over. We had to transport this time. They finally told us we could go because he was being admitted. I called the hospital as we travelled back home only to be told he was not being admitted to the hospital geri-psych unit but one across town and that they had a no visit policy for the two weeks he would be there. Good thing DH was driving as I was too emotional and immediately loaded with the what have I done questions.

Thankfully they only kept him for a few days, I didn't like the results. Dad was a zombie. I then worked with hospice to tapper him down. Why can't the MC unit do this for you? Does the mc have a primary doctor that can try meds?

I've got to run. Hope this helped.

MN Chickadee

I'm guessing psych facilities give preference to people waiting in the ER for a bed so it may take longer to get in on your own, but certainly worth checking with his physicians to see what options there are. In theory it is possible. Check with the facility on logistics to make sure they will hold his room. FWIW I have a friend who went through this. The facility was upfront in how they could not manage his increasing behaviors and recommended a geriatric psych stay. The closest one to here is a few hours away but she went for it anyway. Her LO stayed there a few weeks and came back successfully to his MC facility and spent the rest of his days there. It can definitely be the right move for some.

Marta

Mental health and geriatric psychiatric facilities are so limited across this land that triaging from ERs makes sense.

In my town of 200,000 residents there are two such facilities.  Each one required a trip to their ER prior to admitting my DH.

Likely, the ER is the way to go.  Bring legal documents. 

Brittygirl

NatA77, thank you for your reply. Before I posted, I had read several other posts about geri-psych units, including a thread you had started, and my heart went out to you as it seems we have much in common. My dad has anosognosia as one of his Alzheimer’s symptoms, and his unawareness of having any issues has caused his behavior to be problematic after moving into a memory care facility. After weeks of reports that he was being verbally abusive to staff and other residents, we were called the other day and told that he grabbed another resident’s arm. They said he needed to leave the facility and can’t return until he has been treated at a geri-psych unit. As it turns out, we were able to take him directly to the geri-psych facility ourselves after the memory care facility called ahead to see if a bed was available. 

What I don’t get is why memory care facility staff aren’t trained in strategies and interventions to deal appropriately with residents who have anosognosia. My husband and I were my dad’s live-in caregivers for almost two years and then my brother and his wife were for six months before we moved Dad into memory care. We quickly realized that we needed to approach certain things with my dad with kid gloves, otherwise we’d be met with indignant opposition because, in his eyes, where does his daughter/son get off telling him to take a shower? So we learned ways to “trick” Dad into showering; I don’t know why memory care staff can’t use such tactics. Instead, they list my dad as a “stand-by assist” for showers, meaning they tell Dad to shower and proceed to stand in the bathroom while he does so.