INNOVATIONA IN MODEL PROGRAMS: Empowered for Life Home Treatment for Behavioral Health Conditions

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1 INNOVATIONA IN MODEL PROGRAMS: Empowered for Life Home Treatment for Behavioral Health Conditions Mary Lynn Stewart, RN, BSN, MSN Amedisys Home Health Care Learning Objectives: Identify key components of teaching for behavioral diagnosis Describe the common symptoms seen in each diagnosis Review common medications used to treat each disorder DISCLOSURE OF COMMERCIAL SUPPORT Mary Lynn Stewart, RN, BSN, MSN does not have a significant financial interest or other relationship with manufacturer(s) of commercial product(s) and /or provider(s) of commercial services discussed in this presentation. 1

2 Empowered for Life Mary Lynne Stewart RN, MSN, CNS Adult Psychiatric Mental Health Clinical Specialist / Behavioral Health Case Manager 2012 Course Overview Amedisys - Goals Medicare Requirements Behavioral Health Diagnoses Characteristics Modalities Medicinal and Non-Medicinal The Nurses Role Managing Care 2 Who is Amedisys? A leading provider of home care and hospice services located across the United States and Puerto Rico Publicly traded ( AMED ) since 1994 ACHC Accredited (Accreditation Commission for Health Care) 2

3 Vision, Purpose and Mission Vision Statement: To be the premier home health care company in the communities we serve Our Purpose: To assist patients in maintaining and improving their quality of life Our Mission: To provide cost-efficient, quality health care services to the patients entrusted to our care 4 Trends Trends in mental health care support more community based care Older Americans are our fastest growing segment in the population, with many being diagnosed with behavioral disorders such as anxiety, depression, mood disturbances, and cognitive impairment Shorter inpatient stays resulting in patients in the community with more acute illness 5 Program Goals Decrease emergent hospital care Provide early assessment and early intervention Increase patient and caregiver s knowledge base Evaluate patient outcomes/improve clinical practice Ease transition of care from hospital to home setting Become provider of choice - home psychiatric care 3

4 Program Features: A Team Approach Nurses can give the physician insight into home situations that may affect medical management Home health nurses can reach patients living in rural areas where there are shortages of available psychiatric services Multidisciplinary approach / MSWs / RPTs / OTs / Speech / HHA Support for the caregivers / Education Key Advantages Helps family cope with complex issues Provides a professional observer at home Alerts MD of relapse signs/symptoms Keeps treatment on course 8 Medicare Criteria Medicare requires that a patient have an Axis I diagnosis to receive psychiatric nursing services 9 4

5 Admission Criteria Primary psychiatric diagnosis or emotional disturbance secondary to medical illness The client is under the care of a psychiatrist and/or primary care physician Psychiatric Diagnosis 20-22% of people over the age of 65 will meet criteria for a psychiatric diagnosis... not counting forms of dementia 11 Alzheimer s / Dementias Currently afflicts million worldwide 6th leading cause of death Related Dementias Vascular Senile Degeneration Parkinsons Lewy Body Disease Huntingtons Chorea NPH Picks Disease Reversible Dementias 12 5

6 Prevalence of Psychiatric Disorders 22% of Americans aged 18 and older suffer from an axis1 psychiatric disorder Depression is cited as the number one global health problem Four of the ten leading causes of disability worldwide are psychiatric disorders 24% of all health related disabilities are psychiatric in nature Homebound Criteria Impaired reality Risk of injury/aggressive/assaultive Refuses to leave home/agoraphobia Severe depression/suicidal Impaired attention/concentration Suspicious/fearful of others Anxious/panic disorder Memory loss/unsafe to be alone 14 Importance of Early Diagnosis Rule out reversible causes Know the difference between MCD and Alzheimer s/dementias Dx-depression/comorbid diseases Initiate appropriate therapy Family caregiver education 50% of caregivers become depressed or acquire a major medical illness Life planning 15 6

7 Behavioral Health Diagnoses Depression - Depression secondary to complicated grief Anxiety Disorders - Generalized Anxiety Disorder - Agoraphobia - Obsessive-Compulsive Disorder - Post Traumatic Stress Disorder Bipolar Disorder Chemical Dependency - Behavioral Interventions for Chronic Pain Thought Disorders - Schizophrenia - Schizoaffective Disorder - Brief Psychotic Disorder Alzheimer s and Dementia Frequent Complications Pneumonia - URI Infections - UTI is the most common Falls - fractures, head injuries Psychiatric problems - delusions/hallucinations Diabetes Electrolyte problems/dehydration 17 Characteristics of Depression Ongoing sad, anxious, or empty feelings Feelings of hopelessness Feelings of guilt, worthlessness, or helplessness Feeling irritable or restless Loss of interest in activities or hobbies that were once enjoyed, Feeling tired all the time 18 7

8 Characteristics of Depression cont. Difficulty concentrating, remembering details, or difficulty making decisions Not able to go to sleep or stay asleep Overeating or loss of appetite Ongoing aches and pains, headaches, cramps, or digestive problems that won t go away Thoughts of suicide or making suicide attempts 19 Depression with Comorbid Illness Cancer Heart disease Macular degeneration Parkinson s Disease Multiple sclerosis CVA (stroke) Dementia Chronic Obstructive Pulmonary Disease Rheumatoid arthritis Diabetes Kidney Problems Neuropathy Chronic Pain 20 Depression and Aging Depression is not a normal part of aging. Depression may be due to their physical decline Secondary to accumulative and unresolved grief Secondary to changes that occur late in life Secondary to a move into a living facility Follows being forced to sell home, leave behind possessions and relocate Grief can lead to a serious depression 21 8

9 Medications to Treat Depression Selective Serotonin Reuptake Inhibitors- Celexa, Lexapro, Prozac Other antidepressants- Cymbalta, Effexor. Remeron, Desyrel Watch for neuroleptics used to treat agitation- Haldol, Risperdal 22 Characteristics of Anxiety Disorders Generalized Anxiety Disorder (GAD) Panic Attacks Social Phobias Agoraphobia Other Simple Phobias Traumatic and Post Traumatic Stress Disorder (PTSD) Obsessive-Compulsive Disorder (OCD) 23 Symptoms of Anxiety Racing heart/chest discomfort Trembling Dizziness Scary and uncontrollable thoughts Panic episodes Muscle tension Headaches Numbness in parts of the body Nausea / indigestion 24 9

10 Medications to Treat Anxiety SSRIs Other Antidepressants Benzodiazepines Antihistamines 25 Characteristics of Bipolar Disorder Feeling high Feeling extreme amount of energy Not needing to sleep Loss of appetite Sense that they can accomplish anything Feeling high Feeling extreme amount of energy Not needing to sleep Loss of appetite Sense that they can accomplish anything 26 Medication Management / Bipolar Mood Stabilizers Lithium Anti-psychotics Risperdal Anxiolytic Drugs Xanax, Ativan, Klonopin Antiepileptic Drugs Depakote, Lamictal, Neurontin 27 10

11 Characteristics of Thought Disorders Schizoaffective Disorder Delusional Disorder Brief Psychotic Disorder 28 Medications for Thought Disorders Thorazine (chlorpromazine), Prolixin (fluphenazine), Trilafon (perphenazine), Compazine (prochlorperazine), Mellaril (thioridazine), Stelazine (trifluoperazine), Navane (thiothixene), Haldol (haloperidol), Loxitane (loxapine), Moban (molindone), Risperdal (risperidone), Invega (paliperidone), Clozaril (clozapine), Zyprexa (olanzapine), Seroquel (quetiapine) Abilify (aripiprazole), Geodon (ziprasidone) HIGH RISK DRUGS WHEN USED FOR OLDER PATIENTS Watch for: sudden fever, muscular tightness, rapid heart rate, elevated blood pressure, decreased consciousness 29 Characteristics of the Stages Alzheimer s Stage 1 Cognitive level 5-11 years old Duration 2-4 years Severe forgetfulness Short term memory loss Lack of spontaneity Difficulty finding words Social withdraw and depression 30 11

12 Characteristics of the Stages cont. Alzheimer s Stage 2 Cognitive level 2-4 years of age Duration 2-10 years after the diagnosis Problems organizing thoughts Makes up stories, fills in words Problems recognizing close friends and relatives Restlessness in the late afternoon Loss of impulse control 31 Characteristics of the Stages cont. Alzheimer s Stage 3 Cognitive level newborn to 18 months Duration 1-3 years Complete dependence Loss of ability to communicate Incontinence Loss of ability to walk Increasing need to sleep 32 Benefit of Home Health Interventions Evaluate the family dynamics Provide information to the treating physician Assess the home environment Appropriateness Safety Caregiver ability and knowledge Lifestyle concerns Nutritional concerns 33 12

13 Program Benefits Chance to continue to live independently Ability to re-engage with activities that were meaningful prior to the last exacerbation of the illness Opportunity to improve relational skills Move from disability toward independent functioning Return to meaningful work and employment Ability to avoid further inpatient hospitalizations Improved management of co-morbidities Patients receive treatment in the comfort of their home PSN Role of Managing Care Holistic approach Therapeutic use of self Mindfulness Conscious attention/peripheral awareness Clinical assessment skills Empathy/compassion Radical acceptance 35 PSN Treatment Approaches Mindfulness / Stress Reduction Validation strategies Problem solving Positive diversion Cognitive behavioral therapy Social skills training Relationship strategies Goal setting 36 13

14 Vital Nursing Interventions Protect from self harm Protect others from harm Establish trusting relationship Set limits Identify and build on strengths Use behavioral strategies Teach problem solving/coping skills Monitor physical/medication complications 37 Goals for the Patient Report a decreased depressed mood Scale 1-10 Identify 3 positive coping strategies to improve functioning Verbalize 3 positive affirmations to reverse alter negative thought process Acquire and demonstrate breathing skills to practice mindfulness and reduce anxiety Regain and maintain ideal body weight and sleep pattern 38 Tips for Connection Eyes are the window of the soul Handshake can be a bridge of connection Smile is the fingerprint of one s essence Unspoken messages in communication are the most important Imagination is a great leveler 39 14