Leo J. Borrell, M.D.
President & Senior Medical Consultant
It is our pledge to provide compassionate service, care, and treatment for the emotional, social and physical well-being of the elderly, their family and caregivers.
Our goal is to allow seniors to retain the highest possible level of comfort and cognitive ability while maintaining their quality of life.
Because 50-90% of patients are undiagnosed with dementia and other brain or psychiatric problems that lead to behavior problems they are under treated or over treated. This often results in difficulties with Medicare surveyors with the consequences of F501, F329, F330 and F429 tags. Senior PsychCare, in cooperation with nursing staff, has developed a progress to conduct initial screening s on all patients. We utilize objective tests to evaluate the neurocognitive status of patients and cover a range of mental processes, such as motor performance, attention, and memory if there is suspicion of a problem. We ten have professionals so neurobehavioral evaluations and if indicated a more comprehensive computer assessment called BCNI (Borrell Cognitive Neuropsychiatric Inventory) is conducted. This assessment allows to:
• Establish and document current status and use in later treatment decisions
• This distinguishes early mild or subtle behavioral problems in patients through comparison to other individuals his/her age
• This leads to decision making on the course of action to take. Counseling, medications, and social treatments to maintain quality of life are provided.
• It helps families understand the problem that effect emotion and behavior. Also it allows making a
prediction of the future functions, emotional, and social needs to improve the quality of life.
Senior PsychCare will make best efforts to use the evaluation to direct treatment in collaboration with the family, facility, staff and primary care physician.
More information about the screening process is available by contacting Tammy Simon, FIR Director at SPC, at 713 850 0049. Based on the fact that we are committed to providing the best and available care, we are providing there services under the professional staff of your long-term health care center. Thus we comply and are compliant with all HIPAA regulations.
Thank you for your time and patience.
The Utility of Mandatory Depression Screening of Dementia Patients in Nursing Homes
Carl I. Cohen, M.D.
Kathryn Hyland, Ph.D.
David Kimhy, M.D.
Depression in Assisted Living is Common and Related to Physical Burden
Lea C. Watson, M.D., M.P.H., Susan Lehmann, M.D.,
Lawrence Mayer, M.D., PhD., Quincy Samus, M.S.,
Alva Baker, M.D., Jason Brandt, Ph.D.,
Cynthia Steele; R.N.,M.P.H., Peter Rabins,
Adam Rosenblatt, M.D., Constantine Lyketsos, M.D., M.H.S.
In the first clinical study implemented by geriatric psychiatry professionals in AL, depression was found to be common, under treated and related to physical burden. AK is a rapidly growing segment of long-term care and represents an important setting in which to find and treat serious depression. (Am J Geriatric Psychiatry 2006; 14:876-883)
Why Screening is Indicated on all Ltc. Residents for Depression and Dementia
Neuropsychological testing in Skilled Nursing Facilities: The Failure to Confirm Diagnoses of Dementia
Irwin J. Mansdorf, Ph.D., Mary Harrington, LCSW, Jacqueline Lund, LCSW, and Nancy Wohl, LCSW
Dementia diagnoses may be inaccurate for 90% nursing home residents. Using objective measurement of cognitive functioning provided by neuropsychological testing could result in greater diagnostic accuracy and help provide for more accurate and appropriate treatment planning (J Am Med. Dir. Assoc. 2008; 9: 271-274).
Why Do We Do Screening
This tool was developed to aid primary care clinicians in caring for their patients who suffer primarily from Dementia and Alzheimer’s. However , many of the tools will also be useful for managing chronic depression and minor depression, secondary to Dementia and Alzheimer’s. The care management process recommended here builds on the earlier guidelines from the Agency for Health Care Policy and research (AHCPR)- now known as the Agency for Healthcare Research and Quality (AHRQ)- which have been updated and adopted from other evidence based sources including recently published multi-site trials and current studies.
Quick Facts About Psychological Counseling
• In psychological counseling, patients with depression work with a qualified health care professional who listens to them, talks and helps them correct overly negative thinking (which reinforces depressed mood) and improve their relationships with others
• Psychological counseling for depression is not talking about your childhood, but rather focused on current concerns and ways to address them.
Treating Depression with Psychological Counseling
Psychological counseling has been shown to be effective as antidepressants in treating many people with depression. Psychological counseling can be done individually (only you and a mental health professional). in a group (a mental health professional, you and others with similar problems) or it can be family or marriage counseling where a mental health professional, you and your spouse or family members participate: -More than half of the people-with mild to moderate depression respond well to psychological counseling. While the length of time that persons are involved in counseling differs, people with depression can typically expect to attend a weekly hour-long counseling session for 6- 20 weeks. If your depression is not noticeably improved after 6-12 weeks of counseling, this usually means that you need to try different treatment for your depression. Psychological counseling by itself is not recommended as the only treatment for persons whose depression is recurrent, more chronic or severe. Medication is needed for those types of depression and it can be taken in combination with psychological counseling.
What Can You Do To Help SPC and Senior Psychological Most Effectively Treat Your Depression With Psychological Counseling?
• Be honest and open and ask questions
• Work cooperatively by completing tasks assigned to you as part of the psychological counseling
• Be available and tell your mental health care professional how well the psychological counseling is working (e.g., whether your depression is getting better or worse).
Information for Clinicians, Administrators, and Primary Care Physicians about Screening
We believe that our integrated Model of Care (psychotropic management and therapy) and protocols developed over the years can provide your families with a distinct advantage in day-to-day operations resulting in a higher quality of care for your residents.
The integrated Model of care stresses regulatory compliance for long-term care facility by addressing medical management (F-329, F-4290), assessment, and administrative tag (F-501). Reduction in medications result in reduced falls and engage residents in more activities of daily living. This results in better participation in psychotherapy modules and behavior modification provided by higher training psychologists and therapists adhering to our protocols to further the quality of life of your clients. When residents respond to mediation and therapy, hospitalization is therefore reduced resulting in higher occupancy for the facility.
As you are aware, the more engaged the residents, the less prone to agitation they become. This reduces stress on your caregivers and turn over. You are bale to attract an retain happier staff and other clinical members of your facility. With stable occupancy and staff it is easier to plan for staffing, and scheduling, Educating physicians , family and the general public are also part of our responsibility.
If we can be of any assistance to you, please do not hesitate to contact any of us. We look forward to working with you.
Leo J. Borrell
Reducing Psychotropic Drug use is Easy
67.7% of assisted living residents have dementia and 26.3% have an active non-cognitive psychiatric disorder. Screening has been found to be helpful in assisted living facilities and nursing homes.
Research shows that in nursing homes with treatment:
• 51% of participants with dementia and depression did improve their quality of life.
• 58% of those with depression alone, receiving counseling and medication recovered six months later and had a better quality of life.
• Only 25% of those receiving medication alone improved, but did not have a significantly better quality of life.
• Patients need to be seen 1-4 times per month in order to monitor-the constant fluctuation of behavioral and psychiatric symptoms and medical problems.
• Post stoke depression usually resolves in 6 months but can last two years.
In conclusion, patients who received psychotherapy (counseling) did 100% better than those that received medication alone. They also had a significant decrease in behavioral problems sooner and a better quality of life for longer.
Without psychotherapy, individuals with depression or dementia or both:
• 20% continued to-exhibit behavioral symptoms.
• 40% exhibited physically and/or verbally aggressive behavior
Because of these residents at nursing homes and assisted living facilities:
• Need to be routinely screened for depression
• All patients with behavioral problems need to be evaluated by a team of psychiatrist and mental health professionals.
• Most patients with many medical illnesses are not depressed.
• Staff needs to realize that many demented people will not spontaneously engage in activities because of depression or Alzheimer’s.
• Residents with dementia are taking several medications for problems such as insomnia or anxiety, the resident’s physician needs to review and possibly reduce the number of medications.
In conclusion, early evaluation and accurate comprehensive diagnosis is necessary. Medications alone are not enough. A comprehensive plan of 6-24 months with counseling is necessary to maximize results, prevent relapse and improve lie quality of life.
Screening is Important on Admissions to Nursing Homes
Psychiatric and Behavioral Symptoms in Dementia
• 80% of Nursing Home residents have psychiatric symptoms that progress unless properly treated.
• The elderly account for 20% of all suicides and have the greatest amount of depression, delirium, and dementia.
• Improving social skills, social involvement, the ability to participate in psychotherapy, coping skills, and avoid adjustment problems.
• Proper Diagnosis Important – Pseudo Dementia, Psychosis, and Cooperation.
• Psychotherapy minimizes the use of psychiatric medications and improves communicational development of the families.
Initiation of Services for Psychotherapy & Psychiatry
For All Primary Care Physicians and Charge Nurses
Please give completed form to the Director of Social Work.
Please refer to the list below as a guideline for determining which patients could benefit from psychiatric and/or psychotherapy treatment. If you have a question about whether or not a patient would benefit, please go ahead and refer that patient and an evaluation will be done to determine the course of treatment, if any.
Appropriate Mental Health Referrals include:
1. Residents who are newly admitted and dealing with adjusting to the loss of their previous residence and the nursing home setting.
2. Residents who are not new, but still struggling with adjusting to the nursing home setting and loss of their prior life.
3. Residents who are not complying with their medical or rehabilitation treatment needs.
4. Residents who are depressed about family or personal issues.
5. Residents who are nervous, anxious, or agitated.
6. Residents who have a history of depression, anxiety, or “nervous breakdown”.
7. Residents who have behavioral difficulties such as aggression, attempts at elopement, and resistance to A.DLS.
8. Residents who express a wish, intent or plan to die.
9. Residents who are dealing with chronic illness or disability (such as an amputation or gait disturbance with forced use of walker or wheelchair, etc).
10. Residents who are experiencing chronic pain and/or somatic symptoms that fail to remit with treatment.
11. Residents who are having difficulty resolving conflicts especially with their roommates.
12. Residents who are facing family conflicts.
13. Residents who are not responding to psychotropic medications.
14. Residents with previous psychiatric problems such as insomnia, depression, anxiety or previous psychiatric medications or hospitalizations.
15. Residents who are referred for Psychotherapy should also be seen by the Psychiatrist for medication review.
Please Evaluate: ? Psychiatric Medication Management ? Psychotherapy ? Other
Facility Name: ______________________________________________________________
Date: __________________ Referred by: ________________________________________
Send to DON or the Social Worker who is the coordinator of Mental Health referrals and if it is an emergency then call (210) 438-1900 or fax form to (800) 605-2138.
Lists of Patients:
Patient Name Room Number
SCREENING FOR PSYCHIATRIC MEDICATIONS AND PSYCHOTHERAPY REFERRALS
This form is to assist staff of non professionals in identifying behavior and psychiatric problems that require evaluation and treatment. Please have the Director of Social Work complete the request for Psychiatry & Psychotherapy Family Evaluation and forward it to SPC by fax at the number listed above.
Staff Member who completed this form:
Primary Care Physician: ______________________________
REASON FOR REFERRAL
MEDICAL PROBLEMS/MEDICATION PROBLEMS
1. Having hallucinations/delusions/disordered thinking
2. Crying and/or persistent feelings of sadness/depression
3. Suicidal ideation (talks about suicide)
4. Persistent verbal/physical aggression toward others
5. Not coping well with terminal illness
6. Sexually inappropriate behaviors
7. Appears anxious/fearful
8. Significant change in eating/sleeping habits
9. Significant decline in physical/cognitive functioning or loss of limb
10. Death of family member or friend
11. Persistently low self esteem
12. Family issues that adversely effect resident’s emotional state
13. Has a new/old mental illness diagnosis Dx: ________________
14. Agitation and/or depression related to unrealistic expectations for rehabilitation
15. Somatization (obsessive health complaints not consistent with current physical status)
16. Withdrawal from activities/isolation
17. Resistant, uncooperative to counsel
18. Behavioral or cognitive side effects of psychoactive medications
19. Diagnosis of alcohol, drugs or pain medication dependence/addiction
20. Having significant difficulty adjusting to nursing home environment
21. Recent or impending loss of limb, speech or hearing
22. New medical problem that may affect behavior
23. Family concerns or problems
24. Evaluate medication
SENIOR PSYCHCARE, INC. IN AFFILIATION WITH SENIOR PSYCHOLOGICAL CARE, INC.
4314 Yoakum Blvd. Houston, Texas 77006 Phone: 713-850-0049 Fax: 713-850-0036 Toll-Free Fax: 800-605-2138
Date Consultant :
FACILITY REFERRAL REQUEST FOR PSYCHIATRIC MEDICATIONS/PSYCHOTHERAPY CONSULTATIONS
(Short Form – for more detail use the Long Form)
Consent Form/ Face Sheet appreciated at time of consult. PCP order and info required before patient can be seen.
*******************TO BE COMPLETED BY REFERRAL MANAGER/ NURSING HOME STAFF***************
(CIRCLE) 48HRS / Routine: 3 to 7 Days Requested by______________________ Primary Care Physician______________
Urgent: Call Dr. Borrell at 713-850-0049; if no response, call cell phone 832-265-2882_______________________________
Nature of Urgency: ___________________________ Resistant to Care ? Family Session Other: _________________
Please Check One:
Medicare Part A
Chief complaint or immediate reason for Referral (Please Check all that Apply):
Chief complaint or immediate reason for Referral (Please Check all that Apply):
Other Diagnoses: _________________________________________________________
A. EMOTIONAL SIGNS & SYMPTOMS (*E1,a,b,c,d,e,f,g,l,m,h,I) A resident’s emotional status interferes or enhances his/her ability to adjust to the institutional environment or to achieve self-actualization. Description:
A3. High Risk Behavior
A4. Reduced Social Interaction
A6. Sleep Problems
Hallucinations Description: _________________________________________________
B. INTERACTIVE SIGNS & SYMPTOMS (*C-1, 2, 3, 4, 5) Communication problems may interfere with an individual’s ability to interact in positive ways, putting them at risk for isolation and sensory deprivation. The following are indicators.
B3. Rarely understands others
B4. Rarely understood by others
B5. Sight Impairment
C. BEHAVIORAL SIGNS AND SYMPTOMS (*E4) Behavior associated with cognitive, emotional or diagnostic symptom logy may interfere with the efficient and safe operation of a facility. Such behaviors include:
C1. Disruptive Behaviors (also consider C3)
C2. Resistance to Care or ADL/Medications
C3. Inappropriate Behaviors (also consider C1)
C4. Aggressive Behaviors (Verbal/Physical)
C5. Wandering (also consider C2b, C2c, F3-Elopement)
C6. Weight Loss
D. COGNITIVE SIGNS & SYMPTOMS: Many factors contribute to changes or decline. If addressed, symptoms may be minimized to improve quality of life.
D1. Confusion (also consider B3 and B4)
D3. Disorganized Speech
D4. MR/Developmental Disorder with Organic Condition
D6. Short/Long-term memory problems
E. SOCIAL SIGNS & SYMPTOMS Difficulties in social relationships may lead to emotional and/or behavioral problems.
E1. Adjustment Difficulty
E2. Conflict/Anger with family and/or friends
E3. Constantly Critical
E4. Loss of Close Family Member or Friend
E5. Sadness/Anger/Emptiness over Loss of Status
E6. Unhappy with Others
F. OTHER CONCERNS
F1. Substance Abuse
F3. Elopement (also consider C5-Wandering)
F4. End Stage
F5. Wants and Needs
????F6. Pain ????F7. Evaluations