Is a Psych consult in assisted living okay?

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Is a Psych consult in assisted living okay?

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I was contacted by a rep with AL on Friday that my LO's doctor had recommended a psych consult with a psychologist they often use She said it was talk therapy and would help her. I asked why this came about and they said due my LO's outbursts This is the first time I have heard about any outbursts. The reported to me that she had an argument with her first roommate several months ago, but she was moved and that has worked out well, except for a disagreement about the room thermostat. I haven't been told about anything further though. Just that my LO reports the problem to the office and staff about the thermostat being turned on heat when it's 90 degrees outside. I talked to the Resident coordinator about that about a week ago and no outburst were mentioned. I think it's understandable to be upset when your room is extremely hot due to the heat being on this time of year. i have personally arrived to the AL and saw the heat on.

Also, my LO hasn't seen her doctor in a few months. She has an upcoming appt. This doctor has diagnosed her with significant dementia and suspects Alzheimers. Wouldn't outbursts be from Alzheimers? Would they need and benefit from a psych consult prior to returning to her doctor?

Is this standard or will it put a negative mark on her file and hurt her chances of being accepted into another facility in the future. Anyone know? I want her to get all the help she needs, but the way this came about seems odd to me.

Assisted Living

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I guess what I'm wondering is how can they make any findings regarding someone's psychological condition unless they know the status of their brain function.

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Talk therapy with dementia? To me, that doesn't add up. I'm curious to hear what others have to say. What is al doing about the heat problem ? Your LO's place of habitation is unliveable. Is there a warrant of habitility clause in your contract? What if the roommate starts spreading feces on lo's bed? I think the roommate is the one who has the problem.

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Habilitability.

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Psychiatric consults [a term capable of a multitude of meanings] are capable of being conducted anywhere. However, I would consider that an arrangement made without your knowledge was a bit dodgy. You should insist on being present.

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This not a psychiatric, rather with a psychologist.

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Then it is probably an assessment of how much deterioration, if any, id present, and establishing a baseline. It sounds like a positive, although I am more than a little surprised that the AL has not kept you in the loop all the way.

Time to readjust their programme. :)

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If it is a functional assessment that should be fine. They may be trying to determine if she needs an increased level of care. But talk therapy would be of little value to someone with dementia. They would need to remember conversations with the therapist. And in my Mom's case that would be impossible.

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Thanks for your input. I spoke with the doctor yesterday. She said the psych evaluation would be fine and it would be helpful in her evaluation of the medical condition. I explained to her that I don't get how a psych evaluation would be helpful if the patient is losing brain function due to a medical condition.

Also, how can the psychologist even know what information the patient gives is accurate, imagined, etc. It makes no sense to me, but if the doctor recommends it, then I don't think it would be prudent to not allow it. The ALF may not want my LO to reside there if I resist and I don't want that. My LO tells me the people there are good to her and she likes them. I may not find that elsewhere.

I will inquire more about the person doing the evaluation, her credentials, etc. and ask to be present. Today, I'm requesting from the ALF for a list of when the outbursts allegedly occurred and the circumstances. The only problem I've heard about is the heat being turned on in her room and I think that's understandable for someone to be upset about that.

Yesterday, when I asked about the heat being on in her room and a Nurse there told me that my LO reports being cold and that's why the heat is on. I don't believe that, because when I got back from the ER yesterday (LO fell and broke her foot) the heat was on and my LO had not been in the room for 5 hours. Her roommate was in the room. AND, even if my LO does report being cold, if it's hot they should not turn the heat on. That's bizarre.

Why is it always something? I'm not sure how much more responsibility I can take. It takes so much time, energy and effort. This is for a cousin, who would not have done the same for me. Oh well, that's the subject of a different thread. lol

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Sunny, about the heat, as we get older our skin thins which is our first defense against getting cold. Thin skin also causes bleeding quite easily. Old folks just get cold. If folks had their way here, the heat would be on all summer. Instead they are wearing heavy sweaters in the house. And, no the air conditioning is not on the majority of the time. I am always wearing shorts and T-shirt and dripping wet.

In the winter, they would like thermostat set to 80 or 85. Shorts season even in the winter at times. LOL!

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I am not sure what you mean by LO (sorry) but I think I can answer your question. My mom has dementia, however, I also am a geriatric care manager with many of my clients in assisted living. Talk therapy in and of itself not a bad thing, but if we are dealing with dementia, seems a strange choice. If it were me here is what i would want: Prompt visit with internal medicine doctor to see if any behaviors are caused from medical problems. ( A genontologist would be ideal); then a consult with a psychiatrist if medical doc thinks it is warranted. I would go with the gerontologist - one stop shopping. It is important that whoever you choose has experience with dementia!!! the behavior described, while annoying, is certainly not combative. I cannot diagnose, but yes, seems pretty typical for dementia, and Assisted Living should know that.
Remember you are the one calling the shots. Meet with the director of nursing at Assisted living and ask for clarification and specific problems; get appointment with medical doctor whose specialty is geriatrics. If there is a behavior problem, causing problems in her current living situation you need a psychiatrist to evaluate and make recommendations. I disagree firmly that a psychologist is the place to begin! Again YOU are in charge and can guid your mom's care, do not be bullied into anything that feels uncomfortable. Get all the facts first. Never assume they will do all the coordination of care. They usually do not jave time. Not a criticism, a fact I will be happy to answer any more questions if I can. I just have to figure out how to navigate my way around. I am not offering you professional advice but that of a daughter once caught in the system with my mom.
Good luck, I'd like to know the outcome

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Great information. Thanks to all. LO is for loved one. The one I am referring to is my second cousin. I am POA and only family member willing to offer an input at all. It's just me.

I will try to find a doctor in geriactics, but I thought that her current doctor does that. She is the doctor who initially saw her and diagnosed with dementia and filled out form for her to be admitted into the assisted living facility and get medicaid.

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My husband was put in Asst. Living Facility about 3 months ago. I signed lots of papers, apparently one was that I would be told/asked about everything. They asked if a psych nurse could evaluate him, make suggestions about his care and perhaps his medicine. I said yes. He cannot speak or indicate anything. She made suggestion about taking him off alz meds since he so far along. But nothing was done without MY yes or no. I found her to be very helpful, in our situation.
He now has Hospice coming in.... first thing they did was take him off the alz meds.

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sunny. My mother was admitted to a geriatric psychiatric hospital and tested by a psychologist to determine her level of cognition, memory, judgement etc. I have no problem with that and was not present. She has also been seen by psychiatrists. Vascular dementia (with paranoia) was diagnosed. She will also be tested by an OT to determine her level of physical function. Talk therapy is another thing, and I wouldn't see much of that being useful, but it may deal with some current issues. For example, my mother has been very resistant to taking any meds, and slowly they have convinced her to take them. How long that will last I don't know. Mother also has Borderline Personality Disorder (lifelong) which they are not trying to treat.

You said that this is a cousin who would not do this for you. Did she have some psych issues before she entered assisted living? I would request an account of the outbursts. I "made friends" with a coordinator at my mothers ALF and had regular though not that frequent contact with her which was invaluable and filled out the picture of mother's problems for me, along with the phone calls I had from mother. I care give at a distance. (((((hugs))))) for the often thankless job you are doing

selfadvocate - welcome - LO means loved one There actually is a thread for acronyms - somewhat humorous but also informative. :)

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I should clarify that mother was in an ALF when her problems increased so that she was eventually admitted to the geriatric psychiatric hospital. ALF staff were involved, as well as a community psychiatrist, part of a visiting group who were pulled in after a hospitalization (regular hospital) following the increasing behavioural/mental problems. Mother changed doctors off and on so her current general practitioner was not involved. It was a geriatrician on the hospital staff who recommended the visits by the psychiatric team. Dementias can be more difficult to handle when there is a long existing mental disorder is already present.

I see we cross posted about the LO.

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LO = Loved One? It was good to confer with her physician before consenting to any further evaluation. Her physician is in the second best position to determine the benefit to her with you as her primary decision-maker. Good advice from SelfAdvocate.

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So much helpful info. Thanks.

UPDATE. When I spoke with the GP yesterday by phone she told me that she would proceed with the brain scans immediately as soon as I was sure if Medicare and/or Medicaid would cover. So, this morning I called a local Neurologist, who specializes in Alzheimers and other brain disorders and spoke with their rep. They said if the GP will refer her to their office, they will check with her insurance and get the prior approvals and have them scheduled ASAP. I asked about a psych evaluation and they said to wait and if it's necessary, they will order it. So, now I'm not sure what to do.

I faxed a detailed letter addressing my concerns to the director this morning. I hope she's had a chance to review it.

I'm going to the ALF soon. I have to transport my cousin to the ortnopaedic doctor as their transport person is out this week. I intend to tell the Director what the Neurologist's office said and if the ALF still wants the eval, prior to the brain scans, I'll probably go along with it, ONLY if there is documentation of these outbursts they are describing.

My cousin is an only child. She is spoiled and has always gotten things her way. I would not be surprised if she has outbursts, but I haven't seen ANY since she got the full blown dementia and I have required her to do some things she did not like, such as wearing a bra, brushing her teeth, etc. She has been completely compliant with me, but I will believe what they report if they have it documented.

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I wanted to give an update as of this evening. It looks like the psych eval will have to be put on hold for awhile. The orthopaedic doctor took more x-rays and says my cousin sustained a fracture to her spine! No wonder she's in such pain. (I have a question about the procedure the doctor is advising.) Meanwhile he prescribed her Percoset every 8 hours. I don't think they can do a evaluation while she's on narcotics.

This is turning out worse than I had expected. Now she needs an MRI for her spine, before the vertebroplasty can be done PLUS, she needs the MRI for her brain. I'm so confused. I'm going to just inform the doctors and let them and the insurance company decide who to handle it.

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Meet with the head nurse at least monthly, go over meds and behaviors and activities. They do track attendance at all the activities and bus trips. One of the warning signs is less participation, which points to physical or mental changes, things slowing down.

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sunny - sorry to hear about the fracture. I might have an outburst or two with that.The MRI for her spine and also for her brain makes sense to me. The brain MRI will rule out, or not, any physical cause for her behaviour like mini-strokes. It is part of the diagnostic procedure and will give them a baseline of her brain appearance. She is going to have surgery which can be very hard on an Alz/dementia patient. I would think that the other evaluation will have to wait until she has recovered some from surgery.

We always seem to get more than we bargained for when we agree to care give. It is interesting, and I think somewhat unusual, at least for those on this website, that your cousin is compliant with you, despite her history of being used to getting her own way. I hope she stays that way. It would make life easier for her and those caring for her. (((((hugs))))

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I appreciate the kind word of support from everyone here. It really helps.

The procedure they are tenatively advising is called vertebroplasty. It's outpatient procedure where they place a needle into the spine and fill the fracture with a cement like substance. It's known to really reduce the pain almost instantly. I hope it works out. They don't use a general either, so that's good.

I am worried that she's on Percoset every 8 hours for now. I'm scared it'll make her fall again. So much to deal with. Plus, the ALF didn't give me a file that I was supposed to take with us to the doctor. Apparently, there are forms they need to fill out. I signed her out from the facility and talked to the nursing staff 3 times before we left, but no one mentioned taking anything with us. I'm frustrated.

My cousin complained of back pain quite a bit, but other than that was okay. Her memory is quite bad of course, but on the way back to the ALF I think she suffered from sundowning. She grew very confused. She kept asking if she lived at the ALF. She asked how she could return there with no clothes. I explained her clothes were there. She asked if she knew anyone there and why I was taking her there. It was as if she had never been there before.

I explained she knew many people there who help her every day and that she has lots of friends. Once we got inside, things became familiar, but she sulked. She then said she wasn't even in pain anymore. It was so odd.

Lesson learned. willI never keep her out of the facility after 3:00 p.m. if at all possible.

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We have not taken mom out of her facility ourselves since the memorable day when she tried to grab the steering wheel out of my husband's hands. We have an amulets transport both ways. The drivers always remember to ask for the paperwork, which I never did, I was always busy reassuring mom we weren't taking her to "the bad place". Glad the procedure is/ was an easy one. My experience is that dementia patients often don't process pain in a straightforward kind of way.

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If her doctor diagnosed her with "significant dementia" I hardly think a consult with a psychologist about behavioral outbursts is needed. She should be seen by a neurologist to properly diagnose the type of dementia he/she thinks it might be, and perhaps an anti-anxiety med (low dose) might be needed PRN (as needed). However, outbursts are part of the symptoms of dementia and the storm blows over soon. The heat being turned on is another serious problem since heat will dehydrate seniors very fast and they (ones with dementia) don't know to ask for water. Get this rectified immediately!

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Update: I contacted the Neurologist office and they said they would set up the brain scan as soon as her GP sent over the referral. The problem is that will have to be put on hold as she fell on Sunday and the orthopaedic doctor diagnosed a small fracture in her spine. So, we scheduled the MRI of her spine for next week. I asked about doing her brain scan and spine at the same time, but they said that would put her in the machine for almost 2 hours straight. She can't handle that. I'm praying she can last 40 minutes. The brain scan will have to come later, since the back issue is serious, according to the doctor.

I'm wondering if we should have her sedated and do both scans at once. ??? I don't know. This is so overwhelming.

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I would certainly ask about sedation for the back scan.

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He prescribed a Xanax, but I'm not sure if that will be enough. I spoke with the MRI scheduler and she said if she cannot tolerate it, then they reschedule it at their main hospital and do IV sedation. I want to avoid that if possible since I think it would disorient her further, but, will do if necessary.

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Sunnygirl, I'm so sorry about the fall and this new complication. She would need to be sedated, I'm sure. Your idea about getting the scans done at the same time is terrific if that can be arranged. This has to be so stressful for you, knowing that she is in pain from the fall and then having an uncooperative AL. Please keep us updated as things happen.
Carol

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Thanks Carol,
When you say sedate, are you talking about with IV and put asleep or do you mean relaxed with a Xanax? The MRI rep said if she cannot tolerate the MRI with Xanax, they will reschedule to do it with the IV.

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I'd check with her doctor first, but likely they'll want to try Xanax first. However, if the doctor says an IV is okay - that could mean that a possible trip back is eliminated.

It's generally safest to go with the least sedation, so likely Xanax would be the first choice for the rep and with an elderly person, Xanax can be quite powerful. Yet, the doctor may have more insight - checking out the possible negatives to an IV with the doctor can help you decide.

Please update us!
carol

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Sunnygirl1 - The real purpose for the MRI is to see how her brain is functioning chemically and her electric connections. Sedating her defeats that purpose. A vertebral fracture will start to heal and "remodel" right after the break, so what is done is done. I have fractured my L1 recently and my spine dr. wasn't that concerned. I would find out about the dementia if she were my patient. Like I said, just having another MRI of the spine will only confirm what has already happened. If she is claustrophobic, get the MRI done in an open machine, with less stress to her. My best wishes for you both!

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I do not see anything wrong with it. Psychology wise, they may be able to find some reasons as to why the outbursts.

The very best of luck to you.

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Is a Psych consult in assisted living okay?

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