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My LO has already had three episodes where she has had agressive physical encounters with other patients in the Facility. Each one of these has resulted in the facility, understandibly, sending her to ER and hospital stays of 4 to 10 days where the mention of having her see a Geriatric Psychologist has been brought up but never acted upon. Our Medicare and our Advantage plan appears to pay with no deductible if placed in a facility dealing with this condition for a period of time rather than ER. If I just follow the recommendation to make an appointment with a Geri-Sych then it just comes under the Specialist Co-Pay plus the daily charge for the Hospital stay. I am not familiar if such a facility would accept Emergency Patients or it is something that you have to make arrangements while in ER such as Rehab..

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I would contact a social worker ASAP to find the proper route... continuing with the ER is very unhealthy and not solving the problem... there could be something else going on in her that needs to be addressed.... like a medication change or she could have some underlying health problem that nobody is paying attention to... I would not ignore this and continue pursuing it until your loved one is safe
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Reply to DeeDeeIrwin
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The SNF where my mother was for 10 months would send residents who were violent and had no private neurologist or geriatric psychiatrist...to a psychiatric hospital to get medication adjustment. & then when they became calmer, they returned to SNF (nursing home) hugs 🤗
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Reply to CaregiverL
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I have my 89 yr old mother-in-law living with me and her son for over 5 years.
We had been keeping a log of her aggressive behavior and able to share this with her primary physician. Just this past October, we were able to meet via Zoom with a psychiatrist. The recommendation was to add Zoloft 10 mg to her arsenal of other meds and reduce the daily dose of her Seroquel.
She is the most calm, gentle spirited soul now.😊 Zoloft has lifted her spirit. We now have peace in the home.🤣🤣You may want to have this discussion with your LO's physician and have a psyvhistry Zoom call (if possible). This just may be an alternative to visits to the Emergency room.
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Reply to Peegee
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Geri-Psych units usually don't offer emergency services. Many areas don't even have geriatric psych facilities.
It's up to the ER (and sometimes your gentle urging and questioning) to make the referral in an emergency situation.
I assume your LO lives in an AL or a skilled nursing facility?
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Reply to IsntEasy
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To be admitted to an inpatient psych unit she would have to come directly from the ED or the hospital.
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Reply to EmotionallyNumb
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Imho, while at the hospital and your LO is known to have required a psychiatric evaluation, the hospitalist should have addressed that.
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Reply to Llamalover47
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I think a lot of people here are overestimating the ability of the medical system. Just because a patient would benefit from going to a geriatric psychiatric unit or having a consultation with a geri-psychiatrist, does not mean it will happen if they go to the ER and are admitted to the hospital. I have had two patients like this in recent months and they both ended up spending a month in the hospital with no geri-psych consultation and the two geri-psych units in my state were full this entire time, we called daily to check for openings. Hospitals do not just retain geri-psychiatrists for when a consultation like this may come up. There are outpatient psychiatrists and occasionally the inpatient doctor might be able to get one to consult but geriatric psychiatry is also a specialty within psychiatry and there aren't very many of them around. Ultimately, both of my patients discharged to memory care facilities.

If you want your LO to see a geri-psych, you need to do a lot of legwork on your own. Do a search for them at hospitals near you, when you find one, ask what you need to do in order to schedule an appointment. In my experience, the nursing home staff is not much help in arranging in this, you need to do it and harass the family practice doctor for referral until you get one. Also, your loved one does not sound appropriate for a regular longterm care nursing home and likely needs a memory care unit. You can go to Medicare.gov and do a search for these facilities in your area. Then you should call them one by one and find out what they need in order to consider admitting your loved one.
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Reply to EmotionallyNumb
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I think ?? you get her to the emergency room and have her admitted. Then do NOT take her home. Work with the powers in charge to send her to a psych ward. That should handle the situation - but do NOT take her home. You could call these psych wards and ask them what procedure would get her into their care.
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Reply to Rusty2166
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The next time she goes to ER for this, assuming she probably always goes to same place, as ER dr to review the records that show the history. Then tell him that in the past Geriatric Psychologist mentioned but not acted on. See if he can get it handled for you and perhaps keep her out of the ER. Once they get the GPsych dr involved, you'll have a contact and the facility will, too.

You might talk to the social worker at the facility, too. Surely their doctor can do referrals to avoid all the trips to the ER
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Reply to my2cents
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I suggest you talk to a geriatric psychiatrist about this. Your loved one will probably need to become his/her patient. When your loved one acts out, the facility should then call your loved one's psych doctor who will write for the admission to a psychiatric facility. Generally, psych hospitals do not have ER-type admission rooms.
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Reply to Taarna
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There are very, very few geri-psych beds available in most states. Unlikely the hospital will be able to get her into on. Best get a referral to a geri-psych doctor on an outpatient basis and starting looking for a memory care bed
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Reply to EmotionallyNumb
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The hospital should have called in an geriatric psychiatrist. You need someone who can provided medication which psychologist does not. You should be able to get a referral even if the patient is not in the hospital.
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Reply to Ricky6
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Keep in mind when a LTC or NH sends it's resident to an ER because of numerous behavioral problems, they may not accept the resident back into their facility. They don't have to "hold" their bed and will send you a letter saying their facility "can no longer meet the needs of the patient", especially if it's an "unruly" patient. NHs CAN do this and do it legally. Some places don't want to deal with "disruptive" residents.

If your LO goes to the ER and is subsequently admitted to the hospital, INSIST on a geri-psych evaluation and actually SPEAK to the geri-doctor. I found you MUST be an advocate for the elderly or many times they will "slip through the cracks" and the hospital wants to discharge them back to where they came from as soon as possible. As an advocate, sometimes you have to camp out in your LO's hospital room so you can speak to the attending doctors. It's hard, exhausting and maddening. But you do what you have to do. Never leave it up to the hospital "system" because their job is to get them out of their hospital as soon as practicable (treat 'em and street 'em).

If I sound jaded, it's because I spent 15 years caring for elderly parents and dealing with MANY doctors, nurses, NH personnel and hospitals. You MUST advocate for your LO or it won't get done. My "job" was to get the best care for my LOs in their final days. It was hard. It was exhausting. But now that they're gone, I can sleep at night knowing I did my best to care for them.
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Reply to help2day
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This is such a good question. I’m sorry for everything you’re working through. At mom’s previous facility, after other outburst issues she crawled out the window to escape. They sent her to an ER, where she had to wait a couple days for an empty bed at a psych floor. The Dr to the facility made the recommendation/request before mom left the facility, the ER just acted as a weigh station. Someone from a county or state agency had to come to the ER to talk to mom and make the confirming and/or actual decision.
This may help: the facility felt they couldn’t control what was happening themselves.. that may be some key language.
If you haven’t, definitely discuss it with the director of the facility - ask how it all normally unfolds, ‘hypothetically,’ that may get you more answers. I’d also ask your contact from her last stay at the hospital, called a ‘care coordinator’ or similar.
You could additionally call the psych dept. of the hospital/s close to you and ask them. If you get the right nurse they’ll give you some insight. There’s a state agency that governs nursing homes; maybe they have language about it in their code which you can read online.
Another time that mom was in the hospital, I had a lengthy conversation with the care coordinator and she agreed to bring in a geri-psych but it never happened. So it all seems to start with the facility’s initial direction, then ‘that agency’ coming for an eval while at the ER. Sorry I can’t remember its name but had ‘social’ or ‘human’ in it, probably.
As an aside, I’d say mom’s time on the psych floor was pretty helpful - but the Dr never did adjust her meds! So don’t necessarily hang hopes on that part. If you don’t have a name for the geri-psych at her facility, get it - there is one. There may also be a social worker at your facility, mom was leaving hers by the time I found out there had been one all along and she didn’t do diddly-squat for us.
Best wishes to you and your wife.
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Reply to Zdarov
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Many times, it's an insurance issue - where the insurance will cover it if a patient is an admit from the ER, but not from another facility.
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Reply to dragonflower
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Not sure what country you are in but here in Australia - those type of referrals can only be done by doctors or psychologists................
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Reply to Janetr
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My mother's assisted living facilty told us her behavior was a oroblem and they recommended she go to the geri psych ward in a nearby hospital for a 2 week stay where they "adjust the medication." We drove her over to the hospital and she was admitted through the ER. The bills were paid by medicare and supplemental like any other hospital stay. This seems to be common here for assisted living facilities to send the behavior problem people to the geri osych wards, get on different meds, then they can come back to the assisted living facilities. Good luck to you. I know how hard it is to go through all this.
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Reply to Tryinghard1
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Zdarov Feb 21, 2021
I also noticed that the facility has to say something like ‘this is beyond us.’ This may be the key.
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