Psychiatry in the Nursing Home

D. Peter Birkett

Contents



Introduction
Part I. The Places
Chapter 1. The History of Nursing Homes
Omnibus Reconciliation Act of 1987
Chapter 2. Paper, Paper, Paper
Care Plans
Acronyms
Chapter 3. The New Asylums?
The Homeless and the Jailed
Deinstitutionalization and Transinstitutionalization
Chapter 4. What Is a Nursing Home?
Skilled Nursing Facilities and Intermediate Care Facilities
Board and Care Facilities
Section 8 Housing
Home Care Agencies
Assisted Living
Mixed Level Retirement Communities
Chapter 5. Who Pays for What?
Medicaid and Medicare
The “Spend-Down”
Long-Term Care Insurance
Resource Utilization Groups
Balanced Budget Amendment and Prospective Payment System
Health Maintenance Organizations
The Balloon
Chapter 6. Anger at the Nursing Home
Complaints
Nursing Home Exposés
Litigation Against Nursing Homes
Measuring Quality of Care
Part II. The People
Chapter 7. The Families
The Absent Family
Disputes Between Family Members
The Difficult Family
Chapter 8. The Staff
Owners and Administrators
Nurse Assistants
The Nurses
The Doctors
Other Mental Health Professionals
Chapter 9. The Patients
Age
Sex
Socioeconomic Status
Psychiatric and Medical Conditions
Measuring Need for Care
The Informal Network of Care
The Road to the Nursing Home
Part III. The Problems
Chapter 10. Psychotropic Drugs
Surveys
Backlash
The Impact of OBRA'87
Antipsychotics
Drugs for Mania
Anti-Anxiety and Hypnotic Drugs
Recommendations
Chapter 11. Memory Loss and Confusion
The Terminology of Dementia
How Many of the Elderly are Demented?
Measuring Memory Loss and Confusion
Treatment of Dementia
Head Injury
Mental Retardation
Chapter 12. Delusions and Hallucinations
Delusions in Depression and Mania
Schizophrenia in the Nursing Home
Late Paraphrenia
Phantom Boarders
Release Hallucinations
Management of Delusions and Hallucinations
Chapter 13. Sadness and Depression
Depression in Old Age
Depression in the Nursing Home
Depression and Dementia
Incidence of Depression in Nursing Homes
Rating Scales
Treatment of Depression in the Nursing Home
Antidepressant Medications
The “New” Antidepressants
Suicide
Chapter 14. Anxiety and Sleeplessness
Hysteria and Hypochondriasis
Panic Attacks and Agoraphobia
Agitation versus Anxiety
Psychotherapy
Sleep Disorders
Anti-Anxiety Medications and Sleeping Pills
Chapter 15. Wandering, Falls, Restraints, and Loss of Mobility
Wandering
Falls
Physical Restraints
Loss of Mobility
Chapter 16. Violence
Risk Factors
Classification
Management
Medications
Chapter 17. Nonviolent Antisocial Behaviors
Agitation
Demanding and Difficult Patients
Noisemaking
Drooling and Smearing
Hoarding and Rituals
Incontinence of Urine and Feces
Sex
Chapter 18. The Medical Interface
Medicalization of Care
Pain
Bedsores
AIDS
Nutrition
Chapter 19. Neurological Disorders
Communication Impairment
Stroke
Head Injury
Seizures
Parkinson's Disease and Parkinsonism
Chapter 20. Death and Dying
Patient Self-Determination Act
Dementia and DNR
Hospice Care
Hospitalization of Nursing Home Patients
Part IV. The Future
Chapter 21. What Is Wrong?
Research
The View from Abroad
Chapter 22. A Modest Proposal
Is Home Care the Answer?
Calling a Spade a Spade
Medicaid Should Be for the Poor
The Cheapest Gift is Money
Envoi
References
Index
Reference Notes Included