The new Tucson Medical Center Geropsychiatric Center opened in mid-January on the Handmaker campus, to provide short-term inpatient mental health treatment for older adults. The center specializes in mental health disorders related to aging.
Director Terri Waldman, now about 90 days into the new 16-bed unit, shares her perspective about lessons learned so far.
What have you found to be the most satisfying?
So many people just don’t believe people are going to get better in seven to 10 days. It has been great to see the awe in people’s eyes at the transformations they see. We won’t make patients’ dementia go away, but they won’t be agitated and scared when they leave. A lot of the times when people come here, they’re just broken – physically, emotionally and cognitively. And when they leave, their eyes are bright, they’re sitting up straight, they’re eating and they’re smiling.
How do you help them get to that better space?
It may sound simple, but it’s love. It’s unconditional love. We have a patient now who is crawling on the floor, hallucinating and diving into holes. When that patient leaves here, that won’t be happening.
We won’t make the patient get up off the floor or yell or try to force feed him to eat. We have learned that if we puree food and sit with him on the ground, he’ll eat. He will eventually get off the floor, but right now, that’s where he feels safe and that’s where he wants to be. The process we’re in is to find out what he needs and not judge that.
We have another woman in here who gets very agitated at meal times and throws food at the staff in the facility where she lives. We’ve found out she just doesn’t like to eat with other people. If you take her into another room, she’ll calmly eat.
Here, when things don’t work, we don’t keep doing them.
What’s the underlying philosophy of this type of treatment?
The standard thought in psychiatry is that when you have people with dementia, the behaviors they are exhibiting generally are related to their dementia. I look at it differently. I think patients have the dementia, but then they have the psychiatric problem: psychosis, depression, anxiety…if you treat those psychiatric disorders, it doesn’t make the dementia go away but it does improve their quality of life so they can live in the least restrictive environment in the community.
So when they leave, do they just cycle right back in again?
Clearly, we have advantages that the average family does not have. We have expertise and experience. We have 24 hour help. That’s hard for families to replicate. But what we’re able to do is try to find approaches that can be taken back into the community setting. So for example, we have a woman right now who has night terrors, and in her screaming and fear, she whacks her husband, and he gets frustrated and it just starts this cycle that isn’t conducive to calming the situation. We found there is a way to just rub her arm – it’s a certain kind of touch – and it can help comfort her. We can help figure out these techniques and share them so they are better able to manage their loved one or their patient.
Are you operating at capacity?
We have been really pleased with our ongoing census. It’s been seven years since I was doing this kind of work with this population, and in that seven years, I kept hearing from people about the need for a facility like this. So it has been really rewarding to learn the truth in the community response. Everyone was saying they needed us – and they really did.
What has been the biggest challenge?
One of the things that’s been challenging is the realization of the degree to which insurance dictates our care. It’s not impossible to work with the system, but I have learned these last three months that you need an advocate to get the care you need and unfortunately, there are very few advocates for older adults. I don’t want to blanket all health plans, but in a general sense, their goal is to limit costs and keep people out of inpatient settings. The problem is that if people are in crisis and are discharged back into the community without treatment, they’ll just keep ending up in the emergency departments and it will end up costing more in the long run. It takes advocacy to get people to the right place – especially people who have dementia compounded by psychiatric problems – and families for the most part aren’t equipped to navigate the system by themselves.
How can patients be admitted to the facility?
Patients have to be medically cleared to be here, because some underlying medical conditions can trigger some behavioral health issues. Since patients need to have labs done and other evaluations, it’s best to go to a clinical provider, whether that’s your primary care doctor, urgent care or an emergency room, if need be, to ask for an assessment.