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..
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.
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?
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.
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
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.
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.