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Seasons to offer outpatient health
services
by Mary
Helen Yarborough
Public
Relations
Depression, anxiety and bi-polar disease lurk in the lives of many
people in the autumn of their years, who are generally isolated and
alone, and usually left unattended and untreated. Their mental disease
becomes a part of the agony accompanying physical illness, lost skills
and a loss of independence.
MUSC’s Institute of Psychiatry (IOP) is doing something unique to help
older people through an upcoming program called Seasons. Seasons, a
partial hospitalization program that offers intensive outpatient
services, will be located on the second floor of McClennan-Banks.
Slated to open this month, it will be able to treat up to 50 people a
day during weekdays, depending on patient needs. Staff will include a
registered nurse, several social workers, attending physician Jessica
Broadway, M.D., and other staff.
Seasons is not the first program used to treat the mentally ill in an
outpatient setting, said Fred Thompson, community liaison and Seasons
program coordinator. IOP used to have a similar program, but it treated
only people with severe psychoses, such as schizophrenia.
“Seasons will initially focus on geriatric patients with mental
disease, but will eventually expand to offer services to baby boomers
with moderate to severe cases of depression, bi-polar disease, anxiety
and mood disorders,” Thompson said.
The program, announ-ced June 28 during the Day of Discovery that
focused on issues that the baby boomer generation faces, is part of a
new vision for senior psychiatry, said Joan Herbert, R.N., who helped
develop Seasons.
“Seasons is a new service line to lead with unique issues that
require new psychiatric services,” Herbert said. As opposed to
inpatient services, “Our focus is to have services taken to patients to
divert the need for inpatient hospitalization.”
Meanwhile, Herbert said that IOP is working with five nursing homes in
the Charleston area on how to detect and treat psychiatric disorders in
the elderly. In addition, patients can be referred to Seasons for the
five-hour-a-day treatment that includes group sessions. Referrals can
come from physicians, family, mental health clinics and practitioners,
as well as nursing homes.
However, Medicare will not pay for a person in skilled care who has
been diagnosed with dementia with behavioral disturbances, or
Alzheimer’s disease, Thompson said. “Plus, a person with advanced
Alzheimer’s would not benefit from group therapy sessions, he said.
“This program is for older adults and baby boomers who are falling
through the cracks.”
Medicare will pay for Season’s partial hospitalization and the
intensive outpatient services for up to eight weeks. People who meet
inpatient criteria —suicidal or homicidal—would be referred to IOP and
would not qualify for Seasons, Thompson said.
The need for the program emerged after about 20 percent of patients who
had been hospitalized at IOP were being re-hospitalized within 30 days
of release, Thompson said. “They were being released with nothing to
serve as a safety net by their next follow-up appointment,” he said.
“So Seasons would be a place they could be referred where they could
maintain their treatment and medication.”
Herbert said that Seasons could be expanded to other areas of the
state, including Columbia. Thompson said that a similar part-time
program is being run in Florence, but it is unaffiliated with MUSC.
For more information, contact Thompson at 792-6376, 906-8410, or
thompsfe@musc.edu.
Take
time to visit, listen to elderly
A dynamic of growing older is how people reflect on their lives and
develop some sort of meaning for all of it, said Michael Hartley,
advanced practice registered nurse, who is involved with Seasons and
other geriatric services for IOP.
Helping people reflect, talk and connect with someone is very important
to an older person who is coping with the harsh realities of aging and
increasing frailties.
Allison Meeks, R.N., said that hearing people talk about their lives
also helps her. “I learn an awful lot from them,” she said during the
Day of Discovery symposium. She said she also listens to signs that
these people may have been abused during their lives, or may have
experienced trauma. Knowing about these issues, no matter how long ago
they may have occurred, can be important in the treatment and care of
the elderly, she said. “As people grow older, there is co-morbidity
with a mind-body connection.”
For example, an elderly person is hospitalized and reacts strongly to
touch, bathing or being restrained. This might point to early abuse,
she said. “And with UTI [urinary tract infection], you see pinching and
biting,” Meeks said.
But an overriding issue for the elderly is depression. And loss is a
trigger for depression, Hartley said.
“Loss comes in many forms,” Hartley said. “It could be loss of a job,
loss of independence, loss of a spouse or friend. …or loss of their
status in society …For the depressed, isolation eventually compounds
the problem when friends and family begin to pull away, Hartley said.
In any event, what clinicians see in their offices presents only 10
percent of the picture.
Meeks said that’s why it’s important to spend time with the elderly and
listen to them. She said that a therapy called Life Review is short
term with long-term benefits. MUSC’s Barbara Height, Ph.D., R.N., is
president of the International Institute for Reminiscence and Life
Review.
“What we’re doing is not reminiscent,” said Meeks, explaining that Life
Review is a way to help individuals assess their lives and experiences
to gain a greater understanding of their illnesses.
“People think all you want to hear is all of the bad stuff. We want to
hear what got you here,” Meeks said. “You’ll hear about prejudice and a
lot of regrets. You’ll learn whether they had a substance abuse
problem. …And you will hear whether they were successful.”
And often, the elderly are assumed to have a mental disease when
something else could explain bizarre behavior.
“There was this woman who lived in a high rise and was very isolated,”
Meeks said. “She had severe anxiety. Her children thought she was
suffering from mental illness. But when I went to see her, and I
offered her food, which was the only way she’d let me in; I learned
that this woman’s children had moved her to the 10th floor of this high
rise apartment and she had never used an elevator before. She was from
the country. This was a very unfamiliar space for her.”
After determining the woman’s anxiety came from the sudden shift of
living conditions, Meeks said that she was taught how to adjust to her
new setting and rebounded to mental health.
Practitioners also are forging into the growing realm of “healing
touch” therapy that has shown promising results in treating anxiety and
depression, as well as physical illness. Though healing touch actually
is not touch at all, it involves using one’s hands like wands to wave
over the body to create an electronic field. The method has been deemed
a legitimate form of touch therapy, as much as massage and hands-on
therapy has been proven effective in a variety of therapeutic uses.
Still, the general prejudices toward mental health shove people deeper
into the closet for fear of being called weak. Insurance coverage,
which is paltry at best, also has become a deterrent for many
practitioners to treat mental disease.
During the symposium, a physician who does house calls said that though
he is not a psychiatrist, he often treats his patients for mental
disease because he knows that they would not be able to afford
psychiatric treatment—if they could get an appointment. “If they can
get an appointment, it could take at least three weeks,” he said.
“That’s too long for many of these people.
Turning
over a new leaf with Seasons
Seasons Intensive Outpatient Services and Seasons Adult Behavioral
Health Intensive Outpatient Services provide the most thorough,
advanced care available for a full range of psychiatric illnesses such
as depression, bipolar disorder and anxiety.
Providing an alternative to hospitalization for adults and older
adults, Seasons offers treatment, education and coping skills that
teach each patient healthy ways of managing their symptoms and
improving their level of functioning.
The treatment team, led by Jessica Broadway, M.D., utilizes group,
family and individual psychotherapy. Care is coordinated with the
existing provider. Clients also benefit from easy access to
comprehensive care provided by MUSC medical center.
The program includes:
- Individual assessment by the admitting physician to
determine the level of care
- Group, family and individual psychotherapy focused on
recovery and life enrichment skills
- Progress assessment and case monitoring
- Referral for other services and access to comprehensive
care provided by MUSC (Heart & Vascular, and Digestive Disease
Center, Hollings Cancer Center, etc.)
- Individualized discharge plan that includes follow-up
aftercare
- Transportation is available within a limited services
area
- Medicare, Medicaid and most major insurance plans accepted
Referral guidelines
Patients may have failed a less-restrictive alternative service, such
as outpatient therapy or in-home care, or be stepping down from
inpatient psychiatric treatment. Patients must have the capacity to
participate in a cognitive based program and must be able to cooperate
with a structured program, must be able to attend regularly, and must
not be actively suicidal or homicidal.
For information or to schedule an assessment, call 792-9888 or 906-8410.
Friday, July 13, 2007
Catalyst Online is published weekly,
updated
as needed and improved from time to time by the MUSC Office of Public
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