A trend that is growing in the care management of long term acute care (LTAC) patients is the prevalence of severe mental illness (SMI) within the population. SMI patients requiring long term acute care generally end up in an LTAC facility due to an accident, a fall, or some other temporarily disabling physical injury. Having a history of SMI, such as major depressive disorder or bipolar disorder type 1 increases the likelihood of physical injury. People who don’t have SMI are not as likely to encounter physical injuries. People who do have SMI are also, because of the heightened propensity for physical injury, likely to be younger than many LTAC patients. As much as 46.3% of LTAC residents were diagnosed with depression in 2015 and 2016.
It’s important, therefore, to assess and care for these individuals appropriately. As important as it is to have occupational therapists and other adjunct staff to help with the care management of LTAC patients, it is especially important for LTAC patients who have SMI to be referred to psychiatry and psychological services as quickly as possible. Even if SMI patients in an LTAC hospital are stabilized on their medications, doing so helps ensure that staff and other residents in the LTAC develop prosocial relationships with those patients. This in turn leads to fewer interpersonal problems, as well as the development of trust and rapport, which is especially important for SMI patients.
While one goal is often to wean patients off of medications in an LTAC hospital, this approach must not be taken with psychotropic medications that SMI patients are taking to stabilize their mental illness. Developing a regimen of medications and, sometimes, supplements, takes years of fine tuning. Disrupting this regimen, especially at a time when the patient is in a more stressful situation than normal, may have terrible consequences for the patient.
If lifestyle factors, such as smoking or drinking, that contribute to poor health are present, LTAC facilities can provide support for these patients by directing them towards viable alternatives. Smoking cessation may be achieved by the use of nicotine patches, lozenges or gum. Support groups such as Alcoholics Anonymous often meet in hospitals, and your patient may be able to participate in these meetings. Of course, the health and well-being of the patient should always be considered first and foremost; if moving a patient would be uncomfortable, inconvenient, or a hardship for them, these alternatives may not be so viable after all.
Many of the aging population of patients with SMI factors are patients who were deinstitutionalized from hospitals in the 1970s and 1980s with little or no support structure to turn to. As a result, many of these patients have built up their own inner strength to manage their mental illness and the rest of their lives as well. Use a bit of caution when approaching, and make sure you take into consideration the fact that they have often made it this far mostly on their own. Then, see what you can do to help.
