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Mental Illness In Home Health Care: Are We Really Getting The Job Done Or Are We Leaving The Patient Behind The Eight Ball?

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Considering this is the end of May and it is Mental Health Month, it leads us to look a little deeper into how we handle mental health issues in home health. Some agencies have robust programs with a psych nurse at its helm working through issues with staff and the physicians. Others do not and have not put training into place that equips the nurse to properly assess and handle mental health issues as part of the plan of care. Let’s consider some road blocks agencies have seen with mental health programs in their agencies.

We Don’t Really HAVE A Mental Health “Program”:

You are not alone. Many agencies don’t have one that is organized in a way to be helpful to the client. Let’s Look at steps to developing one:

  1. Hire a qualified psych nurse: This RN not only needs to be qualified to fill the role, he or she needs to be excited to start a program dedicated to better care in the home for those dealing with all kinds of mental health issues.
  2. Train your staff nurses: The reality is that most of us nurses did our psych rotation in school and that was the extent of mental health being a focus of our care plans.  Focus should be disease processes, proper assessment, appropriate interventions specific to disease process, and documentation that is helpful to other clinical staff when seeing the patient. As a side note, too often anxiety and depression are undetected by staff as we are more focused upon diseases of other body systems. Anxiety and depression are so prevalent for our patients, but are often unaddressed. Therefore, it takes longer to meet goals or we never get there with the patients because anxiety or depression gets in the way.
  3. Psych nurse needs to see all mental health referrals: Based upon her evaluation, he/she will determine how often he/she needs to see the patient in conjunction with the primary nurse. The psych nurse also needs to direct the focus of the care plan and help the primary nurse to understand what interventions will help this patient.
  4. Keep the physician in the care plan: Let your docs know what you are trying to accomplish, what you see in the home, and where ongoing issues arise. The physician only sees the patient for a short period of time in the office and is often unaware of the ongoing issues at home.

We Tried A Psych Program, But It Really Never Worked:

In these cases, we often see the psych nurse that is set to lead the program is never given guidance or support to set it up. We also see that this person may not be someone that wants to head up a program. He or she may be a great clinician, but is best left to complete routine visits and manage the patients they see. We have to remember when starting a program, not everyone is well-trained in operations. That psych nurse may not know how to put a psych program into place. The psych nurse may need to work directly with your Director of Nursing or Clinical Manager to develop a process for referrals and care coordination between the psych program director and the staff nurses. Expectations need to be clear for everyone involved in the care of the psych patient and communication with the psych nurse needs to be set on a routine basis.

Initiating any new changes can be difficult within an organization, and if you need help, please call Kenyon Homecare Consulting at 206-721-5091 or contact us online to see how we can help you to meet your clinical and financial goals.

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