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Acute Needs

Wing’s Center for Geriatric Psychiatry Fills a Critical Role
Acute Needs

Dr. Ricardo Mujica said Wing’s geriatric psychiatry unit has the advantage of being on a hospital campus, with the full resources of the institution available to meet whatever medical needs might arise.

It’s retirement time for the Baby Boomers.

Specifically, by 2030, more than 75 million Boomers will be age 65 or older, and the population considered elderly in the U.S. will be double what it is today — partly because this demographic is healthier and more active than past generations of senior citizens, and cutting-edge medical breakthroughs are helping them to live longer.

But as that population increases, so do the specific needs of the elderly, including behavioral-health services targeted for that age group.

That’s where Wing Memorial Hospital saw an opportunity. The Palmer-based hospital opened its Center for Geriatric Psychiatry (CGP) last September, offering 15 beds to care for older people with behavioral-health needs too acute to be managed in an outpatient setting.

“We take a comprehensive approach that includes a medical evaluation to determine whether a medical problem may be causing the psychological symptoms,” said Dr. Ricardo Mujica, a geriatric psychiatrist and director of the center. “The idea is to stabilize the acute problem and send them back to their previous environment.”

The center is designed to treat people age 55 and older, but the typical patient is at least 75, Mujica said, and most are female, since women tend to live longer. Their conditions range from mood disturbances and anxiety disorders to cognitive impairment and dementia, and they’re generally referred by long-term care facilities, primary-care physicians, family members, even the emergency room at Wing or another hospital.

“The reason we wanted a unit that focuses on the elderly population is that the demand for this treatment is growing, and as the Baby Boomer population gets older, we expect that to continue to be the case.”

Safe and Sound

To operate the center, Wing has partnered with New England Geriatrics, a Massachusetts-based organization specializing in mental-health services to residents and their families in long-term care facilities.

With its 15 beds, the center increases the number of acute-care beds at Wing from 59 to 74, an increase of 25%. To create space for the unit, Wing moved its medical/surgical unit into the hospital’s new Country Bank Pavilion in 2008.

That move was followed by eight months of work to renovate the vacated space. The $1.5 million, 11,000-square-foot project includes 11 private rooms, two semi-private rooms, an activity room, a dining room, and various other areas designed for treatment and rehabilitation purposes.

On a tour of the facility, Mujica showed off a series of security features designed to keep patients safe. For example, each entrance to the CGP is electronically monitored and access-controlled. All patients wear wrist bracelets that ensure they remain within the safety of the unit and alert staff of any patients’ attempts to wander. In addition, the center is equipped with 10 security cameras monitored by staff, who conduct safety rounds every 15 minutes.

In patient rooms, Wing also follows the safety standards set by the Mass. Departments of Public Health and Mental Health. These include secure ceiling tiles, drawerless shelving for clothes, tamper-resistant bathroom fixtures, electrical cords run with as little slack as possible, and blinds embedded between the windows — all measures to prevent patients from hurting themselves.

The medical team in the Center for Geriatric Psychiatry includes nurses, social workers who specialize in procuring follow-up care, therapists, a psychiatrist board-certified in geriatric psychiatry, and physicians who specialize in the geriatric population. But the center also has the advantage of being located within a full-service, acute-care hospital in case a patient’s medical needs change.

The unit is one of only two geri-psych programs in Western Mass. (the other is at Providence Behavioral Hospital in Holyoke), and is the only one to have on-site access to acute hospital-level medical treatment, Mujica said.

“We have our own medical team working on the floor, but all of the hospital is a medical backup,” Mujica said. “If there’s an acute problem, if we need to increase the level of medical care, we can provide other services.”

Mujica touted the unit’s dual emphasis on physical and psychological care as critical to its success in transitioning patients safely back into the community.

“Many people assume that people with mental illness don’t have other medical issues, but if you don’t look for medical reasons in mental illness, you can do a lot of harm to that individual,” he said.

The CGP also provides psychological education to family members and caregivers regarding each patient’s illness, including medication management.

“Even though, with certain conditions, we don’t have a cure — let’s say for dementia — medication can still improve the quality of a patient’s life and reduce the stress that is secondary to assorted psychiatric symptoms,” he said.

Mujica told BusinessWest that it’s difficult to express why he chose the niche of geriatric psychiatry when he selected a career path, but it was likely a variety of reasons.

“I have a good deal of respect for the elderly, and the challenges of treating frail individuals with multiple medical problems is interesting to me,” he said. “It’s also gratifying to give back to this ‘greatest generation’ that served this country and all of us.”

Still, he worries about the ability of the health care system in general to provide this type of care at a time when the need is growing, especially considering the current atmosphere of uncertainty surrounding Medicare and health reform in general. “I hope the elderly don’t get left out as they shift their focus to something else.”

Picking Up the Pieces

That concern applies to all mental-health services, said Maria Russo-Appel, Wing’s chief of Behavioral Health Services, who called the need for such resources “enormous.”

Wing’s program includes inpatient services through its 13-bed Parker North unit and outpatient mental-health and substance-abuse services through the Griswold Behavioral Health Center. Both are being strained right now, she said.

“There were two significant layoffs by the Department of Mental Health last year, and that left many patients stranded without an advocate,” she said. “The role of the DMH worker is to coordinate care for people who are disenfranchised.”

At the same time, she said, many group homes and other behavioral-health programs have been closing or changing hands (as in the case of Baystate Health’s substance-abuse programs being taken over by Behavioral Health Network). The reduction in program capacity statewide, and a general sense of uncertainty over the status of services, has programs like those at Wing feeling the pinch.

“We receive, at the Griswold Center, up to 75 calls a day for services. That far outstrips our resources,” Russo-Appel said. “We’re doing everything we can to meet the needs of the community.”

And those needs tend to grow when the economy sours, she added.

“We’re seeing more situational depression, situational anxiety syndromes, more addictions, including gambling,” she said. Meanwhile, more people are being hospitalized with behavioral-health issues, including many who can’t access outpatient services and are relying on emergency-room care instead. “The emergency rooms have become deluged with mental-health patients who can’t find resources.”

To meet these growing needs, Wing is adding two or three more psychiatrists within the next few months and is looking at programmatic changes, like new support groups targeted to specific disorders, but before it can make more wholesale changes to grow the behavioral-health program, it needs to make sure the programs it does offer are stabilized, she explained.

That’s partly why the Geriatric Psychiatry Center is so important, Mujica said. It takes pressure off the entire system and helps allows patients to access a continuum of care in the Wing system.

“The challenge with mental-health patients is that different facilities maintain their own histories, and patients tend to have a very fragmented history,” Russo-Appel said. “The advantage of Wing is that we’re able to maintain a continuity of behavioral-health care that many hospitals cannot.”

No matter how old a patient might be.

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