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Vnsny Behavioral Health and Dementia Management VNSNY BEHAVIORAL HEALTH AND DEMENTIA MANAGEMENT Home Healthcare as a Treatment Option For Patients With Mood and Cognitive Disorders Studies show that up to 40% of the Each patient receives a comprehensive homebound elderly population have assessment of mood and cognition, at least one psychiatric disorder, with which forms the basis of an depression and dementia the most individualized treatment plan. A common.1 These patients are often trained interdisciplinary team provides: overlooked or misdiagnosed for behavioral health needs. • Diagnosis-specific psycho-education • Care coordination To help you provide the highest • Medication management quality care for them in the home • Supportive counseling setting, VNSNY has developed a • Caregiver education Behavioral Health and Dementia • Links to community support Management program that incorporates the most recent advances and best practices in clinical care. Developed by leading industry experts and innovators, this person-centered program utilizes proven, evidence- based protocols to: • Enhance patient experience and satisfaction • Improve clinical outcomes • Reduce hospitalization rates and ED utilization. For more information, or to refer a patient, please call VNSNY at 1-866-632-2557. 1Qui et al. Physical and Mental Health of the Homebound Elderly: An Overlooked Population. J Am Geriatr Soc. Dec 2010.58 (12): 2423-2428. Clinical Scenarios for VNSNY Behavioral Health and Dementia Management ALZHEIMER’S AND DEPRESSIVE DISORDERS ANXIETY DISORDERS RELATED DEMENTIAS For patients with these common For patients with these common For patients with these common symptoms and clinical indicators: symptoms and clinical indicators: symptoms and clinical indicators: • Reports feelings of: • Excessive worry, anticipatory • Increasingly erratic behaviors, o Sadness anxiety, agoraphobia including: o Helpless or hopelessness • Panic attacks o Agitation, aggression and o Worthlessness or guilt • Physical symptoms such as: resistance • Fatigue or lack of energy o Perspiration o Wandering or rummaging • Anhedonia (inability to enjoy what o Heart palpitations o Screaming is usually pleasurable) o Xerostomia (dry mouth) o Sexual inappropriateness • Dramatic appetite changes or shift o Muscular tension o Paranoia or suspiciousness in sleep patterns o Dyspnea or hyperventilation • Caregiver in need of counseling/ • Taking psychotropic medication, o Insomnia support in need of monitoring • At risk for repeated hospitalizations • Difficulty with ADLs and IADLs • Recently suffered a loss or change • Recuperating from acute illness or • Unstable gait and/or history of falls in health status challenged by other comorbidities • Dysphagia or speech difficulties • Frequent hospitalizations • Medication adherence challenges VNSNY can provide: • Frequent hospitalizations VNSNY can provide: • Comprehensive assessment of • Comprehensive assessment mood and cognition, using VNSNY can provide: of mood and cognition, using evidence-based screening tools • Comprehensive assessment of mood, evidence-based screening tools • Individualized treatment plan, cognition and functional levels, using • Individualized treatment plan, utilizing clinical pathways based on evidence-based screening tools utilizing clinical pathways based diagnosis and acuity • Individualized treatment plan, on diagnosis and acuity • Diagnosis-specific psycho-education, utilizing clinical pathways based on • Diagnosis-specific psycho-education, using self-management tools such as diagnosis and acuity using self-management tools such stress reduction through relaxation • Caregiver education in: as reframing strategies and self- and mindfulness exercises, and self- o Disease process and symptoms esteem building techniques esteem building techniques o Promoting independence, • Supportive counseling and • Supportive counseling and goal- positive behaviors, and quality goal-setting setting of life • Care coordination and clinical • Care coordination and clinical o Techniques to manage patient’s monitoring of condition monitoring of condition ADLs and IADLs • Medication management, with • Medication management, with o Home safety, strength strategies to improve adherence strategies to improve adherence development and falls prevention • Identification of community linkages • Identification of community linkages o Managing difficult behaviors including support groups including support groups • Medication management, with strategies to improve adherence • Assessment and management of speech and swallowing difficulties • Care coordination and clinical monitoring of condition For more information, or to refer a patient, • Identification of community linkages please call VNSNY at 1-866-632-2557. including support groups BIPOLAR DISORDER SCHIZOPHRENIA For patients with these common For patients with these common symptoms and clinical indicators: symptoms and clinical indicators: • Mania or manic episodes with mood • Hallucinations or behavioral changes, including: • Delusions or illusions o Long periods of feeling “high” • Movement disorders (agitated body o Extreme irritability, rage, agitation, movements) feeling “jumpy” • Thought disorders (unusual or o Talking very fast disorganized thinking) o Easily distracted • Flat affect (trouble showing emotion) o Restlessness, decreased sleep • Difficulties focusing or paying o Impulsive behaviors attention • Depression or depressive episodes • Problems recognizing illness (do not with mood or behavioral changes, believe they are ill) including: o Long periods of feeling worried, VNSNY can provide: worthless or empty, sadness or • Comprehensive assessment of mood despair and cognition, using evidenced- o Loss of interest in activities based screening tools o Decreased energy • Individualized treatment plan, o Problems with concentration, utilizing clinical pathways memory, and decision-making based on diagnosis and acuity o Changes in eating, sleeping, or • Medication management, with other habits strategies to improve adherence • Psycho-education to identify triggers VNSNY can provide: and support use of self-management • Comprehensive assessment of tools to control symptoms mood and cognition, using • Care coordination and clinical evidence-based screening tools monitoring of condition • Individualized treatment plan, • Identification of community linkages utilizing clinical pathways based including support groups on diagnosis and acuity • Medication management, with strategies to improve adherence • Psycho-education to identify triggers and support use of self-management tools to control symptoms • Care coordination and clinical monitoring of condition • Identification of community linkages including support groups VNSNY Behavioral Health and Dementia Management SCREENING TOOLS USED BY VNSNY VNSNY employs widely accepted, evidence-based tools as part of its comprehensive assessment and reassessment. A sampling includes: DEMENTIA BIPOLAR DISORDER DEPRESSION AND ANXIETY (COGNITIVE IMPAIRMENT) AND SCHIZOPHRENIA • GDS (Geriatric Depression Scale): • Mini-Cog™ (Mini-Cognitive • Young Mania Rating Scale a screening instrument that has Assessment Instrument): (YMRS): measures the severity been tested and used extensively a simple, effective screening of behaviors exhibited during the to identify depression in older tool used to uncover cognitive manic phase, from none/mild to populations (65+ yrs) impairment in its earliest stages severe • PHQ (Patient Health • FAST (Functional Assessment • Abnormal Involuntary Questionnaire): a screening and Staging scale): used to evaluate Movement Scale (AIMS): test diagnostic tool to identify mental a patient’s stage of dementia to detect tardive dyskinesia (TD), health disorders (<65 yrs). PHQ-2 is within seven stages involuntary movements which a two-item questionnaire used for • CSI (Caregiver Strain Index): are side effects of medications depression. If positive, the PHQ-9, a 13-question instrument that • SAD PERSONS Scale: assess a nine-item questionnaire, is measures a caregiver’s strain suicide risk administered. related to care provision • HAM-A (Hamilton Anxiety Rating Scale): a 30-point scale used to measure the severity of anxiety symptoms PATIENT ELIGIBILITY CRITERIA • Psychiatric diagnosis with • Psychiatrically or medically symptoms of behavioral homebound disturbances: • Requires psychiatric skilled – Depression, anxiety disorder, nursing care acute exacerbation of bipolar • Under the care of a physician disorder or schizophrenia • Medicare eligible – Alzheimer’s Disease or other Patients are not eligble if they may cause harm dementia, and has an involved to themselves or others, or are actively abusing caregiver drugs/alcohol without participation in substance abuse treatment. For more information, or to refer a patient, please call VNSNY at 1-866-632-2557. © 2016 VNSNY VE-GBH-0416.
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