Addressing Mental Health and Psychological Issues of Nursing Home Residents

Introduction/Problem Description

Considering the high number of nursing home residents with mental illnesses, the quality of care in these homes is a critical clinical and policy matter. Common mental health problems among elderly people in nursing homes include psychosis, anxiety, depression, and dementia. Besides, elderly people also suffer from other psychological problems such as deterioration in cognitive functioning, behavioral and sleep disorders. These issues are a big problem for nursing homes because they are not well-equipped to cater to residents with mental health problems. Despite years of reforms in nursing homes intended to cater to the needs of nursing home residents with mental disorders, the issue of the quality of mental health care in these homes continues to persist.

The patient identified is a 56-year-old retiree suffering from dementia and is living in a nursing home. The patient suffers from severe memory loss and has a short attention span. The patient also has a problem coping with new situations, and difficulty in organizing his thoughts and words. Dementia is one of the many forms of mental disorders where an individual exhibits a very rigid and unusual pattern of reasoning or thinking and behavior. Patients with dementia usually have difficulty in perceiving things and people. This usually brings about problems to such individuals and hampers greatly their social activities and even work. An individual’s personality is shaped and influenced by their surroundings, experiences, surrounding environment, and inherited traits and characteristics. Dementia affects the brain and affects how they think and behave which usually goes against societal expectations.

Common symptoms in all mental disorders mentioned above include distortion in perception, a change in behavior which can be classified as being abnormal, becoming anti-social in most cases, and personal distress in individuals afflicted. The one common factor in all the types of mental disorders mentioned above is that an individual’s brain is affected to the extent that their reasoning or thinking abilities are in one way or another affected leading to unreasonable behaviors

Evidence from Peer-Reviewed literature

Nursing homes need to have awareness of the appropriate interventions for mental health problems. They must have specialists who know the management of mental issues. In terms of policy, regulations require nursing homes to be aware of the classification system of mental health problems. There are two ways of classification of mental health problems, the International Classification of Diseases also called ICD-10 by the World Health Organization, and the Diagnostic and Statistical Manual of Mental Disorders also called DSM-5 and is published by the American Psychiatric Association (Fung, Xu, & Bodenreider, 2020). Both classifications have synchronized the characteristics of mental health problems, however, some differences exist in each classification. For example, ICD-10 does not recognize narcissistic disorder as a category of mental health problem in nursing home residents. On the other hand, DSM-5 does not also count personality change occurring after a traumatic experience as a psychological problem (Tolentino, & Schmidt, 2018). Even then, the two classifications of mental disorders by the World Health Organization and American Psychiatric Association have put in place common diagnostic parameters that all cases of mental disorders must meet before further and specific inquiries can be done.

Among the criteria used by health facilities and nursing homes to classify mental disorders include; remarkable changes in behavior and attitudes, an abnormal pattern of behavior that runs for long periods and is not limited to short episodes of abnormal behavior, and the fact that such abnormal behavior appears when one is young and continues throughout his adult life. Nursing homes must be aware of the mental status of their residents and which clusters they belong to for appropriate management.

Mental disorders are clustered into three major groups based on the similarities of their descriptions. Cluster A Mental disorders are disorders that have a close association with Schizophrenia. All mental disorders put under this group have common and similar symptoms that include individuals have very strong discomfort with those they have close relationships. Other common symptoms for mental disorders under this group include; distortion of perceptions and exhibiting eccentric behavior. Cluster B personal disorders, also called erratic or emotional disorders are characterized by antisocial behavior which entails a disregard for other people and having a bloated self-image (Liu et al., 2017). Other common symptoms under this cluster include excessive emotions, attention-seeking tendencies, and having no empathy whatsoever to others. Cluster C which is also a fearful and anxious disorder is characterized by such symptoms as being dependent on other people, becoming excessively controlling, and seclusion of oneself from leisure activities and people.

There are many types of mental disorders among nursing home residents. Some of the mental health problems include paranoid mental disorder, Schizoid mental disorders, avoidant mental disorder, and dependent mental disorder among many others. Paranoid mental disorder is characterized by having strong suspicion and distrust of other people, having the belief that other people are out to harm them, having strong suspicion about other people’s loyalty towards oneself, reacting angrily to perceived insults, and distorted perceptions.  Schizoid mental disorder has the following symptoms; always preferring to be alone, lack of interest in social activities, having limited or no emotional expressions, being indifferent to other people. Dependent mental disorder on the other hand is characterized by being excessively reliant on other people, being too submissive to other people, lack of self-confidence with a high degree of low self-esteem, and fear of being left alone. With avoidant mental disorder, an individual may experience certain symptoms such as; being extremely harsh on criticism, feeling insecure, having an inferiority complex, fear of rejection, and fear of embarrassment.

Practice Standards for Nursing Homes in dealing with Mental and Psychological issues

In the United States, over 600,000 people with mental disorders reside in nursing homes on any given day. This figure significantly exceeds the number of all other patients/persons admitted in all other health care facilities combined. Based on this analogy, mental illness sometimes become the decisive factor for admission into nursing homes. However, the issue of the appropriateness of nursing homes as a residing place for people with mental disorders is a controversial matter. After the dramatic closure of state psychiatric facilities in the 80s and the 90s, nursing homes gradually became the de facto facilities for caring for persons suffering from mental disorders.

The standards of care for nursing homes aim to improve the quality of care given to the residents of these homes. The Federal Nursing Home Reform Act of 1987-also known as OBRA sets the minimum standards of care and the rights of people living in nursing homes (Popp, 2018). The minimum health requirements for a nursing home are achieved through a variety of protocols established both by regulatory authorities and the nursing home itself. Based on this analogy, all nursing homes must use OBRA as the foundation stone of creating an environment that provides care, safety, fulfillment, and joy to residents of nursing homes.

One of the critical practice standards for nursing homes is the pre-screening process. The Federal government introduced the Pre-Admission Screening and Resident Review Program-PASRR that requires all states in America to pre-screen all persons seeking admission into nursing homes (Carpenter, 2018). The objective of the PASRR program is to identify persons with mental disorders and other people with intellectual disabilities. Most nursing homes are ill-equipped to deal with patients with mental disorders, especially severe disorders such as bipolar or schizophrenia. The facilities that admit people with severe mental disorders without having the requisite staff, equipment, and appropriate facilities put themselves and their patients in danger.

Some state laws and policies make it difficult for nursing homes to effectively manage and care for patients with mental problems/disorders. For example, patients with bipolar or schizophrenic conditions may get into altercations with other patients in the nursing home. However, creating separate quarters or units for such patients to secure them may be viewed as an unnecessary restriction which in some states is an infringement on the rights of nursing home residents.

Leadership Strategies to Improve Patient Outcomes in Nursing Homes

Leadership is integral for any organization to function optimally. Leadership comes in several styles; toxic leadership is one of them. Many leaders spend most of their time trying to pump in positivity in the workplace while reducing negative aspects to the bare minimum to create better systems of management. To do this, leaders must exhibit characteristics such as inspiration, motivation, and the ability to influence people into achieving goals set by the organization.

Collaborative leadership is essential in the healthcare sector for effective decision-making. Collaboration is essential because it promotes teamwork. Where people work together harmoniously, they find solutions for complex problems (Crowne et al., 2017). Collaboration also creates an inclusive environment where employees release their creativity and creates a productive work culture. Communication is another critical component of effective leadership. Good communication is essential for relaying information. It curbs chances of frequent misunderstandings as well as errors.

The increased complexity of the operations of modern-day organizations and globalization leads to the greater need for cooperation within members of the staff and with it come increased possibilities for conflicts. As a result, the functions of organizations are more involved, and the requirement by organizations to create a healthy working environment for their employees has created a greater need for employees from different sectors of the organization to come together to accomplish the mission of their organization. This interaction and cooperation between people with different backgrounds, ideas, opinions, beliefs, and education standards are bound to create some discord or conflict in the organization.

Dealing with mental disorders in nursing homes requires skills, tact, and effective leadership. Leaders of such facilities must create effective strategies to manage and cope with mental disorders within their facilities. Behavior management/therapy is one of the best strategies to improve patient outcomes in nursing homes. The theory of behavior therapy operates on the premise that all positive behaviors are learned whereas negative behaviors can be unlearned/changed. Thus, the focus of treating patients with mental disorders is to change current problems and the change will be achieved. The objective here is to identify unhealthy and destructive behaviors and change them. Cognitive-behavioral therapy is one of the most popular forms of therapy for mental disorders. This therapy combines both cognitive and behavioral therapy intending to influence a person’s actions and moods by influencing their beliefs and thoughts. The long-term objective of cognitive behavioral therapy is to change a person’s thoughts and behavior.

References

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  • Fung, K. W., Xu, J., & Bodenreider, O. (2020). The new International Classification of Diseases 11th edition: a comparative analysis with ICD-10 and ICD-10-CM. Journal of the American Medical Informatics Association, 27(5), 738-746. https://doi.org/10.1093/jamia/ocaa030
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  • Popp, L. (2018). The Nursing Home Reform Act of 1987: A Policy Analysis. California State University, Long Beach.
  • Tolentino, J. C., & Schmidt, S. L. (2018). DSM-5 criteria and depression severity: implications for clinical practice. Frontiers in Psychiatry, 9, 450. https://doi.org/10.3389/fpsyt.2018.00450