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Maine Med Takes Steps to Improve Treatment for Mentally Ill Elderly  

Reported by Josie Huang on Maine Public Radio's Maine Things Considered
March 18, 2011 

 Listen to report:

As the country's oldest state, Maine is seeing a growing number of elderly patients struggling with dementia and other mental illness. Sometimes care of the most unstable and fragile patients is beyond what relatives or a nursing home can handle. That's where Maine Medical Center's P-6 unit, short for Pavilion 6, comes in. It's the largest psychiatric unit in Maine specialized in treating patients with both mental health and medical issues, most of them elderly.

It's a tough group to treat, but the hospital says a $5 million renovation is going to make the job easier, and help more patients.

"So this is going to be a typical two-bedroom," says Donny Libby, P-6's nursing director, as she enters a room with butter cream walls and ample light from large windows overlooking downtown Portland. "We have everything safety-featured here, we have oxygen and suction in each room covered by metal cases that are locked--they can't be accessed unless they need to be."

There's also a special call button on the bed railing that patients can push. The system is cordless "because we have to be very careful on a psychiatric unit about cords and anything that people can use to harm themselves," Libby says.

Libby demonstrates how the door to the room swings both ways. This is a key feature because sometimes patients will barricade themselves in their rooms.

"They can be older and they can be in a weakened condition, but that doesn't mean that they're always weak," she says. "I don't know if you've ever dealt with an older grandparent or somebody, but they sure know what they want and they can get it done. And I've had patients who are older show extreme strengths at times."

Perhaps one of the biggest changes from the old P-6 is that there will be two beds to a room as opposed to four. This old configuration made it hard to house more than 21 patients at a time, according to Dr. John Campbell, Maine Med's medical director for general psychiatry.

"Nowadays there are drug-resistant organisms that patients have, and they require special precautions that you not have roommates," Campbell says. "And if we overflowed into one of those rooms, we'd have three beds that we couldn't admit to because we had a person in there with MRSA, for example."

Campbell says at any time there are five to 20 people on the waiting list to enter P-6 from all over the state. Examples range from a 75-year-old man "who's been living in a nursing home for a year or so, and has started to become more aggressive with his caregivers--hard to do hygiene on him safely, maybe even injuring caregivers," he says.

Another case, Campbell says, involved "a 50-year-old man who's just become very psychotic after a kidney transplant and he needs to be followed to make sure he's not rejecting his kidney."

Patients like this can be overwhelming for nursing homes. "It's difficult," says Tanya Smith, head of social services at the Victoria Villa nursing home in Canton, which has sent several patients to P-6 over the last couple years.

She says P-6's team of doctors and nurses carefully analyze the patients' drug regimens to make sure they are getting the most suitable prescriptions, which include "many new drugs that other doctors are unaware of because of their specialty. And it seems to work, we've never brought anybody back that with the same behaviors that they had when they left."

Smith is hopeful the renovation will mean spaces on the wait list open up faster. Her nursing home has waited up to four months before to place a patient. She and others say that there need to be more P-6's out there. Among them, Carol Palmer, program director at the Alzheimer's Association in Maine.

"People are living longer, their mental health issues now have an overlay of dementia on top so it presents a much more complicated picture than what a normal psychiatric unit is dealing with," Palmer says.

There are other options than P6 in Maine--other nursing homes and hospitals in Maine that do treat geriatric patients with psychiatric needs. But Palmer, a former head nurse at the state Office of Adult Mental Health says that no other program has a team of doctors, nurses and therapists so specifically trained to treat both psychiatric and medical needs.

Of the 850 or so patients served in Maine hospitals for geriatric psychiatry, 70 percent were treated on P-6. Libby, the P-6 nursing director, says she can't wait for the patients, now being housed on a lower floor of the hospital, to see the renovations.

"Tuesday morning at 9:30 our first patients will be moving up, and if it goes as smoothly as it did on our way down, they'll be each eating lunch in their room at noontime," she says.

But first, there will be an open house of sorts on Monday for state officials, lawmakers and the nursing home employees, who will be making the referrals.





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