KANSAS CITY, Mo. – Dr. Melanie Gentry wants to set the record straight: Melancholy is not a natural part of aging.
A staff psychiatrist at Truman Medical Centers’ Lakewood campus in eastern Jackson County, Gentry is director of the intensive geriatric outpatient mental health program that Lakewood started this summer. Part of her job is correcting misconceptions about the mental health needs of seniors.
“I think a lot of people believe older adults don’t have mental health problems, or that symptoms like depression are normal with aging – that since you are getting old, of course you are going to be depressed,” Gentry said. Another mistaken belief is that seniors are so set in their ways that psychotherapy is of no value.
The loss of friends and spouses, the inability to drive, and living on a fixed income are all potentially stressful for older people, Gentry said. Physical ailments, too, can either cause or exacerbate mental health problems. Medical conditions can also complicate treatment if, for instance, a patient is on oxygen or needs intravenous fluids.
It’s because physical problems can play such a significant role in the mental health of seniors that Lakewood officials consider their new geriatric inpatient unit a critical component of an integrated approach to serving the psychiatric needs of older adults.
Truman spent about $1 million to convert a portion of its long-term care wing into what it calls the Geriatric Psychiatry Acute Care Inpatient Unit. The unit’s July opening coincided with the start of the outpatient program. The plan is to eventually double the unit’s capacity to 14 beds. The unit has logged 75 admissions since opening.
Having a geriatric psychiatric facility in the hospital can expedite treatment for mentally ill seniors who arrive at the emergency room, Gentry said. It also means that patients already admitted to the unit can be treated onsite for any physical problems, and that hospital staff have access to mental health experts when patients have psychiatric problems.
Having such a service mix available to geriatric patients in one location is an “unbelievable miracle,” said Dr. Paul Johnson, an internist who treats patients at Lakewood. “If you would’ve said to me a year ago we are going to have that all right there, I would’ve laughed you out of town.”
It can be difficult to sustain an inpatient program for geriatric psychiatry patients, said Dr. Daniel Swagerty, a professor in the Department of Geriatrics and Palliative Care at The University of Kansas Medical Center. The team approach is costly, he said, and Medicare and Medicaid reimbursements are relatively low.
So the new unit has been a welcome addition to the Kansas City metro area. Mental health officials said Truman’s facility expanded the area’s limited number of geriatric psychiatry beds.
Research Psychiatric Center in Kansas City, Mo., has 26 beds for seniors, according to Ed Plese, the center’s intake director. Research also manages and staffs a 10-bed unit at Cass Regional Medical Center in Harrisonville. In addition, St. John Hospital in Leavenworth has 18 beds as part of its Senior Behavioral Health Center.
Mental health officials said Two Rivers Psychiatric Hospital in Raytown was sometimes a resource for seniors, but it’s unclear whether that unit is still open.
The limited number of inpatient geriatric psychiatry beds means primary care physicians or nursing home attendants are often left to handle seniors’ mental health needs as best they can, said Linda Redford, director of the Central Plains Geriatric Education Center at The University of Kansas Medical Center.
Inpatient psychiatric treatment for seniors is “a real gap in service in this city,” Redford said. “And it’s an ongoing problem for all of us,” as mental health officials field inquiries from long-term care facilities struggling to deal with mentally ill residents.
Even geriatric psychiatrists are in short supply, Reford said. “So, any additional resources that are available are more than welcome at this point.”
Gentry said Lakewood has had a diverse payor mix among its geriatric patients, including some with private insurance. That’s a definite plus, Swagerty said.
“It sounds as if they are taking a really excellent approach to do team-based care and to do a comprehensive assessment,” he said, “and then to not have them fall through the cracks, but to have good coordinated follow up, that’s the best way to take care of our frail older adults.”
At Lakewood, the campus as a whole draws patients from neighboring Missouri communities in Lafayette, Cass and Johnson counties. Officials anticipate a wider service area for the geriatric psychiatric services, given the dearth of other options. Already, Lakewood has had referrals from a nursing home in Liberty.
But Lakewood officials still wants to alert more medical professional that they now have a place that can serve the specialized mental health needs of seniors, said Truman spokeswoman Laurie Rockhill.
“Clearly we want to make sure the provider community is very much aware that the services are here,” Rockhill said. Building relationships with outside clinicians is important to the long-term health of seniors served at Lakewood, she said.
“They are going to go back to that primary care physician or that specialist for many of their medical care needs,” Rockhill said, “so it’s really got to be an extended team.”