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Focus: Spring 2010

Behavioral Health Challenges...

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We also learned from our conversations with home care workers that, while some of them have a gift for helping people with mental illnesses and behavioral problems, most

This suggests, of course, that home care workers should learn a great deal more than is included in their basic training about mental and behavioral problems and how to manage

seem to be at a loss. I certainly found this to be true in my own experience. For many years I was responsible for an aunt who had developed a severe mental illness as well as an array of physical ailments in older age. I hired home health workers to

stay with

her, and they








were skill

obvious. They had great at tending to my aunt’s










from time tried, they to do.

to time, much as they just didn’t know what

The lack of adequate behavioral

health intervention in the home contributed to hospitalizations

Mrs. C lived alone in the apartment in which she and her husband had raised their children. She had always been a bit distrustful. The butcher put his thumb on the scale. A teacher had it in for a daughter who wasn’t doing well in school. But after her husband died, she became increasingly suspicious of everyone. She double checked the pills she got from the pharmacist. She refused to hire a new cleaning woman when the one she had had for years retired. Her daughter visited. “You bitch,” she screamed, “You stole my diamond ring.” The daughter was tolerant to a point but eventually insisted that her mother have help in the home, in part so she didn’t have to face her mother’s abuse every day. “You say my daughter sent you,” the mother yelled through the door when the worker arrived. “Does she want you to kill me?” She did not open the door. Eventually she opened the doo , but she continued to yell accusations at the woman who was trying to help her. She fired her and the next worker

and the next.

them. I have come to believe that this is one of two measures that should be taken. The other is to develop cadres of home care workers with special skills related to mental and behavioral problems. I simply don’t think we should expect that every home care worker can develop these skills—in part because some people just do not have the disposition that is needed to be patient, tolerant, and personally forgiving with people who can be extremely trying.

What would this special training include?

S c r e e n i n g It is very important for home

that I am sure could have been avoided, and ultimately to my decision to allow her to be placed in a nursing home. I have talked about my personal experience frequently in speeches to large audiences. I always get nods of agreement. I am very obviously not alone.

care workers to learn to identify signs of mental disorders that should be assessed by a professional. This can be done with very basic mental health education, and there are also several very simple screening tools that are easy to learn and highly accurate in flagging concern about a patient’s mental disorders.


Community Health Care Services Foundation, Inc. 99 Troy Road, Suite 200 East Greenbush, NY 12061

Tel: 518/463-1167 Fax: 518/463-1606 www.chcfoundation.org

Medication Management

Physicians often prescribe medication to treat a mental illness. Psychotropic medications can be very helpful to some older people with mental and behavioral problems, but they can also be dangerous. Dosages for older adults who are frail are quite different from dosages for those who are younger and/ or healthier. Home care workers should know enough to be cautious and precise in administering, or helping their clients to self-administer. these medications.

Focus is published quarterly. Copyright © 2010 Community Health Care Services Foundation, Inc. All rights reserved. No part of this document may be reproduced in any form without written permission.

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community health care services foundation, inc.

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