Mental Health in the Elderly and the W.V.a Geriatric Psychiatrist Shortage

Herb Myers is one of the only geriatric psychiatrists currently working in West Virginia’s nursing homes. He is also an old friend of health reporter Kara Lofton. Lofton sat down with Meyers a few weeks ago to discuss the state of geriatric psychiatry in West Virginia and what will happen when Meyers retires next year.

LOFTON: You have worked in geriatrics for a number of years in West Virginia. Psychiatry is not something you usually associate with a nursing a nursing home. Why is that important to have geriatric psychiatry in a nursing home?

MYERS: Nursing homes are becoming the institutions where elderly mentally ill end up residing many times so they need good management. There’s a lot of restriction on use of psychotropic in nursing homes…

LOFTON: Can you explain for people not familiar with that term what is a psychotropic?

MYERS: A psychotropic is a medication that is primarily is used for mental illness and behavioral problems. It’s a medication that primarily targets the mind or the brain.

LOFTON: So when I talked to you the other day on the phone you said you were the only geriatric psychiatrist that you knew of working in nursing homes in the state of West Virginia. And you are slotted to retire next year, so what will happen to your patient population when you are no longer in practice?

MYERS: We don’t know at this point. It’s not real hopeful that we’ll be able to find someone to replace me. We are looking at other options. One coming down the road is tele-psychiatry, that’s being developed in West Virginia, but I don’t know that it’s being developed in the psychiatry field at this point. Another group of professionals that are developing are nurse practitioners who specialize in geriatrics and particularly geriatric mental health.

LOFTON: And so when you are working in these nursing homes you said this is where elderly patients with mental illness usually end up. Are you seeing an increase in that population in nursing homes over the last couple of years?

MYERS: Yes it has been increasing. Partly because – and this was true in Pennsylvania as well as West Virginia – the states are trying to get out of the state hospital business. That’s where people with mental illness used to end up if they couldn’t be easily managed in the community. The states are no longer dealing with those people – or trying not to- and closing down those facilities. 4:10. 4:30 And the nursing homes are often hesitant to take them because it increases the percentage of their residents who are on psychotropic or drugs for mental illness. And the higher their percentage, the worse it looks for them.

LOFTON: So that’s really interesting to me that there’s a penalization for having more people on psychotropic medications or folks that are mentally ill. I mean I wonder is it appropriate to put elderly mentally ill in a nursing home with folks that aren’t? I mean should we have a separate facility for them or is it better to kind of have this cross population of folks in what is essentially long-term care facilities?

MYERS: I think most of the time that it’s appropriate. People who are well controlled on their medications generally do well in a nursing home and in the general population. I was talking to a group today about this and emphasized that people with mental illness don’t belong on a dedicated dementia unit with people with dementia, they should be in the general population – unless there’s a safety issue. But by and large they do very well in a nursing home. In fact, I think they do better than they did in the community sometimes because they get their meds regularly, they have programs, they have good nutrition, they have good hygiene in the nursing home so – it’s not a bad place.

LOFTON: You talked a little bit earlier about the shift of states to move away from having severely mentally ill folks in state institutions like hospitals. Is there a benefit to moving them to nursing homes or is that just a shifting of the problem so to speak? I mean do the patients actually have better outcomes in nursing homes rather than a state hospitals.

MYERS: One of the problems you face is that the funding is such that the government – Medicaid generally pays for nursing home care, but they don’t pay for assisted living. Some of these people really could do well in assisted living, which is in a sense a lower level of care where you do more for yourself. Because I see some of these people in the nursing homes who can do a lot for themselves, but they just can’t survive alone in the community.

Well thank you Herb, for talking with me today, I appreciate it.

MYERS: You’re welcome.

Appalachia Health News is a project of West Virginia Public Broadcasting, with support from the Benedum Foundation.