Treating dementia requires facilities

Sen. Pendleton says he’ll lobby for expansion of Western State
Part two in a two-part series

By Nick Tabor, New Era Senior Staff Writer

Twenty miles north of Louisville, in Charlestown, Ind., the small St. Catherine Regional Hospital has a 26-bed facility for elderly patients who have mental problems.

The way a nurse describes it, the facility sounds like a far cry from a lush independent living center. But families, nursing homes and hospitals in Kentucky — including Western Kentucky — would be in worse trouble without it.

Often its patients have worked on farms or in auto shops or maintenance departments for years, said Amelia Johns, a St. Catherine nurse.

When dementia short-circuits their mental faculties, their bodies remain strong and even anxious. They can hardly sit still. Sometimes they tear out sinks, and one patient dismantled his entire bed.

“How he even took it apart with his bare hands is beyond me, but he did,” Johns said. “They’re pretty destructive sometimes.”

It helps having three nurses and four aides for the 26 patients, plus bed alarms and hallway cameras so they can never wander far. Most people stay for 10-14 days to stabilize, then the hospital discharges them.

Here’s where the problem comes.

Because of these patients’ histories, often no nursing home in Kentucky will take them. Glasgow State Nursing Facility accepts a large share, but other times St. Catherine has to find an open bed in Ohio or Indiana.

The situation may soon improve in Central and Eastern Kentucky. Eastern State Hospital in Lexington is undergoing a $129 million construction project, and Gwenda Bond, spokeswoman for the Kentucky Cabinet for Health and Family Services, said it will have 27 long-term care beds for elderly psychiatric patients.

But the Pennyroyal has neither a place to stabilize severe dementia patients, such as St. Catherine, nor a long-term facility for those with extreme cases.

Sen. Joey Pendleton, D-Hopkinsville, wants the state to fund an expansion of Western State Hospital. Should he be re-elected in November, his top priority for his final term in office will be convincing Gov. Steve Beshear to put the expense in his 2014 budget.

Meanwhile, the Pennyroyal Mental Health Center is researching the demand and working with private facilities to develop a plan. As the baby boomers age, the need becomes more pressing every day.

‘Fair share’

When its expansion opens next year, the geriatric unit at Eastern State Hospital will have medical, nursing, psychiatric and therapy services, Bond said. It will specialize in psychiatric services patients can’t get elsewhere in the community.

To enter, a patient must have a psychiatric diagnosis, plus specialty medical needs or nursing needs, Bond said.

According to reports from the Lexington Herald-Leader, the construction cost $129 million and brought the square footage to 300,000.

Bluegrass Regional Mental Health, that area’s equivalent of the Pennyroyal Center, manages Eastern State Hospital.

Pendleton believes Western State Hospital, which was built in the 1860s, is long overdue for a similar upgrade.

“I’m going to see that Western Kentucky gets their fair share now,” he said. “I know, right now money’s tight. If you don’t start planning and you don’t start asking, then it will never happen.”

Pendleton took a personal interest in dementia care when doctors diagnosed his mother with Alzheimer’s disease. He plans to meet with Beshear soon to discuss the matter, and he will bring it up with two legislative committees he serves on.

If the Pennyroyal had a long-term facility like the one at Eastern State, the staff there could likely also help patients with urgent needs, like those who go to St. Catherine, Pendleton said.

Dr. Susan Vaught, director of psychology at Western State, said this would mean a major shift in Western State’s purpose. It presently concentrates its resources on acute-care psychiatric services.

In contrast, Eastern State Hospital proclaims an ambitious vision on its website: “To become a nationally recognized Center of Excellence in a state-of-the art facility on an integrated behavioral health campus. We will set the standard for providing recovery oriented, evidenced-based care, leading the field in research, training and demonstrated improved outcomes.”

Gauging demand

The Pennyroyal Center compiled a list of 16 facilities in Kentucky, Tennessee and Indiana that take in extreme dementia patients. The closest are in Clarksville, Nashville, Bowling Green and Murray.

Tim Golden, the Pennyroyal Center’s ombudsman, intends for nursing facilities to use the list when they need to transfer patients.

However, the remedy isn’t as simple as making a phone call and arranging transportation, Golden said. Some facilities limit the kinds of patients they’ll accept — for instance, some can’t take anyone with severe dementia. And some don’t accept Medicaid, or involuntary transfers, and often they don’t have open beds.

To evaluate the local demand for such a facility, Golden sent a survey to 28 nursing facilities in the Pennyroyal, and at least 14 have responded.

If there were an appropriate facility here, they would send a total of 23 to 30 patients there every month, the surveys reveal. And this doesn’t count the 14 who haven’t responded yet.

Golden asked facilities to rate, on a scale of 1-10, the rate of difficulty they had transferring advanced dementia patients to other facilities.

“It’s nine to ten,” Golden said. “All the way through.”

Anita Gilbert, director of social services at Christian Health Center in Hopkinsville, said her facility has only transferred about two patients this year for intensive treatment. They always send patients to Behavioral Center of Clarksville or TriStar Parthenon Pavilion in Nashville, and no one ever waits more than two days, she said.

But even so, it would make the situation much easier for families to have a facility in Christian County, she said. Even Clarksville can be inconvenient for frequent visits.

As of the 2010 U.S. Census, 16.9 percent of Kentucky’s residents were 60 or older. According to the state’s plan on aging, written for fiscal years 2009-12, that number will rise to 23 percent — more than 1 million people — by the year 2020.

By then the state will have about 87,000 Alzheimer’s patients, compared to 80,000 two years ago, according to estimates from the Alzheimer’s Association.

Private alternatives

Sometimes private facilities, such as hospitals, have facilities for dementia patients. Neither of the Pennyroyal’s largest hospitals, Jennie Stuart Medical Center and Trover Regional Medical Center in Madisonville, have such facilities right now.

The New Era asked both hospitals whether they might open wards for elderly psychiatric patients.

Officials at Jennie Stuart did not answer.

Trover is not considering such an expansion, though its officials recognize the need, company spokeswoman Sara Spencer said.

“Unfortunately, RMC and this community do not have the resources to move the needle in improving, and certainly not in expanding, the needed services, nor do the majority of counties in this state,” Spencer wrote in an email.

Trover is looking for ways to collaborate with mental health providers and obtain more grant money, but “state dollars are slim,” Spencer said.