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Manual of Nursing Home Practice for Psychiatrists

American Psychiatric Association

  • ISBN 978-0-89042-283-0
  • Item #2283

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The shifting demographic toward a graying population—coupled with today's reality of managed care—makes the need for high-quality, cost-effective psychiatric services within the nursing care setting more urgent than ever. As we increase the number of our years, it is also imperative that we enhance the quality of those years.

The product of the American Psychiatric Association's (APA's) Council on Aging and its Committee on Long-Term Care and of the Elderly, the Manual of Nursing Home Practice for Psychiatrists stands out because it focuses on the how—not the why—of nursing home care. Of exceptional importance is its detailed discussion of the Minimum Data Set (MDS), a structured assessment required by both Medicare and Medicaid for all residents of skilled nursing facilities.

Divided into six sections, this how to volume contains practical information readers can use right away, from getting reimbursed by insurance companies to handling nursing facility politics:

  • Clinical—History; evaluation and management of psychiatric problems in long-term care patients; an overview of the MDS; sexuality within the nursing home care setting
  • Regulatory—Introduction to the Nursing Home Reform Act of 1987 (part of OBRA-87) and its implications for psychiatric care; details about the Resident Assessment Instrument (RAI), which includes the MDS, the Resident Assessment Protocols (RAPs), and Utilization Guides specified in the State Operations Manual (SOP)
  • Financial—Documentation, reimbursement, and coding; what to look for when contracting with nursing homes
  • Legal and ethical—The dehumanizing effect of diagnostic labels and the ethical issues inherent in regulating daily schedules (e.g., bed, meal, and bath times); nursing home placement; competence and decision-making ability; comfort care for end-stage dementia; coping with Alzheimer's disease; and the role of caregivers
  • Summary and Future Perspectives—A detailed vision about how psychiatrists can improve the diagnosis and treatment of nursing home patients
  • Appendixes and bibliography—Staffing recommendations and assessment instruments

Edited by a distinguished authority and former chair of the APA's Committee on Long-Term Care and Treatment of the Elderly, this comprehensive volume will appeal to a wide audience of professionals: from general psychiatrists, nurse practitioners, and clinical nurse specialists, to primary care physicians and residents.


  • Foreword
  • Preface
  • Section I: Clinical Considerations
  • Chapter 1. Nursing homes, mental illness, and the role of the psychiatrist
  • Chapter 2. Evaluation and management of psychiatric problems in long-term care patients
  • Chapter 3. Sexuality in the nursing home
  • Section II: Regulatory Aspects—OBRA, The Minimum Data Set, and Other Regulations That Chapter 4. Affect Nursing Home Practice
  • Chapter 5. The Minimum Data Set (MDS) as a tool for the psychiatrist
  • Chapter 6. Introduction to OBRA–87 and its implications for psychiatric care
  • Section III: Financial Aspects
  • Chapter 7. Documentation, reimbursement, and coding
  • Chapter 8. Contracting with nursing homes
  • Section IV: Legal and Ethical Issues
  • Chapter 9. Legal and ethical issues
  • Section V: Perspectives for the Future
  • Chapter 10. Perspectives for the future
  • Chapter 11. Appendixes
  • Chapter 12. Staffing in long-term care
  • Chapter 13. Sample preadmission note to a nursing home
  • Chapter 14. Sample form for transfer from a nursing home to a hospital or clinic
  • Chapter 15. Minimum Data Set (MDS), Version 2.0
  • Chapter 16. Other scales
  • Suggested reading
  • Index

This small manual is practical and to the point. It should be required reading for every fellow in geriatric psychiatry. Even experienced practitioners might be expected to occasionally carry it to the nursing home to use as a ready reference regarding issues not usually discussed in standard textbooks of geriatric psychiatry. The information in this text embodies the basic tenets for all those who intend to carry on some aspect of practice within the long-term care facility and survive financially. It is truly a 'how-to' book in the best sense of the word.—Journal of Clinical Psychiatry, 8/1/2002

This landmark text is a real contribution to the field of long-term care psychiatry. It combines essential information about what makes nursing home psychiatry fun and different from other kinds of work, special issues in clinical assessment and management, and a clear-eyed, objective look at some of the more controversial issues in long-term care, with background material on national nursing home policy, a usable format for recording information and communicating with other providers, and invaluable material on billing in a single volume. This book is long overdue and will make a very large contribution to improving clinical care for residents of long-term care, and to making nursing home practice a viable option for both general and geriatric psychiatrists.—Soo Borson, M.D., President, American Association for Geriatric Psychiatry, Seattle, Washington

This excellent review of nursing home practice is a must read for those psychiatrists interested in an overview of nursing home practice. It contains clinical, legal, and regulatory chapters that will serve as an excellent base of information. Practical information provided in an easy style makes it especially valuable.—Jeremy A. Lazarus, M.D., Associate Clinical Professor of Psychiatry, University of Colorado Health Sciences Center, Englewood, Colorado

A comprehensive manual for the psychiatrist and other physicians who render their professional expertise to the ever increasing numbers of American nursing home residents. The manual includes state-of-the-art biopsychosocial practice models interwoven with profound understanding of current legislative mandates for health assessments, treatments, documentations, and communications with regional Medicare carriers. There is guidance here for the appropriate use of type, dose, and durations of medications commonly used by psychiatrist with suitable modifications for an elderly patient population with at times multiple comorbidities. The guidance for the use of ever changing complexities of mandated coding systems, by type, site, and time rendered is invaluable as is the alternative of hourly contractual arrangements with a nursing home. This manual will facilitate the work of all our colleagues who make a professional commitment to contribute to improve the quality of late life of patients who can no longer live independently in the community.—Marion Zucker Goldstein, M.D., Associate Professor, Department of Psychiatry, SUNY at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York

This is an outstanding reference for any clinician involved in nursing home care. Many will benefit from this clear, comprehensive overview of clinical and regulatory issues. The wisdom, experience, and clinical skills of the seasoned authors—all leaders in the field—shows through.—John S. McIntyre, M.D., Past President, American Psychiatric Association, Rochester, New York

We know that nursing homes are modern-day mental institutions in which many patients need our help. The Manual of Nursing Home Practice for Psychiatrists has just made caring for them easier. It guides the clinician through the perplexities of medical comorbidity, regulatory oversight, financial disincentives, and environmental limitations. It gives hope to patients and their families that help is on the way.—Barry W. Rovner, M.D., Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania

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