Lynne A. Valenti
Cabinet Secretary

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REFERRALS FROM NURSING HOMES

The services of the Human Services Center (HSC) are available for adult persons of all ages that need mental health treatment.  Residents of nursing homes are a unique patient population that requires special mention.  A number of conditions can interfere with their ability to effectively communicate and advocate for themselves.  It is imperative that cognitive and communication difficulties are recognized and appropriately addressed in the community setting.  Nursing home patients can also have lifelong mental health issues that can become more apparent and decompensate while in residential care; these disorders are often amenable to psychiatric treatment.

It is common for persons with dementia to develop “challenging behaviors,” also known as neuropsychiatric symptoms.  These may include repetitive calling out, aggressive behavior (particularly during bathing or toileting), and delusions (believing that someone is stealing from them or trying to hurt them.)  These symptoms may represent an attempt at communicating an unmet need (i.e. pain, infection, boredom, loneliness, or fear.)  When a patient is becoming more challenging to care for, their personal physician may complete a thorough evaluation for underlying medical problems or medication toxicities that may be contributing.  If possible, the patient’s family, caregivers, and nursing staff should visit to discuss the challenging behaviors and develop different treatment approaches to meet the patient’s need.  The first line treatment for persons with neuropsychiatric symptoms due to dementia, include behavioral interventions, which should be attempted prior to moving a patient from their home environment.

There are a number of options available if a community nursing home is having difficulty meeting the needs of a resident.  One option is to contact Adult Services and Aging for assistance in finding a different facility or providing extra resources to help meet the person’s needs.  An additional option is to contact the Clinical Review Team at HSC, a team of professionals that can collaborate with the nursing home to help them find the best approach for the resident.

See Clinical Review Summary Form

Short term psychiatric hospitalization is not optimal for patients with dementia, as it removes a patient from familiar settings and can aggravate confusion and fear.  Occasionally, when other options have failed, this may unfortunately become necessary.  In this case, the following checklist should be utilized:

  1. A petition for emergency psychiatric hospitalization can be completed and submitted by the person who is requesting transfer to HSC.

  2. This petition should be forwarded to the Chair of the County Board of Mental Illness. Please call your local County States Attorney’s Office for a listing of Board Chairs. If the Chair feels it is appropriate, a mental health hold will be initiated.

  3. Contact the resident’s physician, nurse practitioner, or physician assistant and ask for an evaluation within 24 hours.  Acute medical problems, delirium, medication toxicities, exacerbation of chronic medical issues, and pain management should all be evaluated.  Environmental factors that are influencing the patient’s behavior should also be evaluated.  The medical provider is a “Qualified Mental Health Professional” (QMHP) under South Dakota statute 27A-1-3, and should complete the QMHP petition.  It is critical that the medical provider make a judgment based on the medical and mental status evaluation about the most appropriate treatment options for the patient. 

  4. Contact the Admissions Office at 605.668.3138 (after hours 605.668.3100) at HSC to inform them of the referral.  The legal paperwork, medical provider assessment, medication lists, recent laboratory/radiology tests should all be forwarded to Admissions Office (Fax # 605.668.3429).  The information will be reviewed by the Admissions Nurse.  If there are concerns about HSC’s ability to meet the patient’s needs, the Admissions Nurse will ask for HSC physician review.  If the physician has concerns about the proposed transfer, a direct conversation will be initiated between providers, to ensure that both parties are in agreement that the patient is safe for transfer to HSC.

  5. HSC is not intended to be a disposition for challenging placements.  The nursing home that is referring the patient retains a responsibility to the patient under federal law, and is expected to accept the resident back to the facility after a time of stabilization.  

    Reference F201 through F206 from the CMS State Operations Manual

  6. Transfer of nursing home patients should occur between the hours of 8 a.m. and 4 p.m. on weekdays, preferably by vehicle with a person who is familiar to the patient; if possible it would be helpful for the person to be accompanied by the guardian or Durable Power of Attorney (DPOA).