Mental Health

Case Study | Hospice Helps

Susan, 83 Years Old

Parkinson's Disease

Susan was admitted to hospice care in 2019. This is another of our case study examples that demonstrates the compassionate care we provide. She has a primary diagnosis of Parkinson’s Disease. Prior to admission to hospice, patient had been moved into a skilled nursing facility after losing her home to flooding; a year prior to that her husband passed away. At admission, patient was noted to be tearful and family reported episodes of depression. Initially, Susan was engaged with hospice staff and attended social and religious activities offered at the facility, however, as time progressed, she began to become more withdrawn and less communicative. Her family was approached about starting medication for depression, however, they initially declined to begin medication. At this time, the interdisciplinary team (IDT) was consulted, and a plan of care was put in place including:

    • Depression screenings to be conducted by a social worker
    • Increased visits to combat depression and isolation as well as monitor psychosocial developments by social worker
    • Increased visits by Chaplain to provided spiritual support
    • Continued education to family about the use of anti-depressants by both RN/LPN and social worker

Initially, it appeared that increased visitation and opportunities for self-expression were positively impacting the patient’s mood; however, in early 2020 COVID-19 caused facility lockdowns, and all visitations outside of nursing and aide services were moved to telehealth sessions. This caused an immediate and drastic decline in her affect, mood, and demeanor. Susan rarely spoke more than a few words at visits, received little to no benefit from telehealth sessions, and began to exhibit physical symptoms of decline not related to her primary diagnosis. A subsequent IDT meeting resulted in the primary physician encouraging staff to facility family agreement to medication to alleviate depressive symptoms. Staff again spoke to the family and after reiterating the usefulness of medication of exacerbation of patient symptoms due to COVID 19 restrictions of both staff and family. The family agreed to medication and the patient was started on a course of anti-depressants. Staff noticed an immediate improvement in patient mood and affect. The patient began engaging in conversation more frequently, sitting up more, and verbalizing needs more. The Patient reported feeling improved mood, is less tearful, with improved appetite. Our compassionate care goes above and beyond.

Conclusion

Susan’s case demonstrates the role hospice staff play in attending to the mental health needs of patients. Although the philosophy of hospice is geared towards comfort care and not curative care, treating symptoms that arise from mental health issues such as depression or anxiety falls under comfort care and can be addressed by the hospice team. Mental health issues are best addressed from a collaborative care approach involving the entire hospice team, from nursing and aide care to psychosocial care from the social worker and spiritual care from the chaplain.

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