Psychological consultation to nursing homes: Description of a six-year practice

The prevalence of psychological problems in nursing homes is estimated to be as high as 50-90% of residents. Yet psychological consultation is rarely available. This article describes six years of experience by one practitioner consulting to nursing homes in the Midwestern U.S., combining clinical and anecdotal descriptions with data collected on all the referrals during the six years. Data include referral questions; standardized assessments of mental status, memory, and depression; disposition; and therapy outcome ratings. The most common referral questions were depression and behavior problems. Staff assessment of presenting problems differed significantly from assessments by clients and therapist. Results suggest that the presence of a consultant may have a positive environmental impact. Interventions used included staff training, behavioral techniques, and cognitive therapy for depression and anxiety. Although there are numerous barriers to psychological work in nursing home settings, results suggest that this is an important and fruitful area of practice.