The Pathway is Clear: Treating Mental Illness Among Senior Citizens



     Along highway 61, just west of the smoldering, underground fires of Centralia, rests the heart of Pennsylvania's coal country, and within it, the sleepy town of Shamokin.  Once a prosperous mining town, what remains today is little more than a sad reminder of past grandeur.  Coal-covered hillsides, defunct mining operations, dilapidated houses, empty storefronts, and abandoned warehouses overwhelm the landscape.  Hidden away on the outskirts of town one pleasant deviation from this sad scenery can be found.  Navigating up a short, winding, blacktop road a sign appears, reading Geisinger-Shamokin Area Community Hospital. The massive, red-bricked structure rises above the surrounding dirt, dust, and ash like an exotic symbol of hope.  As if, representing the multiple generations of care that have been provided here, the structure is divided into two unique sections. The historic older section stretches along the back two thirds of the property, flanked by a lush wooded hillside.  The new section, behind the lawn, can be easily distinguished by its contemporary architecture and helicopter pad.  Through the main entrance and up three flights of stairs, in a secluded part of the older construction, two massive oak doors are posted, “Inpatient Gero-Psychiatry Unit.”

    
     A button on the wall reads “Secure area, please ring bell for assistance.”  The bell rings and a delicate, feminine voice flows from the intercom, “Just a moment.”  An audible click followed immediately by a low buzzing noise emanate from the locking mechanism of the doors.  It slowly opens to reveal a soft spoken, thirty-something, brunette with sky blue eyes. “Hi, I’m Jess, welcome to Pathways.” 

     
     After eleven years of experience as a registered nurse, Jess is no stranger to elderly care environments.  Jess recalls, “After working five years as a nursing assistant at Mountain View Manor, a local nursing home, I decided to become a registered nurse.  I wanted to further my education while also providing a better life for my family.”  After graduating and spending some time in other areas of nursing, something occurred to her.  She realized a career in Behavioral Health was her calling and that she possessed a valuable talent for elderly care.  She found an opening within the In-Patient Geriatric Psychiatry Unit of Shamokin Hospital, otherwise known as Pathways, took the job, and has been caring for its patients ever since.  Now one of the senior nurses within the unit, Jess feels, “You must be compassionate and have the ability to make quick decisions for the care and welfare of your patients.”
 

     Inside the facility, a cacophony of laughter, singing, moaning and muted crying fills the entryway.  Along the green and white tile-floored hallway, slipper-clad feet and rolling wheelchairs moved randomly between the walls, tiled in matte sage green ceramic.  Making her way around the chest-high, L-shaped nurses station counter, Jess reviews the notes about the patients from the previous shift.  The odd aromatic combination of bacon, toast, vinegar, and slightest hint of urine are present in the air.  Seemingly oblivious to the smell, Jess steals a quick sip of coffee and, with a sense of urgency, heads down the long hall to help with breakfast.  Starting with the patients that have special physical needs, Jess ensures that the patients are dressed and ready to make their way to the dining room.  With only four tables pressed against the outer walls of the room, the patients have no difficulty taking a seat or navigating their wheelchairs amidst the other tables.  While eating, most seem to enjoy conversing with staff or peers, but for some, food isn’t the only thing on their mind.
 

     Gesturing for Jess to come over, a freckled, bald man appearing in his seventies comments quietly, “Wow, look at those eyes, you’re a knock out.”   

     “Oh, well aren’t you sweet? Thank you.” Jess replied, in a soft, caring voice.

     “Are you married?” asked the man, forty years her senior. 

     “Ye....” Jess attempts. 

     Anticipating the dreaded response, he interrupts, “I don’t see no ring…” 

     Giggling, Jess attempts to changes the subject,  “We’re not allowed to wear jewelry.  You’d like my husband, though. He’s a good man and an Irishman like you.” she claims, hoping for a reprieve.

     Recognizing her sincerity he retorts, “He's one lucky fella. Let me know if you have any single friends though, huh?  I’m looking for a lady between thirty-five and forty."  Gently moving his fingers back and forth, he waves and turns back toward his meal.

     “I’ll see what I can do, sir.”  She gently pats his shoulder and walks toward the food cart at the end of the room.  While at the cart, out of earshot, she touches her forehead and shakes her head back and forth, "... and that's one of the innocent ones.  Though most are harmless, at times, some of the men can be quite disrespectful."
 

     With staff present and the meal underway, Jess heads departs for to the morning Treatment Team meeting.  She addresses the team, comprised of a psychiatrist, program director, operations manager, activities therapist, and herself.  She updates them on the events of the previous twenty-four hours.  All the decisions regarding each patient's plan of care are made in this meeting and Jess incorporates the changes into each patient’s paper care plan.  Upon conclusion of the meeting the previously placid unit bursts into action.  Like a scene from National Geographic, the staff exits the conference room and fan out like so many bees leaving the hive.  Doctors, nurses, program staff, and housekeepers make their way about the unit.  Highly regimented and beautifully orchestrated, each individual has a purpose, and each goes about it dutifully.  Returning to her computer at the nurse’s station to transfer notes, Jess downs several large gulps of her coffee.  Annotating the changes in medication and goals within the patient care plans, she raises her cup and facetiously declares, “As a nurse, this is a necessity!  This is breakfast and lunch.”  Grabbing a laptop computer, she heads to the room closest to the unit entrance, greets the patient, has a seat and begins her evaluation.
 

     Patient after patient, Jess evaluates and documents on each patient's mood and behavior.  Following a mental acuity assessment on the patient in the last room, she stands up, exchanges pleasantries and excuses herself as she steps out into the hallway. Rapidly documenting the patient’s behavioral status, her petite hand comes to an abrupt stop. Placing her pen in her up-swept hair, she leans against the wall,  “Honestly, it’s a little sad sometimes…” Gazing at the ceiling she continues to speak. “Like last week... I had a patient, an elderly woman...” Jess pauses, clearly upset by the remembered event.  “She had advanced dementia.  She would pace the halls, frantically screaming, crying out names, and checking all the rooms.”  Jess interrupts herself to explain. “See in her mind, it was decades earlier and she was desperately trying to find her children who were supposed to be home in bed.  But in reality, her children were grown with children of their own.”  Jess quickly turns her head away, self-conscious of her sad, glistening eyes.  Clearing her throat, she begins making her way back to the front.  “It's not all bad though... a lot of good comes from what we do here.”
 

     Following lunch preparation and service, the day passed quickly.  After hours consisting of patient assessments, admissions, discharges, insurance reviews, and patient group activities, only one task remained undone.  She makes the day’s final trek to the nurse’s station with a patient at her side.  Having discharged hundreds of patients, she makes quick work of the forms and procedures.  The discharge process now complete, Jess reverently delivers the patient into the caring hands of her family.  She proudly escorts the reunited family to the entrance, as the massive doors close, she turns and proudly proclaims, “See, that’s what this place is all about.” Returning to her desk, preparing the notes for her relief, she expounds, “Sometimes a person isn’t able to function within the community or nursing facility due to behaviors associated with dementia or other mental illness.  Family members may not even initially recognize changes in their family member until it has become severe. Through proper treatment and medication adjustments, we are able to give our patients a much better quality of life. That’s what I love the most about this job.”
 

     Due to an unprecedented growth rate among aging Americans, the issue of elderly care has never been more relevant than it is today.  The elderly care infrastructure is buckling under the pressure of a cresting Baby Boomer population.  An alarming number of older citizens are battling dementia, depression, and other mental illnesses, and often trying to do it alone.  We, as a nation, must find a way to combat this issue.  There's no simple solution to this problem, but our community leaders, charitable organizations, and government agencies are working tirelessly in an effort to affect change.  Although national progress on this issue appears slow moving, surprisingly, small-town America seems poised to attack this crisis head-on.  Such is the case in central Pennsylvania, where facilities like Pathways, have key roles in the future of geriatric treatment and elderly care.  It is extremely heartening to know, with the aid of an extraordinary staff, one local facility stands prepared meet the challenges ahead.