About the JHGECC
Disease and Functional Issues
Patient Care Issues
- How can I contact your center?
Go to the contact us page in the About Us section. - Are there other education centers within the U.S.?
Yes, there are 40 geriatric education centers located with the United States. See the National Association of Geriatric Education Centers for a complete listing.
- What is dementia?
Dementia is an acquired syndrome of decline in memory and at least one other cognitive area in an alert person. Its incidence increases with age, i.e. 12% in women 65-80 years old and 33% in women 65-100 years old. - How do you assess for urinary incontinence?
Urinary incontinence is classified by commonly identified patterns, including stress, urge, overflow and functional symptoms. A thorough history and physical exam will help assist in identifying these patterns.
1. In what situations does Medicare pay for home care?
2. What is involved for an Emergency Petition in a Psychiatric Crisis?
- In what situations does Medicare pay for home care?
Medicare will pay for in-home nursing, physical or occupational therapy, social work, nutritionist evaluation, speech therapy, and/or personal care assistance if the patient is “homebound” and has a “skilled need.”
Homebound means that “the patient cannot leave home without excessive effort such as but not limited to requiring the aid of supportive devices (i.e. crutches, canes, wheelchairs, and walkers), the use of special transportation, the assistance of another person, or if he or she has a condition which is such that leaving his or her home is medically contraindicated.” In addition, absences from home must be infrequent, or of short duration, or to get medical attention. Absence from home to attend adult day-care does not negate a patient’s homebound status, nor do occasional absences from the home for non-medical purposes, (for example, an occasional trip to the barber, attending a religious service, a walk around the block, or a drive) so long as they are undertaken on an infrequent basis or are of relatively short duration and do not indicate that the patient has the capacity to obtain the health care provided outside rather than in the home. Generally, if a patient can be away from the home an average of 16 or more hours per month for non-medical reasons then the homebound criterion would not be met.
A skilled need is a level of care that includes services that can only be performed safely and correctly by a licensed nurse (either a registered nurse or a licensed practical nurse) or therapist. Examples include pressure ulcer treatment, bladder catheter management, and hypertension or diabetes management requiring frequent checks or medication adjustments. If a patient does not have a nursing need but has a need for other skilled treatment (for example, physical or occupational therapy after an episode of pneumonia treated at home but resulting in a decline in physical functioning after recovery from the acute illness), Medicare will still pay for a homebound patient to receive those services at home.
Medicare will NOT pay for personal care services (also known as home health aide services) in the absence of a skilled need.
2. What is Involved for an Emergency Petition in a Psyciatric Crisis?
What constitutes a Psychiatric Crisis?
A psychiatric crisis includes but is not limited to suicidal or homicidal thinking and/or behavior, acute psychotic symptoms, sudden change in mental status and violence.
What are the criteria for filing a petition for emergency evaluation (EP)?
A petition for emergency evaluation can be made only if the petitioner has reason to believe that the individual :
- has a MENTAL DISORDER (major mental illness, personality disorder, substance
abuse)- presents a danger to the life or safety of the individual or another.
Danger may also mean inability to take care of ADLs, poor intake, or any kind of harm
Who can petition?
Physician, Psychologist, Licensed Social Worker, Licensed Clinical Professional Counselor (LCPC), Clinical Nurse Specialists in Psychiatric and Mental Health Nursing, Psychiatric Nurse Practitioners, County Health officer or designee and, Law enforcement officer. For all these individuals NO JUDGE’S APPROVAL IS NECESSARY.However, any interested person (friend, relative, neighbor) may file a petition for emergency evaluation for review by a judge. The petition is filed in the District Court.
This procedure may take several hours. When a petition for emergency evaluation is granted, the person is taken by a sheriff or policeman to an emergency room. The person will then be evaluated for possible hospital admission.Is there a special form for filing an EP?
The petition for emergency evaluation is available on the Maryland Judiciary Website.What is the expected outcome of completing an Emergency Petition?
Once the individual is taken to the ER, the law requires a medical and a psychiatric evaluation by two physicians or a physician and a psychologist within 6 hours.What are the criteria in Maryland for involuntary admission to a psychiatric hospital?Maryland law allows involuntary admission to a psychiatric hospital when a person:
- has a mental disorder and
- needs inpatient care or treatment and
- presents a danger to the life or safety of the person or others and
- is unable or unwilling to be admitted voluntarily and
- there is no available less restrictive form of intervention that is consistent with their welfare and safety.
What are the criteria in Maryland for voluntary admission to a psychiatric hospital?Maryland law allows voluntary admission to a psychiatric hospital when a person:
- has a mental disorder and
- is susceptible to care or treatment and
- is capable of understanding the nature of the request for admission and
- is capable of giving continuous consent for admission and treatment and
- has te ability to ask for release.
Note: The patient must complete an application for voluntary admission that stipulates 3 days notice of AMA (against medical advice) leaving.
The physician must certify the patient has a mental disorder susceptible to care and treatment.
Threshold: If 65 or older, patient must have a geriatric evaluation to determine no less restrictive form of care or treatment is appropriate.
