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Liz Unruh (Host): Hello, listeners, and thanks for tuning in to the Well Within Reach podcast brought to you by Riverside Healthcare. I'm your host, Liz Unruh. And joining me today is Heather Lee, who is a Nurse Manager on our Senior Behavioral Health Unit at Riverside Medical Center. Thanks for joining us today, Heather.

Heather Lee: Thank you for having me.

Host: We're going to take a quick break to hear about myChart.

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Host: And we're back. And Heather, we're here to talk about something that you're an expert in, which is our specialized senior behavioral health services here at Riverside. But before we get into that topic, can you tell us a little bit about yourself and your role here at Riverside?

Heather Lee: Well, I've actually worked at Riverside for over 23 years. I started as a mental health tech back in 2003, became a nurse in 2007, flipped over to the medical side, worked on our medical pediatric unit, worked on our emergency department, stepped into leadership and, about a year and a half ago, became the manager of our senior behavioral health unit.

Host: Okay, great. So, you have a good background in the mental health units, but also just generalized nursing in the inpatient side.

Heather Lee: Yes. I actually have a Bachelor's degree in Psychology. In my early 20s, I was going to actually be a social worker and I was going to save the world. It didn't take me long to realize I probably wasn't going to save the world, but I thought maybe I could save a lot of people in Kankakee County.

Host: Yeah. I think you have a great background to talk about the topic we have here. But before we, you know, get into a lot of the details, can you explain what a senior behavioral health unit is and the type of care it provides?

Heather Lee: So, the senior behavioral care unit at Riverside is a 13-bed unit. So, we are a small unit and we specialize in taking care of the geriatric population with behavioral health disorders, things like major depression, bipolar, schizophrenia, and dementia with behavioral disturbances. So, not every patient who has dementia needs a behavioral health unit, but those patients who have disturbing behaviors such as violent outbursts qualify for our unit.

Host: Okay. So, you kind of touched on this, but are there certain signs or symptoms that might indicate that an older adult could benefit from this type of care?

Heather Lee: I think we have a lot of misconceptions about normal aging. And normal aging does not include depression and sadness and loneliness. It doesn't include confusion and wandering. It doesn't include hallucinations and delusions. Those are symptoms that could warrant a stay on a behavioral health unit in the treatment.

Host: Yeah. I think that's the important differentiation, is, you know, just because you're aging doesn't mean you should be sad or depressed all the time.

Heather Lee: No, no. And really, we want to do everything we can to keep patients out of the hospital. That's the most restrictive way to care for a patient. So, we want to start outpatient first. But if our patients are to the point that they can't take care of themselves safely, or if they're at risk of harming themselves or somebody else, then they can use our care on an inpatient unit.

Host: I think that's some great information. Why is it important for older adults to have this specialized type of behavioral health unit rather than just going into a general, like, adult unit?

Heather Lee: So, what's interesting is that I worked on the adult unit. And at that time, it was only one behavioral health unit. So, anybody from 18 all the way up to 80s, 90s could be on the unit. And it was an interesting mix of patients, and we did a really good job of taking care of each person's individual needs. But it was a lot. And you know, you'd have patients that were very active and very busy. And then, patients that were more sedentary and needed more help with their care, like going to the bathroom and taking showers and care like that. So, having a smaller unit just dedicated to the geriatric population, I think they can get more individualized care. And it's a quieter unit with more individual attention.

My patients generally have medical comorbidities. As we get older, we have more medical issues, diabetes, heart failure, patients who've had strokes, just a number of different comorbidities. And so, they just need extra attention to make sure that not only is their mind, but also their bodies getting the care that it needs.

Host: Yeah. I think that's important, knowing that with only having the 13 beds, that the people that are caring for them have the ability to take care of those other health conditions that they might have as well. What makes your unit at Riverside unique compared to other care options?

Heather Lee: The people. I will say by far it's the people. It's their expertise, but also their passion for caring for the geriatric population. My nurses, you know, they're well versed in not only behavioral health, but also medical conditions. So, they're very good about putting the pieces together for both. And they really, truly care about their patients. They are very creative in working together to figure out how do we make things better for this patient, this patient's individual needs, because every patient is different. And they come together and they make that plan together throughout the entire day, formally with the physicians and the psychiatrist, but also just with the techs and the nurses, and the activity therapists and the recreational therapists, really just brainstorming, "Here's what I think this patient needs. What do you think?" And then, through that conversation, they've developed a really well-rounded plan of care.

Host: So Heather, you've talked a lot about the team approach that we take on the unit. Can you talk a little bit about what a typical day might look like for a patient? I know Riverside's been in geri psych for quite a while now. So, I'm sure there are some specialized programming.

Heather Lee: There is. We've actually opened on january 1st, 2015. So, we've had many years now to really enhance the programming that we have on the unit. We do take a team approach, and we individualize the care for each and every patient. So, we have a structure to our day. And then, we edit that structure based on the needs of the patient. So, we generally let patients wake up when they wake up. We don't say, "Okay, six o'clock, everybody up and out of bed," and these are adults. And I no longer want to use an alarm. And I feel like when you're over 65, you shouldn't have to wake up to an alarm either.

Host: Yes.

Heather Lee: But there are some patients that we had to flip their sleep cycles, because they're up all night and then they're sleeping all day. So, we do things to make sure that they're getting their rest, but also to engage them so that they go to sleep at night. They get up. We start with vital signs, get breakfast done, start with med passing, nurses are doing their assessments. And then, right at nine o'clock, we start our programming. We have very robust programming. We have activity therapists, we have recreational therapists, we have nurses who are doing groups. We have techs that are doing groups. So, pretty much every hour is accounted for.

We also have themes to our days and we just find that that adds a little bit of fun. So, we have Music Monday and that's really probably one of our most popular days. And if you're going to have a most popular day, you might as well do it on Monday. But it's not just for fun, there's always purpose behind it. So, our activity therapist and our rec reational therapist will come in and play music. And it might be meditation, if that's what the unit needs at that point in time. It might be more uplifting. And then, they tie it in into kind of that therapeutic part of the programming. So, they have discussions as a group about what does this mean to you? How has this impacted your life? Things like that. Other groups are motivational, coping skills, sometimes we'll touch on finances if that's something that is prevalent on the unit, resources outside of the community. It really is tailored to the needs of the unit at that time.

Now, we will have patients who can't participate in that group therapy for whatever reason. And in those cases, we go to that patient, we have one-to-ones with them. And every Tuesday, I do a group and I check in with each and every patient, see from their point of view, "Why are you here?" Now, I read, I know from their chart why they're here, but I want to know what their thoughts are. And I ask them how their stay has been. I've asked them about the staff and their interactions with the staff-- and I always get glowing feedback on the staff-- and what their plan is while they're here and what their plan is for discharge and medication management. And I do that because what I want to do is assess their knowledge, but also are we doing our part? And we are. I feel very confident that I can say that we are.

We do put in rest time during the day because elderly people need time to kind of go back to bed and close their eyes and rest or just have a moment to themselves. And then, dinner, more groups after dinner, kind of a wrap-up group of how was your day, what was your goals? What was good? What did you take away? What could be better? Questions like that. And then, when they're ready, it's bedtime and then we wake up and we do the same thing again. Always keeping an eye on what each patient needs and then what the group needs as a whole.

Host: Yeah, I think that's great. I would love to participate in Music Monday. That sounds like a lot of fun. And I know there's a lot of science behind using music for healing. So, I think that's a great concept. It sounds like there's a very robust day.

Heather Lee: I love the fact that every day is different, even though there's a structure. And the structure helps people feel safe, it helps kind of control the situation. But every day is different, because it's based on what the patient needs individually, but also as a whole. And I really enjoy that part.

Host: Yeah. Well, that's some great information. We are going to take a quick break to talk about primary care at Riverside.

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And we're back. So, you know, we started off talking about like the team approach and what makes this unit different, but how do you go about supporting not just the patients, but also those families, especially those we hear it talked about a lot about is that sandwich generation where they're caring for their own children, but also their parents now.

Heather Lee: So, I see this over and over again since stepping into the senior behavioral health unit. And to back up a little, I started my nursing career as a pediatric nurse. And it was really hammered in as a pediatric nurse that your patient's not just the patient in the bed, but it's the entire family. And so, what I learned early on in my career is that the entire family is who you're caring for.

And the sandwich generation is an interesting phenomenon that I keep seeing over and over again. And a lot of times, family members are surprised that this is their life, that nobody prepped them for having to take care of their elderly parents and also their children or their grandchildren. And they may still be working or they may not be working and their view of retirement was completely different, and some angst with that. And I want to reassure anybody who's going through that right now, that it's perfectly normal to be stressed out and to be worried and to maybe be a little disappointed that your life is not what you wanted it to be in that moment as you're caring for so many people. I want to reassure them that there are resources, and there are resources within the community, and I want them to be empowered to educate themselves on that.

To prepare for this, I actually talked to a couple of family members and I asked, "What do you want the public to know? What did you wish somebody would tell you?" And one of my patients' wives said, you know, "Adult daycare was huge for my family. It allowed me to continue to work. And my husband is there and he's happy and he's being well taken care of, and his mind's being stimulated. He's being challenged and he's thinking and he's enjoying it. I get the break that I need. He gets the break that he needs, and this works for our family. So, tell people about adult daycare."

And I can tell you that my father did that when he was caring for my grandfather. He put him in adult daycare and I could see the relief when my father did that. And he felt a little guilty because he felt like he should be the person that was taking care of my grandfather. But you can't be one person's caregiver 24/7, not when you're also taking care of your own children and your grandchildren and working and managing a household, and trying to enjoy your life.

I'm going to encourage you if you're in the sandwich generation to find the information, do what you're doing now. Listen to a podcast. I will say that I haven't gotten to that part of my life yet. But knowing that it's probably coming, I'm already preparing myself for it. So, I do listen to those podcasts about what other people have done to help manage all that they're managing at the time.

Host: Yeah, I know we think a lot about, just like new mothers, we say, "Oh, you can't care for your infant if you aren't filling up your own cup.

Heather Lee: Absolutely.

Host: But it also goes the opposite. You can't care for your aging parents if you aren't feeling a hundred percent yourself. So, you have to take those times and learn what's best for you and your family and maybe, you know, exploring the adult daycare is a great option.

And I have a lot of family members who come in who question their decisions. Should I have done this? Should I have done that? I put my mom in assisted living and maybe I shouldn't have done that. Or maybe I should have separated my parents." And they're questioning every decision. And so, what I want to reassure them is you make the best decision with the information that you have at the time. And that was the best decision you could have made and be okay with that.

Yeah, I think that's some great advice. Do you have any other advice for family members who might feel overwhelmed and trying to balance, you know, the responsibility of making sure that their parents are getting cared for, and maybe seeing if an inpatient unit might be a good fit for them?

Heather Lee: So, I would say utilize every resource that you have to take care of your loved ones. I've sat with a lot of family members and asked some questions about family dynamics and who else can help you. And a lot of times that primary caregiver feels the weight of the world and feels this responsibility to do it all themselves, and they're not willing to tap into maybe siblings or aunts or other family members that can lend some help. They feel guilty. And I don't want anybody to feel guilty about taking care of yourselves. There's a lot of science that shows that caregivers are actually in poor health and the people that they're taking care of because of the stress that they are managing. So, take care of yourself because exactly what you said about our new moms, you can't take care of your loved one if you're not also taking care of yourself.

So, look at everybody around you that can lend support. Involve your primary care physician early as your loved one is aging. Ask them questions like, "What do you see happening in the next few years? What do I need to prepare for? What do I need to know about?" Join support groups. There's an Alzheimer's support group run by Riverside. Join that early so that you are well-prepared as the disease progresses. And, one, you're not shocked and you're not surprised, but you already have a plan in place of what you're going to do.

Host: Okay. I think that is great advice. You know, proactively trying to make sure that you're setting yourself up for success so it doesn't seem as stressful and overwhelming, as you get into the thick of it. I think that's great advice for our listeners. If someone listening thinks that their parent or loved one may need inpatient mental health care, what's the first step to accessing the senior behavioral health unit?

Heather Lee: So, we have a centralized intake department, and they're wonderful experts in behavioral health that can guide that process. So, you can make the phone call, call them and ask their advice, tell them the situation, and they can give you guidance on next steps. A lot of our patients do come to my unit from the emergency department and that is fine too.

Host: Okay. I think that's a lot of great information that we've shared today. Is there anything else that you can think that we might've missed?

Heather Lee: I just really appreciate this opportunity, because I don't think we always think that this might happen to us that we might need these services either for ourselves or for our loved ones. And I don't want people to hesitate to reach out and get the help that they need, because we can make a difference. We can improve the quality of people's lives, not only for our patient, but also for their family members. It's an invaluable resource. And it's a gift that we can give to the community to take care of our patients.

Host: Yes. Well, thank you so much for joining us today, Heather. And thank you listeners for tuning into the Well Within Reach podcast brought to you by Riverside Healthcare. To learn more about the Riverside Behavioral Health Services, visit riversidehealthcare.org.