New Geriatric Admission Policy in a State Mental Hospital*

Abstract

State hospitals are still being used as a dumping ground (the End of the Road) for geriatric patients who present serious nursing problems. The Geriatric Service at Bronx State Hospital, affiliated with the Albert Einstein College of Medicine, underwent a marked metamorphosis from the traditional custodial service to a community‐oriented unit with emphasis on treatment. This was accomplished only when the admission criteria were changed. The community can be educated to accept such a modern admission policy for geriatric patients in a state hospital by: 1) having definite criteria for admission; 2) explaining to the referring agency the reasons why patients may or may not be suitable for admission; 3) answering all complaints of public officials who intervene for their constituents; 4) advising the family what procedure should be followed to have the patient admitted to an old age home or nursing facility, or for obtaining a homemaker; 5) providing an out‐patient department (preferably to include a day hospital) for those patients who are not sufficiently ill to be admitted to the state hospital for 24‐hour maintenance; 6) providing a speaker to explain especially to hospital staffs the criteria for admission; and 7) providing a mobile psychiatric team to visit the patient in his home, hospital, nursing home or old age home, and also to consult with the family physician.

Placement of Elderly Psychiatric Patients*

“…Alternatives to state hospitalization can be found. New admission criteria have been developed (3) which are aimed at preventing the hospitals being used as dumping grounds for geriatric patients with serious nursing problems. Elsewhere, a psychiatric screening unit has sharply reduced the number of commitments of elderly patients to state hospitals (4).…”

Community Liaison with a Mental Hospital

“…While we are working toward increased effectiveness in moving people out of mental hospitals, we cannot fail to note the importance of preventing needless admissions. Setting new admission criteria, as has been accomplished in some centers (18), is not the answer; the problem is merely moved back to the community. There is no question that we need a much greater variety of services for the aged.…”

A Treatment‐focused Geriatric Program in a State Mental Hospital*

“…If then desirable, an appointment is made for the patient to be seen by our psychiatrist for evaluation. Prior to this appointment, the medical work‐up described elsewhere (1) will have been completed.…”