ACT Psychologist Assists in Natural Disaster

Email published with Dr. Bramblett’s consent

From: Paul Bramblett [mailto:leighbram@triad.rr.com]
Sent: Saturday, October 01, 2005 10:35 AM
Subject: hurricane, hurricane

Hello:

 A couple of weeks ago I was made aware of an opportunity to participate in the disaster response to Hurricane Katrina.  Although it felt like the effort was going to be “a day late and a dollar short” and we were going towards a hurricane instead of away from it, I boarded a plane for Monroe, LA last Friday, Sept. 23.

A little more than12 hours after I landed, Hurricane Rita made landfall in the vicinity of the Louisiana-Texas Border, and our trip went from feeling late to being right on time.  Also, I quickly discovered that the physical and psychological effects of a storm of Katrina’s magnitude are ongoing and the impact of both hurricanes will be unfolding for some time to come.

I was part of an eight member crisis response team from the Alachua County Crisis Center that operates in Gainesville , FL and we had been invited to assist the scattered and fragmented New Orleans crisis center (which had been re-located northward to Monroe ) meet the needs of its far-flung population. 

Although we did not get to do the face-to-face critical incident work we had hoped for, we not only helped the New Orleans crisis center handle mental health calls, we also assisted the United Way 211 call center field some of their thousands and thousands of calls, provided support to others working at the call center, and informally discussed their experiences with evacuees staying at the same hotel where we were staying.  When the Lake Charles and Lafayette United Way offices had to evacuate, we took their calls as well.  Even agencies in Texas forwarded their calls to Monroe , LA.   It was tense, draining work this past week to say the least.

As you probably know, the effects of this giant one-two punch of natural disasters are still being felt by the people who endured them along the Gulf Coast from Alabama to Texas . Not only in Mobile, New Orleans, Lake Charles, and Houston, but in small towns named Columbia, Bogalusa, Morgan City, Opelousa, Sulphur, and Port Arthur.

As a team and individually, we experienced highs and lows this past week.  I rode the roller coaster of disaster response, the highs of feeling like I was making a small difference and the lows of knowing there were times when my efforts were no where near enough.

Fortunately, I was working within a group of eight people who know and trust one another and we were able to support and assist one another as we handled rescue, missing persons, and other aid calls.   Many of the calls were seeking information for financial assistance and there were calls from people without power and water.  I was only cussed out twice this past week and those two people tried their un-level best to express the frustration, anger, and desperation of millions of people.  On the other hand, I repeatedly heard gratitude from hundreds of people who were glad for a human presence on the other end of the phone and from people who were glad to know that others were trying to help them.

Although none of you have asked, I have one gripe about the disaster response thus far.  The pipeline for financial donations is open wide, but the portals for distribution are seemingly very small.  If you call to donate to one of the big international agencies that will go unnamed, your call will be taken promptly and courteously.  However, for survivors and for those trying to help them, calls go unanswered for days at time, hang-ups are frequent, and the lack of information is maddening.  To say that aid money is being "funneled" to the neediest is an understatement.

 If circumstances were to allow my absence, I would gladly go back again with the ACCC or with another group.  There is still much to be done in assisting our fellow citizens and their mental health needs may well increase. 

I tried to capture at least some of my experiences during this past week in this haiku:

 Gulf water storm surge

House in splinters, home is gone

Please, can you help us

 pb

Psychiatric Needs of Residents in Assisted Living Facilities

 Extensive research has addressed the prevalence of psychiatric disorders in nursing facility residents (see August, 2000 ACT newsletter).  Assisted living is a fairly new industry, compared to other care settings such as hospitals and nursing facilities.  Recent research findings indicate that the relatively high rate of psychiatric disorders among nursing home residents as compared to the community dwelling elderly population also applies to assisted living residents.

 Findings of the first large scale comparative study of the mental health of assisted living facilities, published in the October, 2004 Journal of the American Geriatrics Society, indicate that two thirds of 2100 assisted living residents exhibited mental health problem indicators.  Mental health problems addressed in this study included dementia, depression, and behavioral symptoms such as wandering, aggressive behaviors, and inappropriate verbal behaviors.

 Dementia has been found to be prevalent in assisted living facilities, ranging from 50% to 70% (Gruber-Baldini, et al, 2004; Rosenblatt, et al, 2004).  Kadly (2005) concluded that “while dementia is common in assisted living facilities, it is under-recognized and under-treated.  The fact that dementia is suboptimally addressed may contribute to morbidity and prevent residents from aging in place to the degree that otherwise might be possible.”

Gruber-Baldini, et al found that over a third of assisted living residents studied had behavioral symptoms occurring at least once a week.  Thirteen percent exhibited aggression, 20% demonstrated physically nonaggressive behavioral symptoms (i.e. wandering, pacing, restlessness, hoarding), and 13% resisted taking medications or ADLs.

 Depression was also found to be prevalent in the assisted living population, with about 25% of residents exhibiting indicators of depression.

 More than 50% of assisted living residents in the Gruber-Baldini study were taking psychotropic medication and 2/3 had some mental health problem indicator (dementia, depression, psychosis, or other psychiatric illness). 

References

Kaldy, J. Assisted living research: Still in its infancy but beginning to grow.  Assisted Living Consult, 2005, 1:3;  22-26.

Gruber-Baldini, A.L., Boustani, M., Sloan, P.D., Zimmerman, S.  Behavioral symptoms in residential care/assisted living facilities:  Prevalence, risk factors, and medication management. Journal of the American Geriatrics Society, 2004, 52:10.

Rosenblatt, A., Samus, Q.M., Steele, C.D., et al. The Maryland Assisted Living Study: prevalence, recognition, and treatment of dementia and other psychiatric disorders in the assisted living population of central Maryland .  Journal of the American Geriatric Society, 2004: 52:16;1618-1625.

Birthdays: 

Michael Quirk: September 9

Jeff Stewart: September 12

Leslie McNamara – September 18

Bryan Connell – September 27

Diane Henderson – October 23

Anniversaries:

John Rucker:  8 years

Susan Pollard:  5 years

Scottie Harrell: 5 years

Paul Bramblett: 4 years

Morina Ramsamooj:  3 years

Jacqueline Marquis: 2 years

Barry Bertolette: 1 year

New Hires:

Pat Gaspar, RN Southeastern GST

Janis Jaworski, PhD, Morganton

Ashley Moore, Administrative Assistant

Theresa Tucker, PhD, Liberty