Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: SATURDAY, March 30, 1991 TAG: 9104020014
SECTION: VIRGINIA PAGE: A-6 EDITION: METRO
SOURCE: CHARLES HITE MEDICAL WRITER
DATELINE: LENGTH: Long
For Wood, 81, the world had become an increasingly sinister place. He had trouble sleeping and would stay up all night. His memory was full of holes. The slightest irritation set him off. If the checkbook wouldn't balance, he blew up. He kept telling his wife that strange people outside their house were spying on him.
One night he grabbed a pistol and insisted Louise Wood stay up with him. Afraid, she hid in a shed adjoining their house.
Owen Phelps, 78, hadn't been himself since he retired from the insurance business nearly 20 years ago.
He didn't want to be around people. He'd sit at home most of the day and not do much but read the paper and drink coffee. Anything out of his daily routine upset him. He spent hours in the bathroom making sure every hair was in place. Before leaving home with his wife, he would check the stove several times to make sure it was off. Then he'd ask her to check it. If he drove with his wife to a shopping mall, he made her park in a certain space.
One day his wife needed to make arrangements to visit her sick sister. Phelps insisted she not go. He picked up a butcher knife and said he would kill himself if she left. Elizabeth Phelps thought he was bluffing. When she got back an hour later, her husband was lying on the bed with a small knife wound in his belly.
Like most elderly patients at Catawba, Wood and Phelps came after brief stays in private psychiatric hospitals or hospital psychiatric units.
Likewise, they came after commitment hearings before special court justices who declared that they were dangerous to themselves or society in their present mental state.
And like the majority of the hospital's geriatric patients, they came because their families could no longer care for them.
Like most, they have no private insurance and rely on state funds or Medicaid - the state and federal insurance program for the poor and disabled - to pay for their treatment.
Wood and Phelps also have two of the most common diagnoses among elderly patients in state psychiatric hospitals.
Wood has primary degenerative dementia. Dementia, a deterioration of mental capacity, is the most common diagnosis for hospitalized elderly psychiatric patients in Virginia. It includes a wide range of illnesses, including Alzheimer's disease, which is thought to affect up to 50 percent of persons over 85. Dementia can be caused by strokes or such illnesses as Parkinson's disease or Huntington's disease.
Phelps has major depression. Depression and the various types of schizophrenia are the next most common diagnoses among the institutionalized elderly.
The vast majority of the elderly can be treated for these and other mental illnesses without long-term hospitalization. Of the 4 million elderly Americans who need mental health treatment each year, only 50,000 are hospitalized - 18,000 in state institutions. In Virginia, nearly 85,000 elderly suffer major mental disorders, but only 800 are in state mental facilities.
Wood and Phelps are among the core group of elderly who are so ill that they require the sanctuary of a state institution. Yet the staff at Catawba never assumes these patients will spend the rest of their lives there.
Phelps, for instance, was transferred to an adult home in Nelson County three months after he was admitted to Catawba in 1988. He stayed there several weeks, but he refused to take his medications, see a doctor or obey rules. His wife, Elizabeth, took him home for several weeks, but he became more withdrawn. One day, he threatened and shoved a social worker who had come to visit. He was readmitted to Catawba in May of 1989.
Elizabeth Phelps thinks her husband is doing better this time. During his first admission, a five-minute visit would exhaust him. He would excuse himself and go to bed. Now, he talks longer and takes more interest in what she has to say. Although he doesn't participate in art or music therapy classes, he is a regular at the twice-weekly exercise class.
Phelps seems less compulsive, too. When he first came to Catawba, the nurses had to keep his electric razor under lock and key. Otherwise, he would shave himself until his face was nearly raw.
"The hospital itself is good. They help you as much as they can. They don't treat you rough or mean," Phelps says during a recent visit with his wife. "But right now I'm not sick. I could walk out and go home with my wife. I don't know why they won't let me go."
Elizabeth Phelps has brought her husband a light blue windbreaker to replace the red one he wears nearly all the time. He prefers the old one, however, and tells her to take the new one back. He does agree to accept a pair of slippers so he'll have something to wear at night besides his blue sneakers.
"Cigarettes is the main thing," Phelps tells his wife. "You got any you can give me? Three or four?" Phelps hoards cigarettes. He's got two and a half stashed away in an envelope in his bedside table.
His modest request is far exceeded. Elizabeth Phelps hands him a pack of Merits. "These are worth a million dollars to me," he says.
Phelps and Wood are patients on the hospital's third floor, otherwise known as the geriatric transition unit. Patients on this floor have the freedom to walk to a small canteen to buy candy or soft drinks or to go to a smoking area at the front entrance of the hospital. If they don't have a class or therapy session, they can visit with other patients in one of two dayrooms. They meet as a group every afternoon to talk with a staff member and, if they smoke, to receive a daily allotment of cigarettes. They take occasional field trips - to restaurants, museums and department stores.
Patients often are transferred to the third floor to gauge whether they might be ready for the less restrictive environment of a nursing home or adult home.
Hospital social workers are trying to find adult homes and nursing homes for Ben Wood and his wife to visit.
Becky Baker, a close relative, wonders if Wood will be able to make it outside Catawba. She acknowledges that Wood has shown a remarkable improvement in his 15 months at Catawba. He's friendly and easy-going and seems happy. Gone are the imaginary strangers that spied on him.
Baker credits the structured environment at Catawba for a large part of Wood's recovery. "He gets up at the same time each day, he eats at the same time, he goes to bed at the same time. He sees the same people every day. He walks around in a place with the same temperature. Not much varies," she says.
Even with that structure, she adds, Wood still functions in his own world. Like many patients with dementia, each day for Wood is often like walking in on the middle of a movie. He often has little memory of what happened the day before. Just two days after he went home for a weekend visit with his wife, he told a visitor he had never left the hospital.
Sometimes, Baker says, he calls his wife and asks, "Where am I? I can't find my car. I can't find my wallet. Come and get me." He has forgotten the home he and his wife lived in for nearly 34 years. Yet he vividly recalls their courting days.
Michael Marsh, Catawba's administrator, says it's understandable that families would like relatives to stay at the hospital as long as possible. "But it's important that we don't encourage people to stay beyond their time at a state facility," Marsh adds.
On average, he estimates, Catawba has about 25 patients who could function in an adult home or nursing home if room could be found. These patients need to leave so the hospital can treat other seriously ill patients, Marsh says.
"Our job is to provide appropriate psychiatric services to the elderly," he says. "We can't afford to be anything less."
by CNB