Living with chronic illness is difficult for many reasons, one being the different ways it can negatively impact mental health. Many of the patients with chronic illnesses who receive palliative care from our Advanced Illness Management (AIM) program also deal with mental health issues, most commonly anxiety and depression stemming from their condition and the loss of former abilities. And with the increasing collective concerns caused by the global spread of COVID-19, mental health symptoms may be exacerbated. With the Visiting Nurse Association of Greater St. Louis’ comprehensive AIM program, patients’ mental health and wellness are prioritized along with their physical care. AIM Clinical Physician, Dr. Fox shares some of the things she encounters working with patients in this palliative care program.
“Most patients are looking towards their mortality coming sooner rather than later. It could be one to two years or it could be less than that. So they do tend to have some anxiety and depression related to that and I certainly address it,” says Dr. Fox.
There are several ways the Visiting Nurse Association addresses mental health for AIM patients including the use of geriatric assessment tools can screen for certain mental health conditions, medication prescribed to treat anxiety or depression, counseling, and good support and communication from the patients’ family and caregivers. For the most severe cases that can’t be treated with medication and other traditional methods of support, there are community partners who will come into the patient’s home for in-home counseling. Our skilled care team of physicians, nurse practitioners, social workers, spiritual counselors and volunteers all add to the care patients receive and can positively impact their mental health. In addition to the VNA AIM team approach, Dr. Fox also shares that she may call a patient’s primary care physician to discuss a patient’s condition and see if they can work together to come up with a plan.
“My expertise is medical, so for me it’s just recognizing that, when people are going through some difficult times in their physical health, they may be struggling emotionally. When spiritual crises are a concern, I ask our spiritual counselors to intervene. Social workers help patients and families with situations such as trouble paying bills or not having a power of attorney set up. So that is why we have this team approach,” she says.
When it comes to concerns about the coronavirus, Dr. Fox shares some of the ways the VNA conducts AIM visits.
“Most of these patients are nearly homebound, but I do counsel them about COVID-19 and why staying home is even more important now, unless there is a medical emergency and they must go to the hospital,” she says. “I encourage them to shelter in and get supplies that they may need ahead of time such as a 90 day supply of medication, so they are better prepared for the months to come.”
Dr. Fox warns patients not to be intimidated by any protective equipment the AIM staff may wear – it is only to protect patients and staff. Patients can rest assured the VNA staff do not go see patients if they are sick with anything, whether or not it is COVID-19. Instead, patients can have a virtual visit set up when home visits are not possible. Additionally, she cautions against going to the emergency room unless absolutely necessary because those with chronic conditions are most susceptible to all kinds of infection or virus. Lastly, she encourages AIM patients to reach out with their questions and/or concerns.
“It is important for patients to feel connected to us and confident that we are there to support them through this difficult time.”
For questions about our Advanced Illness Management program, call 314) 918-7171, ext. 1252