The Chronic Hospitalized Patient

Abstract

As we have seen, the patients in the Wichita program tended to be relatively young and generally had good rehabilitation potential from vocational and educational points of view. In this chapter, we will discuss the chronic patient in a hospital setting. These patients tend to be older than the Wichita clients and have typically been unemployed for long periods. The patients are also found in convalescent centers, nursing homes, VA domiciliaries, and similar institutions. We will report the experiences of Gerald Goldstein (one of the authors) with a ward program for patients with chronic brain damage. There are serious considerations regarding the treatment of this type of patient. They are recalcitrant to most of the standard forms of psychiatric treatment; they often do not respond well to psychotropic medications, nor do they appear to gain much from verbal therapies; they typically have become dependent on the institution in which they reside, and are reluctant to leave; they are frequently alienated from their home communities, and are often not accepted back home by spouses and relatives. Thus, they have a combination of neuropsychological and sociological difficulties that make anything but custodial care difficult. We would therefore like to explore some ideas about treatment of these patients in this chapter.