Lippincott's Guide to Behavior Management in Home Care

Given the continuing trend away from institutional care in hospitals and nursing homes, increasing numbers of patients will be treated at home. This 432-page guide is an outstanding summary for assessment and treatment of mental health problems in the home, whether they are bona fide psychiatric or substance abuse problems or behavioral problems in primary care without a psychiatric diagnosis. It is intended for home care nurses and other health care professionals but is free enough of technical jargon to help aides and others with less training deal with the behavioral challenges of providing care at home as well.

The book has a stated focus on the client-patient and the family or caregiver, with recommendations tailored to each. It is divided into two parts: a shorter introduction about essentials of behavioral management in home care, including caretaker self-awareness and communication, family or caregiver dynamics and communication, and in-home assessment and treatment planning, and a second part, which comprises most of the book, on behavioral problems commonly encountered.

The first part mixes basic psychological information, such as lists of defense mechanisms, with generic nursing interventions and their rationale. The second part presents common behavior problems in home care, organized alphabetically, and offers specific assessment techniques and nursing interventions for them. Under F, for instance, is Family or Caregiver Stress extensively characterized and with coping styles suggested.

An appendix includes 19 assessment scales, which some users may find helpful for quantifying behavioral changes. However, many scales require both background notes and training to begin to be useful instruments. It is unclear why the Mini Mental State Examination is recommended for caregivers here.

A more serious question is the omission of a discussion of assessing, or intervening for, caregiver depression. The state-of-the-art concept of the caregiver as a hidden patient is missing here; the book has a one-sentence statement about no medications being indicated for the caregiver. Overall, the pharmacology sections are weak or open to inaccurate interpretation because of brevity: fluoxetine is reported as a medication that is associated with violence.

The book's strength is its practical and comprehensive summary of the in-home management of behavioral problems, based on the authors' experience and research. This book would be a useful guide for any team dealing with home health care, including psychiatric crisis teams that have been formed to quickly assess home problems and to try to prevent escalation of the problem or hospitalization of the patient.

Dr. Cantillon is a geriatric psychiatrist at the Medical Center of Delaware in Wilmington.