The Savvy Senior: The Cove

November 2021 Issue
By Edwina Hoyle

Ah, the golden years! The Lowcountry is a playground for retirees to enjoy—the weather, golf, tennis, the beach. Yet as we age, we also face new circumstances and new challenges. As they say, aging is not for sissies. The wrinkled face we start to see in the mirror may or may not bother us. That’s more about vanity. However, when myriad medical issues send us to orthopedic surgeons to turn us into bionic men and women, or cardiac problems require stress tests, stents or bypass surgery, or cataracts impair our vision, we spend less time enjoying our favorite activities as our calendars become filled with doctor appointments. We notice that our opportunities for socialization are saturated with discussions of the medical issues we—and our friends—are experiencing.

Some of us navigate these changes with ease, acknowledging the facts of life. Others may be sad as they shrug their shoulders in acceptance. “Being sad and being depressed are not the same,” said Dr. Ravi Srivastava, a board certified medical doctor in both psychiatry and neurology, who works at The Cove, a Senior Behavioral Health Program at Hilton Head Regional Hospital. “Being depressed about something is not a medical problem. Being acutely depressed about nothing is a medical problem—clinical depression. Feeling sad is not the same as when someone says, ‘Everything is fine in my life, but I’m always depressed.”

Dr. Srivastava added, “As we age, incidents of depression go up. Aging and co-morbidities can cause even worse depression and anxiety. When our abilities diminish, there is isolation due to changes in health conditions and the inability to do previous activities. Or we come here to retire and have a stroke or heart attack.” He said drug, alcohol, and prescription drug abuse also increases. “If a person cannot be managed at home and poses a threat, intervention is necessary,” he said.

The Cove is a new geriatric psych unit specialized to support seniors with acute emotional and psychological needs, established in 2020 to meet the needs of those 55+ years of age. Dr. Srivastava explained that The Cove is an acute care unit with an average stay of one week. “Our goal is to discharge patients to the highest level of safe and independent living,” he said. “Preventing falls, addressing agitation, feeding, and cleaning—our patients require a lot of hands-on care,” Simply put, he said, “The quality of our care cannot be compromised.”

Dr. Srivastava said that very few diseases are cured, that most lifelong conditions are managed, like heart disease, diabetes, or kidney disease. Mental illness, such as schizophrenia, is the same; it is managed through medication adjustments and psycho-social adjustments. Dr. Srivastava said, “We are here. Help is not far away. We offer acute care for emerging conditions. We are not long term care, but we plan for future care.”

The Cove offers help and hope to seniors who are experiencing self-injurious or suicidal thoughts or behaviors; destructive or combative behavior; behavior changes with potential for harm to self or others; delusions, hallucinations or paranoia; social withdrawal, loss of interest in personal appearance and hygiene; or dementia with behavioral disturbances such as agitation, anger and aggression.

A multi-disciplinary team approach ensures the highest quality of care. Each patient receives a complete medical evaluation to rule out emergent medical issues that may be causing their disturbances. Once accepted into The Cove, patients receive care from nurses, a psychiatrist, a social worker, a dietitian and a general medical physician. They also receive occupational, recreational and physical therapy. Dr. Srivastava said there are daily team meetings regarding each and every patient to determine the best care.

“There is no pill to make everything better. I believe in bio-psychological-social intervention,” Dr. Srivastava said. “A social worker is involved from the beginning, and family meetings and education are part of the program.” Before the patient is discharged, the level of care that will be needed is evaluated, and many questions must be answered. Can this person safely live independently? Will he/she be alone or with family? What outpatient care will be needed, such as a psychiatrist or neurologist? Would this person be better off in an assisted living facility or a memory care unit? What simple modifications in the home, such as lighting, may help confused dementia patients who wander?

There are several kinds of patients: Those with depression or anxiety, or agitation and dementia, or those with obsessive compulsive disorder or substance abuse, or patients with a psychosis. One size does not fit all, and the team’s goal is to discharge every patient to the highest level of independent living, with every resource and referral possible.

The Cove has a 16-bed capacity and serves a 200-mile radius including Charleston, Walterboro, Hampton and Columbia. For example, the emergency room at the Medical University of South Carolina (MUSC) may call to inquire if beds are available because theirs are full. Dr. Srivastava explained that The Cove is the only place of its kind in the region.

Dr. Srivastava’s philosophy of care is to use a strategic, bio-psycho-social approach to help his patients and their families by improving quality of life and reducing caregiver stress. His goal is to attain the highest level of functioning and long-term stabilization of the psychiatric illness.

How To Call For Help:
Begin the process by calling 888-682-2683. Answer some questions about the patient, and the unit psychiatrist will evaluate the patient information to determine the appropriate plan of action. The care in The Cove, the senior behavioral health unit at Hilton Head Hospital involves stabilizing the crises that led to the hospitalization, providing a thorough evaluation, developing a treatment plan and coordinating care in a supportive, physician supervised environment.