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Psychiatric Care

The Bluestone Psychiatric Team, under the direction of Dr. David Gish, provides both on-site and virtual visits (see below) for patients requiring psychiatric care.


Older adults have special physical, emotional, and social needs. Age-related complications include dementia, depression, anxiety, and late-life schizophrenia. Other concerns may include difficulty coping with change, stress, death, depression, memory problems, anxiety, or agitation. Sometimes chronic medical conditions cause emotional problems to occur for the first time in older adults. Psychiatric care offers valuable help to older adults who are coping with these changes in health and function.

On-site or virtual visits by a psychiatrist allow patients living in a group home setting or attending community day programs to receive the care they need.


A patient residing in a community where Bluestone provides care would see the Bluestone Primary Care Team first, to determine if a referral for psychiatric care is needed. In addressing complex situations involving both medical and mental illness, Bluestone Primary Care Providers collaborate closely with the Psychiatric Team in managing medications and other interventions to support the patient’s mental health.

When a patient is referred for Bluestone Psychiatric Care, a visit date is set for either an in-person visit or a virtual visit (see information below).  The first visit with a patient involves getting a complete medical history, a neurological exam, including tests of memory, problem-solving, language, and counting, a mental status exam and an assessment of functional capabilities. It is beneficial to have family or other caregivers present who can help provide information and observations that the patient may not be able to articulate.  A plan is then developed by the Psychiatrist to address mental health issues.  A schedule is set up for regular follow-up visits to track progress.


Virtual Visits are implemented to give patients real-time access to the psychiatrist using a webcam and a personal computer. Bluestone staff or other Healthcare Professional assists with the setup. Bluestone employs video technology that allows the Psychiatric Team to conduct patient interviews while incorporating the privacy and security measures we require. Bluestone patients will be able to have their follow-up visits from the comfort of their residence with minimal disruption to the patient’s daily routine.


The primary purpose of psychiatric treatment is to improve the quality of life of the patient.

Additional goals include:

  • Educating family and caregivers on the risks and benefits of psychotropic drugs and avoiding or reducing the use of these medications where possible.
  • Educating and involving nursing staff at residential communities to support psychiatric care.
  • Avoiding hospitalizations for psychiatric issues.
  • Reducing the impact of high-cost medications by using generic equivalent prescriptions.


  • Facility Programming
    • Staff training on behavior plans and memory care program development
  • Consultation:
    • Primary care teams and care coordinators consult with Bluestone psychiatrist
    • Routine antipsychotic management
    • Behavioral health-related transitions of care
  • Tele-Health/Virtual Visits:
    • Community-based crisis management
    • Ongoing medication management
    • Supported by selected payers
  • Face-to-Face:
    • On-site psychiatry visit
    • High collaboration with facility/community staff
    • Supported by all payers
  • Psychiatric Primary Care (Medical Home)
    • Intensive psychiatric management for high-risk MH patients.
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