Welcome from Dr. Orr

Dr. William Orr

The GRACE Unit is an acute psychiatric care unit specializing in assessing and treating patients age 65 and older with a range of psychiatric and behavioral problems and neurobehavioral problems, including dementia. For many, coming to a place like the GRACE Unit is an unfamiliar experience. I want to take a moment to let you know how we will work with your loved one and what you can expect from us.

During a GRACE Unit stay, two providers see the patient. The geriatric physician, along with my geriatric nurse practitioner, and one is an internal medicine consulting physician.

As the geriatric physician, I meet patients for the first time within the first few days of their admission and see them daily during the week. The consulting internist sees the patient upon admission and as appropriate to manage ongoing for medical issues. Nursing staff obtains information from families and others about what has been happening with the patient and why they are visiting the GRACE Unit. They will be asking families and caregivers many detailed questions so that our entire team can understand the patient’s unique situation and be of maximum assistance. The nurses, social workers, and mental health technicians are critical members of the multidisciplinary treatment team. On the days that I am not on the unit, I am in phone contact with the staff to direct medication adjustments, review laboratory tests, or assist with discharge planning.

When patients come to the GRACE Unit, they are often very ill. They can be very distressed, anxious, depressed, paranoid, and even psychotic. The majority of them also have significant cognitive impairment or even dementia. Our staff is experienced and skilled at using behavioral approaches to help patients remain calm. Despite these behavioral strategies, if a patient is combative or aggressive with care or severely distressed, we will likely be using medications. These are potent medications with many potential side effects, including sedation. The nursing staff will review consent forms with you regarding medications and their possible side effects.

I make every effort to prescribe the minimum amount of medication necessary, but some level of sedation or loss of function may occur. Finding the proper dosage or combination of medications is critical to the patient's progress while at the GRACE Unit.

The nursing staff will orient you to the policy regarding visiting hours and address any concerns or questions you may have. We ask families to select one primary contact person. In most cases, this will be the individual who has been granted substitute decision-making authority (e.g., power of attorney) by the patient or courts. In our experience, this helps avoid miscommunications and leaves the nurses with more time to be involved in direct patient care.

During the patient’s stay, the primary family contact will receive updates from the unit social worker. On average, patients are on the GRACE Unit for about seven to 10 days. Sometimes when patients are discharged, they may still have some symptoms. Most often, they are improved to the point where they can return to their living situation and tolerate adjustments to the medications. We expect that most patients will need to work with their primary care physician or care facility to manage their new medications.

We are very proud of the members of our GRACE Unit treatment team. Working together, we have helped many patients. Due to the complexities of human behavior, brain functioning, and how patients react to different environments, we sometimes have to modify our expectations of success. Nevertheless, we understand that most patients and their families are under considerable stress and have many concerns when they first arrive. I want you to know that we will do our very best to address those concerns and help those entrusted to our care.

Sincerely,  

William B. Orr, PhD, MD
American Board of Psychiatry and Neurology
Certified in General and Geriatric Psychiatry