Stedfast Psychiatry provides geriatric psychiatry for adults over 65 in our offices, by telehealth, and on-site at assisted living, independent living and skilled nursing facilities through the Stedfast Living program. We treat late-life depression and anxiety, behavioral symptoms of dementia, and review medication regimens for polypharmacy. Medicare and most major insurance plans are accepted.
Stedfast Psychiatry treats older adults in our offices, by video, and where they live. Through our Stedfast Living program, our clinicians visit assisted living facilities, independent living communities and skilled nursing facilities across Florida and South Carolina, so that residents who cannot travel still get psychiatric care from a specialist rather than from a crisis call. Medicare is accepted.
Who it is for
Our geriatric services are for older adults with depression, anxiety, grief, sleep disturbance, psychosis, bipolar disorder, or the behavioral and psychological symptoms of dementia such as agitation, aggression, wandering, sundowning, paranoia and resistance to care. They are also for older adults on complicated medication regimens whose family or physician suspects that a psychiatric medication is causing confusion, falls or sedation rather than helping.
The Stedfast Living program is specifically for residents of assisted living facilities, independent living communities, memory care units and skilled nursing facilities who need ongoing psychiatric follow-up where they live. We work with facility nursing staff, the attending physician, and families. We also see community-dwelling older adults in any of our 13 offices or by video, including those cared for at home by a spouse or adult child who needs guidance on managing behavior and medication.
How it works
Evaluation of an older adult starts with the same structured interview we use for every patient and adds screening for cognitive impairment (MoCA or Mini-Cog), a careful medication reconciliation, review of recent labs and imaging, and collateral from family or facility staff. We look specifically for the medical causes that commonly masquerade as psychiatric illness in late life: thyroid disease, B12 deficiency, urinary tract infection, pain, hearing and vision loss, sleep apnea, and medications with anticholinergic or sedative effects. The Geriatric Depression Scale and the Cornell Scale for Depression in Dementia replace the PHQ-9 where appropriate.
Treatment is conservative by design. Antidepressants are started at half the usual dose and increased slowly. We avoid benzodiazepines and sedating antihistamines wherever possible because of fall and delirium risk. For behavioral symptoms of dementia, the first step is identifying triggers (pain, constipation, infection, overstimulation, unmet needs) and adjusting the environment and routine; medication is added only when non-drug approaches are insufficient and the symptom is causing distress or danger. When antipsychotics are used in dementia, we document the rationale, use the lowest effective dose, and plan gradual dose reduction in line with CMS requirements.
In facilities, our clinicians round on a regular schedule, review the chart and medication administration record, meet with the resident and nursing staff, and leave documentation that supports the facility's compliance obligations. Between rounds, telepsychiatry visits handle urgent changes. Families receive updates with the resident's or their representative's consent, and we coordinate with the attending physician and pharmacy consultant on every medication change.
Depression affects an estimated 1 to 5 percent of community-dwelling older adults, but 13.5 percent of those receiving home health care and up to 11.5 percent of those hospitalized.
Source: CDC, Depression is Not a Normal Part of Growing Older
Up to 90 percent of people with dementia experience at least one behavioral or psychological symptom over the course of the illness.
Source: Alzheimer's Association; Cerejeira et al., Frontiers in Neurology, 2012
Men aged 75 and older have the highest suicide rate of any age group in the United States, at roughly 42 per 100,000.
Source: CDC WISQARS, 2021 data
Roughly 40 percent of adults over 65 take five or more prescription medications, the threshold commonly used to define polypharmacy.
Source: Lown Institute, Medication Overload report, 2019
What to expect
For office or video visits, a new-patient geriatric evaluation runs 60 minutes and we strongly encourage a family member or caregiver to attend. Bring every medication bottle, including over-the-counter products and supplements, and any recent hospital discharge paperwork. Follow-ups are every two to four weeks while medications are being adjusted, then every one to three months. Many older patients find video visits easier than travel, and we offer them to anyone in Florida or South Carolina with a caregiver or facility staff available to help with the technology.
For facility residents, the facility or family contacts us to request a consultation. We obtain consent from the resident or their legal representative, review records, and schedule the first on-site visit, typically within one to two weeks and sooner for urgent behavioral concerns. After that, the resident is seen on our regular rounding schedule for that facility, with telepsychiatry in between as needed. Families can request a call after any visit.
Benefits
- Specialists in late-life depression, anxiety and dementia-related behavior
- Medication regimens reviewed for interactions, falls and confusion risk
- On-site care at assisted living, independent living and skilled nursing facilities
- Non-drug approaches to behavioral symptoms before medication
- CMS-aligned documentation and gradual dose reduction planning
- Family and facility coordination built into every plan
- Medicare and most insurance accepted
Risks and side effects
Older adults are more sensitive to psychiatric medications and more likely to experience side effects. Antidepressants can cause low sodium (hyponatremia), especially SSRIs in the first weeks, as well as falls and gastrointestinal bleeding when combined with blood thinners or NSAIDs. Antipsychotics carry an FDA boxed warning for increased mortality in elderly patients with dementia-related psychosis and raise the risk of stroke, falls, sedation and movement disorders; we use them only when the benefit clearly outweighs the risk and we review them regularly. Benzodiazepines and sleep medications increase falls, confusion and delirium and are on the Beers list of medications to avoid in older adults.
We monitor sodium, kidney function, EKG where relevant, and weight, and we check for movement side effects at visits. The counterbalancing risk is undertreatment: untreated late-life depression raises mortality, worsens heart disease and diabetes outcomes, and is the strongest risk factor for suicide in older men. Doing nothing is not the safe option.
Cost and insurance
Geriatric psychiatric evaluation, medication management and psychotherapy are covered by Medicare Part B as outpatient mental health services, including visits delivered in an assisted living facility or skilled nursing facility and visits by telehealth. After the Part B deductible, Medicare pays 80 percent and the patient or a supplemental plan pays 20 percent; Medicare Advantage plans apply their own copays. Most commercial plans are also accepted for patients under 65 or with employer coverage.
For skilled nursing residents in a Part A stay, psychiatric visits are billed separately under Part B by our practice, not by the facility. Facilities contract with Stedfast Living for the rounding service, and residents are not charged a facility fee by us. Self-pay rates are available; the new-patient visit is $185. Lab monitoring is billed by the laboratory.
Late-life depression
After 65, depression is more likely to present with physical symptoms, irritability, withdrawal and cognitive complaints than with expressed sadness. It is strongly linked to medical illness (stroke, heart disease, Parkinson's disease, chronic pain) and to loss: of a spouse, of independence, of a home. It is also frequently dismissed, by patients who feel they should be able to cope and by clinicians who assume low mood is reasonable given the circumstances. It is not reasonable to leave it untreated. Depression in older adults worsens outcomes in nearly every chronic disease and is the single biggest risk factor for suicide in older men.
Treatment works. Antidepressants, started low and raised slowly, are effective; sertraline and escitalopram are common first choices because of their interaction profiles. Psychotherapy, particularly problem-solving therapy and CBT adapted for older adults, is effective alone for mild to moderate cases and in combination for severe ones. For depression that has not responded to medication, Deep TMS at our Palm Beach Gardens office is an option with a good safety profile in older adults.
Behavioral and psychological symptoms of dementia
Agitation, aggression, wandering, calling out, sleep reversal, paranoia and refusal of care are the symptoms that most often lead to a psychiatric referral from a facility. They are also the symptoms most often treated with sedation that makes things worse. Our approach follows a fixed order. First, rule out delirium and medical causes: urinary infection, pain, constipation, dehydration, a new medication. Second, look at the environment and routine: noise, lighting, staffing changes, unmet needs for food, toileting or company. Third, teach staff and family specific behavioral strategies. Only then, and only for symptoms that cause real distress or risk, do we consider medication, choosing the agent with the best evidence for the specific symptom and the lowest risk, and documenting a plan for gradual dose reduction from the outset.
Polypharmacy review
Each geriatric evaluation includes a full medication reconciliation. We are looking for drugs on the Beers list of medications potentially inappropriate in older adults (benzodiazepines, sedating antihistamines, tricyclic antidepressants, many muscle relaxants), for duplications across prescribers, for anticholinergic burden, and for psychiatric medications that were started during a hospitalization and never stopped. Reducing a medication list is often the single most effective intervention we make.
Working with families
Families carry much of the load in late-life mental illness, and they are often the best source of history. We involve them, with consent, from the first visit: what has changed, when, what has helped, what the patient was like before. We also recognize caregiver strain as a clinical problem in its own right, and we are glad to see a caregiving spouse or adult child as a patient when the burden becomes too much.
Where we see older adults
In any of our 13 offices, by video for patients in Florida or South Carolina, and on site at facilities contracted with Stedfast Living. If you administer a facility and want to know how the program works for your residents and your compliance obligations, see our page on psychiatric services for assisted living and skilled nursing facilities.
Frequently asked questions
Is depression normal in old age?
No. It is common, but it is not a normal part of aging and it is treatable. Late-life depression often looks different: more physical complaints, more memory and concentration problems, less overt sadness. It is also frequently missed because patients and families attribute it to age or illness. Treatment improves mood, physical health outcomes and quality of life at any age.
Does Medicare cover geriatric psychiatry?
Yes. Medicare Part B covers psychiatric evaluation, medication management and psychotherapy as outpatient mental health services, including visits in assisted living and skilled nursing facilities and by telehealth. You pay the Part B deductible and 20 percent coinsurance unless a supplemental plan covers it. Medicare Advantage plans apply their own copays. We accept Medicare at all locations.
What is the Stedfast Living program?
It is our facility-based service. Stedfast clinicians round on a regular schedule at assisted living, independent living, memory care and skilled nursing facilities in Florida and South Carolina, seeing residents where they live, coordinating with nursing staff and attending physicians, and providing telepsychiatry coverage between visits. Facilities and families can both request a consultation.
How do you handle agitation in dementia?
First by finding the cause: pain, infection, constipation, hunger, overstimulation, a change in routine or a medication effect account for a large share of agitation. Then with environmental and behavioral strategies, which we teach to staff and family. Medication is reserved for symptoms that persist and cause distress or danger, started low, documented carefully and reviewed for gradual dose reduction.
My parent is on 14 medications. Can you review them?
Yes, and we do it at every geriatric evaluation. Polypharmacy is a leading cause of confusion, falls and hospitalization in older adults, and psychiatric medications are frequent contributors. We reconcile the full list, flag interactions and Beers list medications, and coordinate with the primary physician and pharmacist on what can be reduced or stopped. Bring every bottle.
Can my parent be seen by video?
Yes, if they are in Florida or South Carolina and someone (a family member, aide or facility staff) can help with the device. Video visits work well for follow-ups and medication checks. The first evaluation is often better in person or on-site at the facility, where we can also observe gait, tremor and the living environment. We alternate as needed.
Will you communicate with the family?
Yes, with the patient's consent or that of their legal representative. We encourage a family member at the first evaluation and provide updates after visits on request. For facility residents, we coordinate with the facility's designated contact and the family, and we will join care plan meetings by phone when asked.
What about memory loss itself?
We screen for cognitive impairment at every geriatric evaluation and can distinguish depression-related memory complaints from early dementia in many cases. When a neurocognitive disorder is suspected, we coordinate with neurology or primary care for workup and imaging, and we manage the mood and behavioral symptoms that accompany it. Dementia medications may be prescribed by us or by neurology depending on the case.
Where this treatment is offered
- Boynton Beach, FL
10301 Hagen Ranch Rd, Suite D720 and Suite B710 - Palm Beach Gardens, FL
11641 Kew Gardens Ave, Suite 209 - Stuart, FL
729 SW Federal Hwy, Suite 104 - Royal Palm Beach, FL
420 South State Road 7, Suite 112 - Jacksonville, FL
2950 Halcyon Lane, Suite 605 - Port St. Lucie, FL
266 NW Peacock Blvd, Suite 203 - Melbourne, FL
6300 North Wickham Road, Suite 110 - Fort Lauderdale, FL
3107 Stirling Road, Suite 107 - Jupiter, FL
3893 Military Trail, Suite 3 - Goose Creek, SC
118 Springhall Drive, Suites B and F - Lexington, SC
120 Brookside Parkway, Suite C - Bluffton, SC
25 Clarks Summit Drive, Suite F201 - Hilton Head Island, SC
19 Shelter Cove Lane, Suite 202
Conditions this treats
If you are in crisis, call or text 988 or go to the nearest emergency room. Educational content; individual results vary. Reviewed by Dr. David Husted, board-certified psychiatrist.