Magnified by visitation restrictions and other challenges, seniors had some of the highest rates of behavioral health conditions during the COVID-19 pandemic. And while the public health emergency has become more manageable, many of those difficulties continue.
Yet seniors often don’t have access to behavioral health care, particularly those in skilled nursing facilities (SNFs).
This could be changing, though, with new federal funding and providers’ efforts to improve behavioral health care for SNF occupants. Specifically, an increasing number of organizations are integrating mental health and substance use disorder (SUD) care into their long-term care facilities.
Catholic Care Center is one such operator.
“There’s always been a strong need, but as we see the baby boomer population [aging], it’s growing even more,” Cindy LaFleur, executive director at Catholic Care Center, told Behavioral Health Business. “And I think it’s a real unmet need in our sector of nursing homes.”
Integrating mental health services into SNFs
Research shows that up to 30% of nursing home residents experience minor or major depression. But 20% to 40% of nursing facilities nationwide report that providing basic behavioral health services is “difficult” or “very difficult,” according to research from the University of Rochester School of Medicine and Dentistry.
Catholic Care Center is looking to tackle this issue by building an acute geriatric behavioral health facility on its campus. This could be a model for its industry peers in the future.
The Bel Aire, Kansas-based facility provides a number of senior-focused services including: skilled nursing, independent living, assisted living, long-term care, memory care and an adult day program.
In 2019 and again in 2021, the center conducted a market study, finding both times that behavioral health resources were key to residents’ health and well-being.
A behavioral health facility on campus, in theory, will make it easier for seniors to transition to care, LaFleur said. Additionally, SNF residents requiring acute mental health care can potentially avoid a costly and stressfully long trip to the emergency room.
Geriatric psychiatry patients can wait over a day in the ER to be admitted, according to one 2018 study.
“We can care for those seniors in a less sterile environment and in a more home-like environment,” LaFleur said. “We believe that we can do it on this campus, where it’s an easier transition and it’s a real natural fit for what we do.”
The new geratric psych unit will treat patients 55 and over with mental health and substance use conditions. The $13 million project is anticipated to open in June 2023.
Since behavioral health is a new license for the facility, the team had to bring in stakeholders. That list of partners included Ascension Via Christi St. Francis, which helped Catholic Care Center understand the Joint Commission and Centers for Medicare & Medicaid Services (CMS) requirements.
In addition to understanding regulations, LaFleur said that integrating behavioral health care into SNFs will also take staff education.
“We’re going to have to train our teams. Instead of throwing up their hands saying, ‘I can’t care for this individual,’ we have that opportunity to adjust the medications appropriately,” LaFleur said. “[We can] help the staff understand how to deal with the situations just like any other medical condition. My whole goal is to de-stigmatize that whole aura around behavioral health – that someone can’t live in a setting because of their behaviors. No, we have to adapt to those behaviors.”
Treating OUD in nursing facilities
Behavioral health needs in SNFs extend beyond mental health care and also include SUD treatment.
Yet up to 81% of patients with an opioid-associated hospitalization are rejected from post-acute care, recent research revealed.
“There’s a growing population of older adults that have opioid use disorder (OUD),” Molly McGrath, author of a recent Health Affairs article on the topic, told BHB. “By addressing the issue of discrimination by expanding access to methadone at skilled nursing facilities, it would actually benefit a much larger population of adults that are already in skilled nursing facilities that may have opioid use disorder.”
Policy changes could help make care more accessible for skilled nursing facility residents.
In McGrath’s Health Affairs article, she suggests three policy changes: aligning Medicare reimbursement for opioid treatment providers (OTP) under SNFs consolidated billing, enabling addiction medicine doctors to prescribe and dose methode outside of OTPs, and covering methadone for OUD with Medicare Part D.
“These policy changes target an important opportunity to provide care for patients with OUD when they’re already undergoing medical care for another issue, outside traditional specialty addiction treatment facilities,” McGrath wrote.
Operators are also looking to help address this issue.
Boston Medical Center rolled out a new training program aimed at enhancing post-acute care for patients with SUD. The pilot included education programs for SNFs.
Federal help
The federal government is also giving behavioral health efforts in SNFs more attention.
In May, the Department of Health and Human Services (HHS) announced a $15 million three-year federal grant related to the issue.
The funding is dedicated to establishing a Substance Abuse and Mental Health Services Administration (SAMHSA) program that delivers behavioral health care to residents in nursing facilities and other long-term care facilities. The grant is funded by the CMS Civil Money Penalty (CMP) fund.
“This grant and our partnership with SAMHSA provide access to prevention and treatment for substance use issues, mental health services, crisis intervention, and pain care,” CMS Administrator Chiquita Brooks-LaSure said in a statement. “Making behavioral health care a priority in nursing homes and other long-term care facilities supports a person’s whole emotional and mental well-being, promotes person-centered behavioral health care, and advances our CMS Behavioral Health Strategy.”
Companies featured in this article:
Catholic Care Center, Centers for Medicare & Medicaid Services, Health Affairs
