Solving the mental health crisis in long-term care facilities

Serious mental illnesses, substance use disorders, and anxiety and depressive disorders are at crisis levels among older adults. These mental health issues are frequently experienced by seniors who are in long-term care facilities.

It has been found that among residents of long-term care facilities, approximately 75% of residents have one or more mental health diagnoses, with dementia, depression, anxiety disorders and serious mental illness being the most common. This mental health crisis is believed to have been compounded by the social isolation and loneliness experienced during COVID-19. The escalation of mental health disorders among the elderly has created an urgent need to better equip long-term care facilities, whether residential or community-based.

This is supported by the Biden-Harris administration’s long-term care reform plan, which calls for the transformation of our mental health and crisis care systems to provide holistic and equitable care to people throughout the lifespan. of the long-term care continuum.

One of the biggest problems with providing this type of care is that the long-term care workforce currently lacks the capacity to recognize, assess, or treat health conditions. mental. Behavioral health specialists are rare among staff in long-term care facilities. Registered nurses, licensed practical nurses, and direct caregivers manage the care of people with multiple medical comorbidities, but often do not receive specialized training in behavioral health.

To provide high-quality, person-centred care, staff must be able to address all aspects of a person’s health, including chronic conditions, a range of mental illnesses, and use disorders. of substances. This requires education that is strategically planned and tailored to the role. Training of authorized personnel is important in the assessment and treatment of mental health issues.

But education cannot be exclusive to licensed personnel. Direct caregivers are the staff who spend the most time with residents, and they must have the tools to recognize and manage the behaviors that characterize mental health disorders.

Another factor is that the long-term care industry generally does not employ mental health specialists and often operates in a silo with no affiliation to other organizations, such as large health systems that may have access to mental health providers. Long-term care organizations should partner with community organizations that provide behavioral health services and have referral and follow-up processes in place. Mental health specialists offering group or individual therapy are available through these services to see residents of nursing homes, assisted living facilities or private homes. Seniors can also benefit from these services in the community. However, long-term care staff need to be trained to know what services are available and how to help people access them.

Finally, reimbursement for mental health services needs to be aligned with medical care. Many insurance companies, including Medicare, do not pay the full cost of these services, leaving the burden up to the individual or, in the case of nursing homes, the facility. This discourages the engagement of a mental health specialist. Mental health care can be integrated into a value-based payment system because research has shown that untreated mental health issues lead to more hospitalizations and exacerbate chronic disease.

As the population ages, the country needs a skilled workforce that can meet the mental and physical health needs of older adults, in addition to specialized mental health care networks that partner with organizations long-term care and federal investments in long-term care to support delivery. value-based mental health care. Without these elements, holistic, equitable, person-centred care will remain out of reach.

Tara A. Cortes, PhD, RN, FAAN, is executive director of the Hartford Institute for Geriatric Nursing and professor of geriatric nursing at NYU Rory Meyers College of Nursing.