Nursing home operators are increasingly investing in mental health, OUD services

Compounded by visitation restrictions and other challenges, seniors have had some of the highest rates of behavioral health problems during the COVID-19 pandemic. And while the public health emergency has become more manageable, many of these difficulties persist.

Yet older adults often lack access to behavioral health care, especially that in skilled nursing facilities (SNFs).

However, that may change with new federal funding and efforts by providers to improve behavioral health care for residents of NJUs. Specifically, a growing 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 has always been a strong need, but as we see the baby boomer population [aging], is growing even more,” Cindy Lafleur, executive director at Catholic Care Center, told Behavioral Health Business. “And I think that’s a really unmet need in our nursing home sector.”

Integration of mental health services in the SNF

Research shows that up to 30% of nursing home residents experience mild or severe depression. But 20 percent to 40 percent of medical 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 sought to address this issue by building an acute geriatric behavioral health facility on its campus. This can be a model for industry peers in the future.

The Bel Air, Kansas-based facility provides a range of senior-focused services, including: skilled nursing, independent living, assisted living, long-term care, memory care and a senior day program.

In 2019 and again in 2021, the center conducted market research, both times finding that behavioral health resources are key to residents’ health and well-being.

A behavioral health facility on campus, in theory, would make it easier for seniors to transition into care, LaFleur said. In addition, SNF residents who require acute psychiatric care can potentially avoid an expensive and stressful long trip to the emergency department.

Geriatric psychiatry patients can wait more than a day in the emergency room to be admitted, according to a 2018 study.

“We can care for these seniors in a less sterile environment and in a more home-like environment,” LaFleur said. “We believe we can do it on this campus, where it’s easier to transition and it’s a really natural fit for what we do.”

The new psychiatric unit will treat patients aged 55 and over with mental health and substance use conditions. The $13 million project is expected to open in June 2023.

Because behavioral health is a new license for the facility, the team needed to bring in stakeholders. This list of partners included Ascension Via Christi St. Francis, which helped Catholic Care Center understand the requirements of the Joint Commission and the Centers for Medicare & Medicaid Services (CMS).

In addition to understanding regulations, LaFleur said integrating behavioral health care into SNFs will also require staff training.

“We will have to train our teams. Instead of them throwing up their hands saying, ‘I can’t take care of this person,’ we have that opportunity to adjust medications appropriately,” LaFleur said. “[We can] help staff understand how to handle situations as with any other medical condition. My whole point is to destigmatize this whole aura around behavioral health—that someone can’t live in a setting because of their behavior. No, we have to adapt to this behavior.

Treatment of OUD in medical facilities

Behavioral health needs in SNFs extend beyond mental health care and also include SUD treatment.

Yet up to 81 percent of patients with opioid-related hospitalizations are turned away from post-acute care, recent research has revealed.

“There is a growing population of older adults who 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 in skilled nursing facilities, it would actually benefit a much larger population of adults already in skilled nursing facilities who may have an opioid use disorder.”

Policy changes could make care more affordable for skilled nursing residents.

In McGrath’s Health Affairs article, she suggests three policy changes: aligning Medicare reimbursement for opioid treatment providers (OTPs) within consolidated billing for SNFs, allowing addiction medicine physicians to prescribe and dose methods outside of OTPs and Medicare Part D coverage of methadone for OUD.

“These policy changes address an important opportunity to provide care for patients with OUD when they are already receiving medical care for another problem, outside of traditional specialty addiction treatment facilities,” McGrath wrote.

Operators are also looking for help to deal with this problem.

Boston Medical Center has launched a new training program aimed at improving post-acute care for SUD patients. The pilot includes educational programs for SNG.

Federal aid

The federal government is also paying more attention to behavioral health efforts in the OJSC.

In May, the Department of Health and Human Services (HHS) announced a three-year, $15 million federal grant related to the issue.

The funding is dedicated to establishing a Substance Abuse and Mental Health Services Administration (SAMHSA) program that provides behavioral health care to residents of 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 provides access to substance use prevention and treatment, 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 overall emotional and mental well-being, promotes person-centered behavioral health care, and advances our CMS Behavioral Health Strategy.”

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