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


Magnified by visitation restrictions and other challenges, older adults had some of the highest rates of behavioral health issues during the COVID-19 pandemic. And although the public health emergency has become more manageable, many of these challenges persist.

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

That could change, however, with new federal funding and provider efforts to improve behavioral health care for SNF occupants. 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], it grows even more,” Cindy LaFleur, executive director of the Catholic Care Center, told Behavioral Health Business. “And I think that’s a real unmet need in our retirement home industry.”

Integration of mental health services in NFS

Research shows that up to 30% of nursing home residents suffer from minor or major depression. But 20% to 40% of nursing facilities nationwide say providing basic behavioral health services is “difficult” or “very difficult,” according to a study by the College of Medicine and Dentistry. University of Rochester.

Catholic Care Center seeks to address this issue by building an acute geriatric behavioral health facility on its campus. It could be a model for his industry peers in the future.

The Bel Aire, Kansas facility offers a number of senior-focused services including: skilled nursing, independent living, assisted living, long-term care, memory care, and adult day program.

In 2019 and again in 2021, the center conducted market research, each time concluding that behavioral health resources were critical to resident health and well-being.

An on-campus behavioral health facility, in theory, will ease seniors’ transition into care, LaFleur said. Additionally, SNF residents requiring acute mental health care can potentially avoid a long, costly and stressful trip to the emergency room.

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

“We can take care of these seniors in a less sterile environment and in a more family environment,” LaFleur said. “We think we can do it on this campus, where the transition is easier and fits very naturally with what we do.”

The new Geriatric Psychiatry Unit will treat patients 55 and older with mental health and addiction issues. The $13 million project is expected to open in June 2023.

Since behavioral health is a new license for the facility, the team had 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 the regulations, LaFleur said integrating behavioral health care into SNF will also require staff training.

“We will have to train our teams. Instead of giving up and saying, ‘I can’t take care of this individual,’ we have this ability to adjust the medications appropriately,” LaFleur said. “[We can] help staff understand how to handle situations like any other health issue. My goal is to de-stigmatize this whole aura around behavioral health – that someone can’t live in an environment because of their behaviors. No, we have to adapt to these behaviors.

Treating OUD in Nursing Facilities

Behavioral health needs in NFS go beyond mental health care and also include SUD treatment.

Yet up to 81% of patients hospitalized with opioids are rejected from post-acute care, recent research has found.

“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 subject, told BHB. “By addressing the problem of discrimination by expanding access to methadone in skilled nursing facilities, it would actually benefit a much larger population of adults who are already in skilled nursing facilities. and who may have an opioid use disorder.”

Policy changes could help make care more accessible to residents of skilled nursing facilities.

In McGrath’s Health Business article, she suggests three policy changes: aligning Medicare reimbursement for opioid treatment providers (OTPs) with consolidated SNF billing, allowing addiction physicians to prescribe and to dose the method outside of OTPs, and cover methadone for OUD with Medicare Part D.

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

The operators are also looking to solve this problem.

Boston Medical Center has launched a new training program aimed at improving post-acute care for patients with SUD. The pilot project included education programs for NFCs.

Federal aid

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

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 for the establishment of a Substance Abuse and Mental Health Services Administration (SAMHSA) program that provides behavioral health care to residents of nursing homes and other long-term care facilities. duration. The grant is funded by the CMS Civil Money Penalty (CMP) fund.

“This grant and our partnership with SAMHSA provides access to substance abuse prevention and treatment, mental health services, crisis intervention and pain treatment,” the CMS administrator said. , Chiquita Brooks-LaSure, 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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