Providing Behavioral Health Services in Nursing Homes Is Difficult: Findings From a National Survey

Orth, Jessica; Li, Yue; Simning, Adam; Temkin‐Greener, Helena

doi:10.1111/jgs.16017

Cited by 21 publications

(30 citation statements)

References 10 publications

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“…25 However, supply of BH services in NHs is yet to meet growing demand. 6 NHs face difficulties providing BH services, 6 and our findings demonstrate these shortcomings are associated with higher rates of severe depression, SI, and severe ABs among residents. Our findings suggest that severe BH manifestations are associated with modifiable facility-level factors, in agreement with prior studies.…”

Section: Discussionmentioning

confidence: 60%

“…We used 2017 survey data about BH service availability from a national random NH sample 6 . Survey questions were based on prior studies and an extensive literature review.…”

Section: Methodsmentioning

confidence: 99%

“…Key covariates were derived from the BH services survey. 6 Responses to three statements: (1) the level of BH education among our staff is an issue in our ability to provide good BH services; (2) there is inadequate coordination/collaboration between facility staff and community providers; and (3) we lack adequate facility infrastructure (ie, to make referrals/transport residents to services) were based on a 5-point Likert scale ranging from totally disagree (1) to totally agree (5). Scores of 4 to 5 were combined, creating dichotomous variables representing inadequate availability of BH services.…”

Section: Key Covariatesmentioning

confidence: 99%

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Severe Behavioral Health Manifestations in Nursing Homes: Associations with Service Availability?

Orth

Simning

et al. 2020

J American Geriatrics Society

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BACKGROUND/OBJECTIVES: Despite high prevalence of behavioral health (BH) manifestations among nursing home (NH) residents, availability of BH services in this care setting is often inadequate. Our objective was to examine associations between availability of BH services and the presence of severe depression, suicidal ideation (SI), and severe aggressive behaviors (ABs) among NH residents. DESIGN: Cross-sectional. SETTING/PARTICIPANTS: This study used 2017 survey data about BH service availability obtained from 1,051 NHs. The Minimum Data Set (MDS) was used to identify long-stay residents in these facilities (N = 101,238) and the prevalence of BH manifestations. Descriptive statistics and multivariable logistic regressions were used. MEASUREMENTS: We constructed measures of three severe BH manifestations based on the MDS: presence of depression, SI, and ABs. Three independent measures of service availability based on survey items asked about degrees of inadequate (1) staff BH education, (2) coordination/collaboration between facility/community providers, and (3) facility infrastructure (ie, ability to make referrals/transport residents to services). RESULTS: Odds of severe depression were 21% higher (odds ratio [OR] = 1.21; P < .001) when NHs reported inadequate BH staff education. Residents with SI had 13% higher odds (OR = 1.13; P = .027) of living in NHs that reported inadequate coordination between facility and community providers. Severe ABs were 10% more likely among residents in NHs reporting inadequate facility infrastructure (OR = 1.10; P = .002) and 7% more likely in facilities with self-reported inadequate coordination between facility/community providers (OR = 1.07; P = .019). Several facilitylevel factors (eg, staffing, training, turnover) were also statistically significantly associated with these severe BH manifestations. CONCLUSION: Residents in NHs reporting inadequate BH services were more likely to experience adverse severe BH manifestations even after controlling for individual and facility-level risk factors. Higher nurse staffing and more staff psychiatric training were associated with lower prevalence of severe BH manifestations. Policy changes and modifications to Medicaid NH reimbursements may be warranted to better incentivize NHs to improve provision of BH services.

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Section: Discussionmentioning

confidence: 60%

“…We used 2017 survey data about BH service availability from a national random NH sample 6 . Survey questions were based on prior studies and an extensive literature review.…”

Section: Methodsmentioning

confidence: 99%

Section: Key Covariatesmentioning

confidence: 99%

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Severe Behavioral Health Manifestations in Nursing Homes: Associations with Service Availability?

Orth

Simning

et al. 2020

J American Geriatrics Society

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“…Unmet mental health need among older adults is especially pervasive in long-term care settings (Orth et al, 2019). Although most older adults live and are cared for in the community, the mental health needs of older individuals in long-term care settings have historically been substantially unmet.…”

Section: Meeting the Enduring Mental Health Needs Of Older Adults: Ad...mentioning

confidence: 99%

Advancing the field and future of clinical geropsychology: Honoring the enduring legacy of Michael Duffy, PhD, ABPP.

Karlin¹,

Molinari²

2021

Clinical Psychology: Science and Practice

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The field of clinical geropsychology has advanced considerably over the past few decades to become a mature discipline and specialty field. Recently, the geropsychology community lost a revered leader, Dr. Michel Duffy, who led major advances in geropsychology training and practice. The current article honors the legacy of Dr. Duffy and traces the maturation of the field of clinical geropsychology, with particular focus on advances in professional guidelines and competencies, training and professional development, and service delivery. It is hoped that this review and tribute to Dr. Duffy promotes awareness of and interest in clinical geropsychology at a time of unprecedented need to meet the psychological and social needs of older adults following from the COVID-19 pandemic and associated psychological sequelae. Public Health Significance StatementThe present article reviews key advances in geropsychology training and practice, including the development of professional guidelines and competencies, training paradigms, and care delivery models for enhancing and promoting competent psychological practice with older adults. Through honoring the legacy of Dr. Michael Duffy and reviewing major advances in clinical geropsychology, the article is intended to promote awareness of the evolution and current status of clinical geropsychology as a mature discipline and specialty field and to increase attention to effectively meeting the mental health needs of older adults at a pivotal time.

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“…In addition to those older adults with neurocognitive disorders, long-term care providers serve the needs of older adults with a range of psychosocial conditions including severe mental illness, substance use disorders, and homelessness. 3 According to a 2019 national study published in the Journal of the American Geriatrics Society, 4 behavioral health disorders affect 65% to 90% of nursing home residents. The care of this population presents growing challenges to long-term care providers because of their special treatment needs, which include specialized behavioral interventions as well as medications known to carry increased risk when used in older individuals.…”

mentioning

confidence: 99%

Dementia Care in Delaware:

Heiks¹

2021

Delaware Journal of Public Health

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Delaware has over 80 long-term care providers, including skilled nursing, intermediate care, and assisted living facilities. That number is growing. The state is fortunate to have providers specializing in pediatric care and others caring solely for individuals with intellectual and developmental disabilities. Skilled nursing facilities, staffed by licensed healthcare professionals, provide post-acute care including specialized therapies, medications, and medical equipment. Assisted living facilities (ALF) designed to provide personalized assistance with activities of daily living are state-licensed and increasing across the country. Some ALFs specialize in care for individuals with memory issues. Assisted living services can be provided in stand-alone buildings or in a separate wing of a larger facility offering additional types of care. Residents in assisted living maintain contact with their primary care physicians and medical specialists.In Delaware, an additional level of care is available, providing flexibility for residents and families. Intermediate nursing care provides regular nursing care to residents who do not require hospitalization or skilled nursing care but need services above the level of room and board. Delaware's providers are a unique mix of non-profit and for-profit, regional leaders and single building facilities; some are family-owned. Many of the providers have long histories of caring for the elderly and disadvantaged. Nationwide, approximately 60% of nursing home residents rely on Medicaid to help pay for their care. The long-term care industry is highly regulated, and there are numerous state and federal rules about what long-term-care providers can and cannot do.

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Providing Behavioral Health Services in Nursing Homes Is Difficult: Findings From a National Survey

Cited by 21 publications

References 10 publications

Severe Behavioral Health Manifestations in Nursing Homes: Associations with Service Availability?

Severe Behavioral Health Manifestations in Nursing Homes: Associations with Service Availability?

Advancing the field and future of clinical geropsychology: Honoring the enduring legacy of Michael Duffy, PhD, ABPP.

Dementia Care in Delaware:

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