Behavioral Health Services in NFCs: Key Challenges and Opportunities

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The psychological effects of COVID-19 have triggered an increase in demand for behavioral health services in skilled nursing facilities, but dwindling staffing and increasingly complex resident populations have made it difficult for providers to respond to these needs.

Under normal circumstances, continuity and staff education would help patients overcome social isolation, trauma and stress related to the pandemic. However, the new skilled nursing landscape requires a more innovative approach to behavioral health, creating new challenges and opportunities for providers in the wake of Covid.

From navigating complex patient populations and managing medications to creating the ideal treatment structure, the right approach to behavioral health can result in better outcomes for the modern post-acute patient, leading to clients and to more satisfied staff.

Meeting demand for behavioral health services in NFCs

SNF populations have changed dramatically since the start of the pandemic, and with the influx of cases of homelessness, mental illness and addiction, among others, existing staff have been tasked with doing more with less. “The pandemic has caused a major crisis, not only within the patient population, but also within the staff populations responsible for caring for them,” said Dr. Wayne Tasker, national director of behavioral health for the provider of TeamHealth medical services, during a recent RETHINK podcast episode with Skilled Nursing News.

Providers take a two-pronged approach to overcoming this challenge by monitoring burnout at the leadership level and providing educational opportunities that enable residents and staff to succeed.

At the height of the staffing crisis, providers are focused on reducing caregiver churn and burnout, but many have not applied the same principles at the leadership level. By focusing on front-line performance, executives run the risk of burning out and canceling their work to avoid burnout at other levels of the organization. If leaders lack the ability to meet new challenges because they don’t take care of themselves, the rest of the organization will not be prepared to meet them as well.

“It’s imperative that providers take care of themselves so they can provide the services their teams, patients, and families need,” says Dr. Tasker.

From there, providers can create continuing education opportunities that improve recruitment and retention while equipping caregivers with the essential skills and knowledge needed to care for a diverse population of behavioral health patients.

“With staff turnover and all the changes happening in post-acute care, we need to make sure that we are providing staff with the training and tools they need to serve new patient populations,” says the director. TeamHealth Behavioral Health Medical Officer in Post-Acute Care, Dr. Richard Thompson Jr.

“You can create more problems for your organization simply by not providing staff with the proper training.”

Create the ideal behavioral health structure

In post-acute settings, the ideal behavioral health framework incorporates both psychiatry and psychology. Medication management is usually led by psychiatric nurse practitioners and supervised by psychiatrists.

Simultaneously, licensed psychologists and clinical social workers
(LCSW) offer psychotherapy to address the source of cognitive and behavioral disorders while limiting drug dependency. Combining these two areas can produce results for any type of mental or behavioral health case, but the best approach to medication management may differ from patient to patient.

When new patients are admitted to a post-acute care facility, many of them are already taking psychiatric medications or have some type of behavioral disorder that could benefit from the use of psychiatric medications. Likewise, longer-term residents may show signs of change that could benefit from psychiatric medication.

Dr. Tasker recommends that new patient medications be evaluated based on why treatment was initiated, how the patient responded, any side effects that may have occurred, and the appropriateness of the medication. Since many of these referrals are from hospitals, patients may have been treated for temporary cognitive or behavioral diagnoses that are no longer present. It is also possible that new patients may have already benefited from the use of psychiatric drugs prior to admission, and it is important not to make unnecessary changes that could hinder rehabilitation progress.

Residents who have been in the facility for longer may show symptoms of behavioral and cognitive disorders that were not present when they were admitted. These changes may require intervention, and although a non-pharmacological approach is always preferred, medication might be the most effective solution. In these circumstances, providers should seek the lowest possible dose of drugs with minimal impact on cognition.

“Providers should aim to achieve the best symptom relief for behavioral and cognitive disorders while avoiding adverse effects with the lowest doses needed,” says Dr. Thompson.

TeamHealth provides administrative support and care practice management services across the continuum of care, from inpatient practices to post-acute care and virtual care. To learn more about how they are helping skilled nursing facilities and senior communities facilitate behavioral health services to meet growing needs, listen to the full podcast here.

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