Managing Chronic Mental Illness in the Long-Term Care Community

Due to the shortage in the availability of psychiatric care services, skilled nursing facilities are increasingly providing care to patients with persistent mental illness, such as bi-polar disorder or schizophrenia. In fact, a 2011 study published in the Journal of Aging & Social Policy indicates that the “percentage of new nursing home admissions with mental illness now exceeds the percentage presenting with dementia only.”
Many such patients find themselves residing in skilled nursing facilities for extended periods of time, creating a challenge to nursing staff who are not necessarily trained to meet the special needs of these patients.
There are a number of specific challenges associated with caring for patients with psychiatric conditions:

•  Use of psychotropic medications. There is increased scrutiny and stiffening of regulations regarding the administration of these medications. Knowing when and how to use them is critical and requires a specific knowledge base and experience. 
•  Non-pharmacological interventions. Knowledge of these techniques comes with proper training, education, and experience, and non-pharmacological management of challenging behaviors must be included in the patient’s care plan when a resident is receiving psychotropic medications. Further, all attempts at management of a resident’s behaviors without the intervention of medication (including the level of effectiveness of the attempts), must be thoroughly documented in the patient’s chart.
• Focused, patient-centered care. It is imperative that patients residing in skilled nursing facilities receive psychiatric and psychological care that is specific to their needs. Failure to contract with providers of this specialized service increases the likelihood that the patient will require hospitalization on a psychiatric unit, raising a concern with regard to re-hospitalization rates and its effect on a facility’s performance metrics, evaluated by CMS and the general public.

So, what can the long-term care provider do?

• Carefully evaluate referrals to ensure that your staff can truly and adequately meet the needs of the new patient.
• Embrace the fact that it is inevitable that you will continue to see an increase in the number of psychiatric patients being admitted to your long term care facility, and be prepared for them by providing enhanced training for your staff that focuses on the care and management of this specific patient population.
• Intensify training on CMS guidelines regarding the use of psychotropic medications and gradual dose reductions.
• Require training and education regarding non-pharmacologic techniques for the management of behaviors. In a 2018 article titled, “When Mental Illness and Aging Make Nursing Homes Necessary: What Next?,” Dr. Maureen Nash addresses this point, stating, “Look at what triggers people. Get to know these individuals…including their fears, phobias, likes and dislikes. When patients with chronic mental illness are getting appropriate treatments and are compliant, behavioral issues are less likely to be problematic if the staff know the resident.”

Ultimately, a team approach and a commitment to adapt to the changing patient population in long-term care is key to the successful management of psychiatric patients. Additionally, support and education in the management of this special patient population is available through your AssuredPartners Senior Living professionals.