The psychological effects of COVID-19 have sparked a surge in demand for behavioral health services in skilled nursing facilities, but dwindling staff numbers and increasingly complex resident populations have made it difficult for providers to meet those needs.

Under normal circumstances, staff continuity and education would support patients in overcoming the social isolation, trauma and stress tied 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 medication management to creating the ideal treatment structure, the right approach to behavioral health can drive better outcomes for the modern post-acute patient, leading to more satisfied customers and staff.

Meeting the Demand for Behavioral Health Services in SNFs

SNF populations have changed drastically since the beginning of the pandemic, and with the influx of homelessness, mental illness and substance abuse disorder cases, 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 tasked with caring for them,” said Dr. Wayne Tasker, national director of behavioral health for physician services provider TeamHealth, on a recent RETHINK podcast episode with Skilled Nursing News.

Providers are taking a two-pronged approach to overcome this challenge by monitoring burnout at the executive level and providing educational opportunities that empower residents and staff to succeed.

At the height of the staffing crisis, providers are focused on reducing caregiver churn and burnout, but many have failed to apply the same principles at the leadership level. By concentrating on frontline performance, executives run the risk of burning out and undoing their work to prevent burnout at other levels of the organization. If leadership doesn’t have the capacity to tackle new challenges because they’re not taking care of themselves, the rest of the organization will be unprepared to deal with them as well.

“It is imperative that providers are taking care of themselves so they can deliver the services their teams, patients and patient families need,” Dr. Tasker says.

From there, providers can create continuing education and training opportunities that improve recruiting and retention while arming caregivers with the essential skills and knowledge needed to care for a diverse behavioral health patient population.

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

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

Creating the Ideal Behavioral Health Structure

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

Simultaneously, psychologists and licensed clinical social workers
(LCSWs) provide psychotherapy to address the source of cognitive and behavioral disturbances while limiting reliance on medication. The combination of these two fields can produce results for any type of mental or behavioral health case, but the best approach to medication management can differ from patient to patient.

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

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

Residents who have been at the facility longer-term might show symptoms of behavioral and cognitive conditions not present when they were admitted. Those changes can require intervention, and while 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 that have minimal impact on cognition.

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

TeamHealth offers administrative support and care practice management services across the full continuum of care, from hospital-based practices to post-acute care and virtual care. To learn more about how they are helping Skilled Nursing Facilities and Senior Living Communities facilitate behavioral health services to meet the growing need, listen to the full podcast here.

Originally published by Skilled Nursing News here