If I were to tell you that a virus was spreading throughout the world and more than 300 million people were infected — roughly the population of the United States — you would probably be alarmed. What are the symptoms? How is it transmitted? Is there a treatment?
Now what would you say if I told you the World Health Organization (WHO) announced this malady is already the leading cause of illness and disability in the world? Essentially, they just did.The illness is depression, and on March 30 the WHO announced its latest estimate that more than 300 million people worldwide are living with it. The organization called the news “a wake-up call to rethink our approach to mental health and treat it with the urgency it deserves.”
Some estimates indicate up to 60% of skilled nursing residents exhibit some type of depressive symptoms. These numbers should actually not be surprising. Individuals admitted to a skilled nursing facility have just experienced a significant medical setback, which has left them, either temporarily or permanently, physically and emotionally vulnerable. In addition to their acute and chronic medical conditions, other stressors such as the uncertainty of their future, physical decline, multiple transitions and living in a challenging environment can all take an emotional toll. Undetected and untreated, depression can have devastating effects on a resident’s quality of life and the outcome of their care.
The Centers for Medicare & Medicaid Services has been addressing the impact of depression over the years and have implemented a variety of approaches to assess and report depression in skilled nursing facilities. The current method of assessment and reporting involves Section D of the Minimum Data Set (MDS) 3.0, CMS’s standard resident assessment tool.
Section D reports the results of the Patient Health Questionnaire-9, a commonly employed screening tool for depression. The PHQ-9 can be administered either through a resident interview or the PHQ-9 OV (staff interview) for residents determined to be unable to be interviewed. CMS, recognizing the importance of identifying residents with depressive symptoms, provides for higher rates of reimbursement based on PHQ-9 scores. The RUGS- IV patient classification system for determining reimbursement, takes into account depression scores in three categories: Special Care High, Special Care Low and Clinically Complex.
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Robert W. Figlerski, PhD, is the Director of Behavioral Health Services, New York Region, for TeamHealth.