Focus on Behavioral Residents Lands SNFs $10.5M to Expand Services

As the prevalence of behavioral health issues grows among the nursing home-aged population, one group of skilled nursing facilities received a major grant to help improve mental health care among its residents.

CareChoice Cooperative, which is based in St. Paul, Minnesota, earlier this year received $10.5 million to bring the Resident Centered Behavioral Health (RCBH) project to 21 of its 43 nursing homes. The initiative, which began on January 1, is expected to run through the end of next year at CareChoice, which includes more than 21 affiliated non-profit skilled nursing providers.

“This program is important, because over the past several years, the overall population that skilled nursing facilities serve has changed,” Brenda Liker, the regional director of assisted living, SNF clinical support, and performance improvement projects at CassiaLife, told Skilled Nursing News in an e-mail. “We are seeing more and more residents that are younger, and more that have significant mental health and behavioral health concerns.”

CassiaLife is an affiliation between the non-profit senior care providers Augustana Care, based in Minneapolis — which has facilities participating in RCBH —and Elim Care, which is based in Eden Prairie, Minn.

As a whole, CareChoice will use its grant money to develop staff training and patient services. The goals are to increase staff competencies, improve the residents’ quality of life, decrease the prevalence of resident depressive symptoms, and lower the incidence of worsening or serious resident behavioral issues. The 21 participating facilities represent 3,030 nursing beds, primarily in the Twin Cities metro region.

Cassia’s Augustana facilities were awarded approximately $2.29 million of the $10.5 million total as part of the project. Management at Cassia already considers behavioral health needs when planning its staffing needs, which vary from site to site depending on population size and building layout.

For Cassia, the RCBH program will serve to enhance existing programs, Liker said.

“Much of our training in the past has focused on dementia care, which remains important,” she explained. “However, with more and more residents having behavioral health and mental health concerns, it is important that we re-focus and enhance our training to meet those needs.”

The existing training for these areas has been broader, but the RCBH project will allow for programming that’s more specific to the topic of behavioral health, including realistic scenarios that will be useful for the staff, Liker explained. Cassia will hire part-time social workers at its campuses in Hastings, Minn., and Apple Valley, Minn., and existing staff that have worked on previously funded programs will continue to participate in the RCBH project, Liker explained.

Outside providers will also be brought in as a result of the project, with the grant-funded work to include behavioral health experts in education, protocol development, and best practices for working with general practitioners, geriatric specialists, and existing health care providers, Liker added.

“As part of the RCBH program, one protocol our sites will implement is a depression protocol,” she noted. “Many of our residents, just as much of the general population, have some level of depression. This protocol will help us to more clearly identify the severity of depression and what we can do to assist the resident in meeting their highest quality of life.”

The outcome measures for the RCBH project include tracking worsening or serious resident behavior for long-stay residents; depressive symptoms; and measures for relationships, Liker said. Each participant facility has a baseline number in the above areas with a goal to reach, and the entire CareChoice network has an overall goal to meet as well, she noted.

The mental and behavioral health needs of SNF residents are becoming more prominent in the nursing home sector, with Massachusetts seeing an increase in younger patients with side effects from substance use and providers in the state of Washington moving into behavioral health as they try to mitigate pressure from low Medicaid reimbursement and general industry headwinds. Some states offer Medicaid incentives for the provision of behavioral health care, which some SNFs in Colorado have used to expand their resident pools and boost their bottom lines.

And the population in need of behavioral and mental health services is increasing, at least according to one CEO whose Missouri company focuses on taking in patients with mental health and behavioral health needs.

“It’s a really under-serviced population that the demographics are crystal clear that it’s on the increase,” Reliant Care Management Group CEO Rick Destefane told SNN last year. “It was on the increase when I started researching this in 1995.”

Though Liker did not have hard numbers for the behavioral patients under Cassia’s cares, she agreed that the demographic is only growing in size. And her estimate for patients with such needs now is still quite high.

“It is difficult to quantify exactly how many residents have behavioral health problems, as this varies day to day with admissions and discharges,” she said. “I would estimate that around 50% of our residents have some type of mental illness diagnosis other than dementia on any given day.”