University of Rochester Behavioral Health Program Meets Growing Demand For Nursing Home Service

As demand for behavioral health services in nursing homes continues to rise amid regulatory pressures and staffing shortages, a university program in upstate New York is trying to fill the gaps.

The digitally-enhanced behavioral health program, first launched in 2017 with funding from the Centers for Medicare & Medicaid Services (DRISP) Delivery System Reform Incentive Payment (CMS) programs, has grown from 29 nursing homes at the start of the two-year demonstration — by on the recent expansion of the program to include facilities statewide.

According to a case study published in NEJM Catalyst, from 2017 to 2019, the use of antipsychotics among long-term residents in the participating homes decreased by 37%. During the pandemic, the program’s services grew to 53 nursing homes.

The need for behavioral health services in nursing homes has only been exacerbated by the impact of Covid-19, but these services were needed well before a global pandemic.

From 2007 to 2017, the prevalence of nursing home residents with serious mental illness increased by 77%—yet only 1 in 10 counties in the United States has a practicing geriatric psychiatrist, according to the case study.

Before the State Department of Mental Health partnered with the University of Rochester’s program in 2019, 500 or more residents were waiting to be placed in a nursing home. That number is now in or near single digits, according to the case study.

“The pandemic has been devastating for nursing homes. Many of our residents have been confined to their rooms or their units for many months during the pandemic and it has had a really noticeable impact on their mental health, much more anxiety and depression,” said Adam Simning, an assistant professor in the Department of Psychiatry at the Medical Center the University of Rochester.

And it’s also more than just focusing on mental illness, anxiety and depression — it’s also quality of life, according to Simning.

“We focus on mental illness, anxiety and depression, but there’s a downside to that too, it’s all about quality of life, it’s about well-being. Sometimes focusing on residents’ well-being reduces anxiety and depression, so it’s really nice to be able to look at residents more holistically in the context of their home,” he said.

Overall, those involved in the program believe they have demonstrated that a telehealth program that includes onsite care support, telepsychiatry, telepsychotherapy and telemonitoring can improve access to behavioral health services in nursing homes and improve both quality measurements and outcomes, according to the case study.

challenges faced

Researchers faced challenges related to nursing home eligibility, initial acceptance, ongoing engagement, and program sustainability as they launched the program.

The case study found that some nursing homes participated in the behavioral health program “quickly and enthusiastically,” while others expressed reservations about how the telepsychiatric visits would work and how it would change the workflow.

Staffing also played an important role in maintaining commitment to the program. Both telepsychiatry and on-site visits require the involvement of nursing home staff, and this proved difficult when staffing was limited due to ongoing bottlenecks in the industry.

“Identifying a nursing home champion was essential to sustained engagement, and monthly on-site visits by nurses were necessary to train new staff,” the authors wrote.

Despite these challenges, developing relationships with decision-makers in nursing homes and tracking quality metrics while communicating these insights to potential funders helped promote the sustainability of the program.

development of a similar program

The report’s authors noted that creating and implementing a program similar to the one developed at the university should require: identified funders, selective partnerships with nursing homes, on-site implementation visits, and the ability to track quality metrics.

On the subject of funding, while it was noted that telemedicine has grown significantly nationally over the course of the pandemic, many of these efforts are temporary and the creation of a similar program would depend on the support of telemedicine payers.

In selecting care home partners, the report said working with facility social workers was “instrumental” in identifying and referring residents to such services.

While Simning believes the program could be replicated in other states, he acknowledges the challenges posed by the reality of living in a largely paid-for healthcare world.

“For this program to expand to other states, it’s really important to look at different funding mechanisms… Training employees isn’t usually easy to reimburse,” he said.

Zhi-Yan Tsun, Resident Physician, Department of Psychiatry, University of Rochester Medical Center; Nirav Shah, Senior Scholar, Clinical Excellence Research Center, Stanford University School of Medicine; Elizabeth Santos, Associate Professor, Department of Psychiatry, University of Rochester Medical Center; Lara Press-Ellingham, Senior Health Project Coordinator, Department of Psychiatry, University of Rochester Medical Center; and Michael J. Hasselberg, Chief Digital Health Officer, Associate Professor, University of Rochester Medical Center, also participated in the program.

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