Addressing Behavioral Health in Senior Housing

The National Institute of Mental Health reports that 15% of U.S. seniors are living with clinical depression with even more (25%) reporting “persistent feelings of sadness,” leading to what NIMH has labeled “a serious public health concern.”

As our senior population continues to grow and life expectancy increases, these numbers will rise even more, creating additional challenges around mental health treatment and how to manage it in senior living communities where most are under-prepared and under-resourced.

“One of the greatest challenges facing senior housing today is managing residents' behavioral and mental health needs." said Craig Patnode, CEO of Eldermark, a Minnesota-based firm offering software and Electronic Health Record (EHR) products focused on senior living. "While treatment and reimbursement opportunities are now available, most providers remain in the dark about how to coordinate the required care," he said.

To put the situation in context, “By one estimate, only about 10% of patients with depression (and less than 1% in some minority populations) receive guideline-concordant treatment under the status quo,” according to a piece in the New England Journal of Medicine.

Eldermark is partnered with Simply Connect to offer Care Management services with Health Information Exchange (HIE) capabilities designed for the senior care industry. To address the escalating need for mental health management in senior living, the company is introducing the Personal Health Record (PHR), a mobile-friendly app that facilitates care management communication and coordination between all care team members.

A Growing Problem With Viable Solutions

In early 2017, the Centers for Medicare & Medicaid Services (CMS) created opportunities to increase access and the effectiveness of behavioral mental health treatment. CMS created 4 CPT codes under Behavioral Health Integration (BHI), which integrates behavioral health treatment into primary care, increasing access to the people who need it most. These services can take place in the community with oversight of the primary care provider, but evidence of strong coordination of care and communication across a multidisciplinary team is required.

“Through systematic care management and more efficient use of behavioral health specialty providers, effective BHI produces more person-centered, coordinated, evidence-based care. It also helps build behavioral health competency in the primary care workforce,” the New England Journal of Medicine piece explains, adding that though the immediate impact was on “clinicians already furnishing these services, who will now be paid more appropriately and accurately,” it also offers the opportunity to substantially increase the pool of Medicare beneficiaries with access to much-needed BHI services.

Simplifying the Process

While greater reimbursement opportunities are now available, most senior living providers do not have the tools they need to consistently make referrals to the program and contribute information to the BHI team. In most cases the team is made up of a primary care provider, a case manager, a psychiatrist, and the person receiving services. The Simply Connect Care Management platform connects all these individuals, senior living stakeholders, the resident and their supports virtually, equipping senior living nursing teams with tools to engage the BHI team.

"For example, when nurses identify residents as showing signs of depression, confusion, agitated behavior and other behavioral health issues, the PHR will allow them to seamlessly inform the BHI team by connecting the care team virtually, sharing timely and important information to best impact the immediate and ongoing needs of patients." Patnode said.

Shannon Mackenzie, Director of Clinical Operations for Simply Connect, explained, “While these codes have been available for a couple of years, they are not widely known or leveraged in senior housing. The regulations, specifically the requirement to track referrals and demonstrate coordination of care within the BHI-program adds an additional layer of complexity that has deterred providers from offering this service.”

Client demand drove the development of the PHR platform, Mackenzie said. “We have consistently heard from providers that they grapple with these issues, but also lack the resources and strategy to provide the right support at the right time to their residents.”

How Big of an Issue is Behavioral Health in Senior Housing?

“The prevalence of under- and undiagnosed mental health needs is a key and rampant issue affecting the senior housing sector. Often individuals transitioning into a senior living environment are experiencing a significant life change,” she said. “Many are moving from their family home after decades or after losing a spouse. And, of course, they have the challenge of getting used to congregate living.”

MacKenzie added that the onset of chronic and serious health conditions, such as Alzheimer’s, also lead to behavioral health symptoms such as isolation and loneliness, aggression, agitation, and depression.

“In our extensive experience in the senior sector, we have consistently heard from providers that they grapple with these issues, but also lack the resources and strategy to provide the right support at the right time to their residents,” she added.

“We are changing that by creating efficient processes for developing partnerships with primary care BHI providers and by working with senior housing to plug and play a model to identify and address behavioral health needs.”

Simply Connect's management platform creates ease in making referrals to Behavioral Health Integration programs and in facilitating ongoing communication amongst the care team. This is accomplished by providing a secure location for care teams to collaborate, share care and treatment plans, report changes in patient well-being (positive and negative), make referrals, and engage the resident in their own care. These are all requirements for primary care to ethically bill for BHI services." Mackenzie emphasized.

An Operator’s Perspective

Texas-based Avanti Senior Living has been using Eldermark platforms for a number of years. This month, they’re introducing the new app, said Lori Alford, Co-founder and COO. She views the service as a complement to the EMAR system which Avanti has been using for a number of years.

“When my child had the flu and I took him to the doctor’s office, everything was electronic. That electronic connectedness is what we want for Avanti and what appeals to us with this platform. We (Avanti) are a healthcare provider to a certain extent and Simply Connect allows us to connect to the healthcare system,” Alford said. “What’s special about Eldermark is it was designed and built for a senior housing platform.”

Alford believes the platform will assist in care coordination for residents living with behavioral health issues. “Right now we may have to go to five or six doctors to gather all the information we need, but with the new platform we have a one-stop shop with all the necessary information in one place,” she said, adding that the doctors, psychologists and social workers involved in managing a BHI case will have a “360-degree picture of what’s going on with the resident, rather than viewing their situation in a silo.”

Alford also believes the new platform will reduce time spent on paperwork. “Especially when our staff has to run down third-party chart notes, for example. This will save us that trouble,” she said. “And I like that everyone involved is alerted with essential information, including the family member, the doctor and the third party vendor for the resident.”

How well will it work? “We’re implementing it this month. So I’ll have the answer to that question in the next 30 days. Check back then and I’ll be able to answer that question.”

Patnode offers a hypothetical. “Let’s say Lori has a resident named Michael, a guy in his 90s who is experiencing depression. The nursing staff will complete an assessment in Eldermark and if an assessment risk threshold is met, an alert is triggered to the BHI provider. The BHI partner can write an order and engage in delivering services. Simply Connect facilitates the bringing together of the care team and their collaboration in meeting the care needs for the resident. Michael, his natural supports, and his care team are all connected within the PHR to create the best in care outcomes.” he explained.

Longevity Leads to BHI

Based on client input and demographic trends, Patnode believes the strong demand for BHI-related products and services in senior living can only grow in the coming years.

Behavioral Health diagnoses are rising across all demographics, and, as the baby boom generation enters its 70s, 80s and even 90s, we’ll inevitably see more older Americans coping with depression and other diagnoses.

In fact, seniors with a mental health diagnoses will be highly represented in the senior housing, Patnode projected. “The inevitability of the presence of mental illness in senior living is inescapable. And, we will have the tools to best equip providers in the efficient and effective management of BHI and related health challenges as they strive toward increasingly better care outcomes.”