Geriatric Mental Health Partnership
The first meeting of the Geriatric Mental Health Planning Group occurred on May 4, 2007 in response to the need to address challenging behaviors of older adults. At that time, hospitals were having difficulty in placing these individuals who were in Emergency Departments or inpatients once they were ready for discharge to long term care facilities.
Initially, staff from Piedmont Geriatric Hospital and the Department of DMHMRSAS (Department of Mental Health, Mental Retardation & Substance Abuse Services) met with staff of the Virginia Health Care Association to explore opportunities for collaboration by creating a public/private partnership to focus on issues of mutual concern, improving communication and sharing of resources. The Geriatric Mental Health Partnership was then created and included representatives from the DMHMRSAS Central Office and facilities (currently the Department of Behavioral Health and Developmental Services), long-term care (LTC) providers, Community Service Boards (CSBs), nursing homes, assisted living facilities, Virginia Hospital and Healthcare Association (VHHA), and was hosted by the Virginia Health Care Association (VHCA).
The group, a public/private partnership, met several times a year and has grown in membership since its inception. Original members included DMAS, Adult Protective Services, VDSS Licensing, Department of Aging, Department of Corrections, academia, private consultants and long term care providers. Though the group has at least doubled in size since its creation, it has remained true to the central core, Quality of Care. This central premise has already been actualized in the collaborative efforts of its members, improving care and access in cost effective means throughout the Commonwealth.
Since 2012, the Partnership has offered a series of three webinars annually through grants awarded by Virginia Commonwealth University’s Center on Aging on key topics in Geriatric Mental Health designed to reach health care professionals in Geriatrics and in Geriatric work force development.
It is important to note that this is not a mandated effort, rather the result of what happens when collaborative partners share a common vision.
Barriers to Care
Using the experience of the Piedmont Geriatric Hospital/Chase City Nursing & Rehabilitation Center example, the partnership came together as an informal discussion group
The group identified and discussed the distrust and misunderstandings among the entities providing mental health care to the geriatric population
Discussions and presentations led to an understanding of regulatory and structural barriers to delivering quality care.
- State geriatric facilities need to move stable individuals into nursing and assisted living facilities
- Nursing and assisted living facilities need assistance with individuals manifesting unmanageable behaviors
- NFs and ALFs are required by regulations to discharge those who present a danger to themselves or others
- Nursing homes cannot chemically restrain residents under federal law and, in fact, federal regulations require them to reduce psychotropic medications
- Assisted Living Facilities also have limited means of addressing challenging behaviors of individuals and may not use chemical restraints
- Hospitals believe nursing and assisted living facilities are “dumping” patients in the emergency rooms
- The TDO process does not solve problems – Why?
- CSBs constantly confront the challenge of an insufficient number of psych beds to which to send NF and ALF residents
- A Dementia diagnosis may discourage CSBs from assisting with nursing and assisted living facility residents
- Nursing facilities are unable to hold a bed for a Medicaid resident while the individual is receiving treatment in a hospital – Medicaid does not pay for bed holds
- ALF regulations require that the facility establish procedures to ensure that any resident detained by an
ECO or TDO is accepted back in the facility if the individual is not involuntarily committed
- Lack of resources throughout the system of geriatric care
- One‐day summit convened (2008) to share geriatric and mental health activities and programs from six geographic regions across the Commonwealth
- Common barriers discovered
- Best practices presented
- Developed a “Continuum of Care Model” for geriatric mental health needs
Continuum of Care Model
- A Continuum of Care Model encompasses a range of programs and services to provide the most efficient treatment at the right time for an individual’s specific needs
- Different Regions would modify the Continuum Model to meet the needs identified in their respective communities
Examples of Services in the Continuum
- Intensive case management
- Home‐based treatment services
- Family support services
- Day treatment programs
- Partial hospitalization (day hospital)
- Office or outpatient clinic
- Emergency/crisis services
- Respite care services
- Therapeutic assisted living or community residence
- Hospital Treatment
- Long‐term treatment facility
- Strengthening the partnership to create solutions and inform decision makers
- Establishing statewide and regional collaborative endeavors to address common issues
- Promoting the need for a statewide Continuum of Care for individuals in need of Geriatric Mental Health care
- Offering the resources and expertise of the Partnership to assist in the development of the Care Continuum