LYNN NORTHROP, PHD

Professionals are challenged with balancing the seemingly competing objectives of providing high quality care while keeping costs down. The escalating cost of providing health care presents a major challenge to the long-term care (LTC) industry. And yet, the primary mission of LTC facilities remains to provide quality care and service.

Decreases in the need for common prescription medications have been linked to behavioral interventions. In addition to reducing the need for pain medications, behavior therapy has been shown to decrease use of hypertension (5 Fahrion, et al ) and chronic obstructive pulmonary disorder (6 Kemper, et al ) medications. In a number of studies, behavior therapy has been shown to be equal to or more effective than more costly drug treatments. For example, sleep hygiene training was shown to be more effective than Restoril (7 Morin, et al ).In another study, relaxation training and drug therapy were equally effective in diminishing essential tremor. However, patients in the relaxation group reported fewer depressed moods and less tremor-related disability than did the patients in the drug treatment group (8  Lundervold, et al ). Decreased medication usage translates to significant savings for skilled nursing facilities that are reimbursed through the Prospective Payment System (PPS). Residents and families who pay for their own medications also stand to benefit. These and other benefits of an integrated behavior health program can be high- lighted when viewing long-term care services, as they clearly offer another, more comprehensive, level of professional care.

Depression is perhaps the most prevalent psychiatric diagnosis in nursing homes, and the diagnosis for which there is the largest body of evidence for the efficacy of behavioral interventions in the elderly. It is estimated that as many as 40% of nursing home residents suffer from moderate to severe depression (9 Randall ). Research suggests that depression results in increased staff care time, even after controlling for physical illness and disability (10 Fries, et al). Thus, in addition to improving residents quality of life, behavioral interventions for depression can reduce staff care time and thus reduce operating costs to the facility.

It should be added that a large proportion of depressed older adults go undiagnosed and thus untreated. Only about half of the 3,410 older adults in a University of Minnesota study who scored in the depressed range on the Geriatric Depression Scale were identified as depressed by their physicians (11 Rolnick). Clearly, if these individuals go unidentified and untreated, nobody benefits. In a recent inter view, Dr Deb Frazer, Director of Behavioral Health Services for Genesis Health Ventures, offered her perspective on the advantages of calling on a psychologist. Frazer states, "In today’s pharmacological climate, we sometimes jump too quickly to a pill for solving our patients’ problems. There is great value in someone having time to sit down and talk with a resident. Residents and families place value in this, as do nursing staff. Psychologists have the rare luxury of being paid by Medicare for spending the time to listen and to help an individual solve problems. Even in the PPS environment, a LTC community can request psychological services at no cost to the community."

Despite strong empirical and anecdotal evidence of the cost offsets of behavioral health services in long-term care, savings in cost have gone largely unrealized. Although researchers suggest that 67% of nursing home residents warrant at least one psychiatric diagnosis, only 4.5% of those with a diagnosis receive mental health services (12 Burns, et al ).Based on the US Department of Health and Human Service’s 1999 survey (13 Jones), there were 1,628,300 residents in US nursing homes, so there were over one million Americans suffering psychiatric problems and less than 50,000 getting care for those problems.

© 2003 Vericare Management, Inc.

Vericare (formerly Senior Psychology Services) is a national provider of mental and behavior health services, primarily to long-term care facilities. After twelve years, it has become the largest such service with over 1,000 client facilities. Vericare employs over 300 psychologists, psychiatrists, social workers, and other qualified professionals in eight states.

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Vericare Monograph 3
Medical cost offset and behavior health
by Lynn Northrop, PhD

Monograph 1, The metrics of care and cost in long-term care facility operations relative to psychological health of residents

Monograph 3, Medical cost offset and behavior health

Vericare - Article

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