Serious Mental Illness in the Nursing Home Literature: A Scoping Review

Use of admission MDS data to capture unrecognized cognitive impairment in heart failure: Implications for community care transitions

BACKGROUND

Skilled Nursing residents who have cognitive impairment (CI) in heart failure(HF) have a significantly higher mortality rate. These residents' ability to self-manage their complex care upon discharge is critical for positive health outcomes.

METHOD

We conducted a secondary data analysis of admission MDS records for 79 residents admitted for HF care from 2021 to 2022.

RESULTS

Seventy-nine eligible admission MDS records were included in the study. Only one additional with DC diagnoses of CI in HF was captured upon discharge. Twenty-seven (35.1 %) records affirming CI in HF were omitted from the discharge diagnosis list or discharge summary.

CONCLUSION

This secondary data analysis of admission MDS records in two large mid-south metropolitan nursing facilities uncovered quality improvement opportunities, including improving facility interprofessional communication, opportunities to capture and improve diagnostic accuracy, the potential value of an evidence-based discharge planning program, opportunity for improved hand-offs back to community primary care providers.

Serious Mental Illness, Substance Use Disorder, and Nursing Home Care: A Narrative Review of the Literature

The prevalence of serious mental illness (SMI) and substance use disorders (SUD) among residents in skilled nursing homes is increasing yet staff are generally not equipped to care for these residents. There is a pressing need to identify and assess practices, including training, intervention, screening, and service integration, that can support nursing home staff to better support residents with SMI and SUD. This narrative literature review examines the literature to identify what is known about this population as well as the current state of care, barriers to better care, and promising practices to support improved outcomes. Using the evidence from the peer-reviewed literature, the authors make recommendations to advance research and practice for this growing population of residents. Strategies to integrate behavioral health services into the nursing home and provide more holistic programmatic social support, behavioral health, and community integration strategies in nursing homes appear to be promising practices.

Care of Older Adults with Mental Illness in Long-Term Care Residential Facility: A Scoping Review

OBJECTIVES

Mental illness affects approximately 1 in 8 people globally, with approximately 15% of adults aged 60 years and older experiencing a mental disorder. With the aging population, there is a growing demand for long-term care. This scoping review focuses on older adults with non-neurocognitive and non-neurodevelopmental mental illnesses (NNNDMIs) in nursing homes, exploring how the care is provided.

DESIGN

A scoping review.

SETTING AND PARTICIPANTS

The review includes studies addressing care for older adults with NNNDMI in nursing homes.

METHOD

The PRISMA-ScR protocol was followed. Four research databases (EBSCO, PubMed, Web of Science, and Scopus) and article bibliographies were used for the literature search. Thematic analysis identified the main themes.

RESULTS

From a total of 1948 search results, 13 articles were analyzed to reveal 5 themes: (1) challenges and recommendations in nursing home admission for older adults with mental illness; (2) impact on the quality of the care; (3) need for specialized staff training and competency; (4) contributions to psychiatric and behavioral symptoms; and (5) need for a range of interventions.

CONCLUSION AND IMPLICATIONS

Older adults with NNNDMI face barriers during admission to long-term care facilities that highlight concerns about care quality and systemic issues. Behavioral symptoms require specialized mental health support, but access to such services is lacking. Deficiencies in staff education and burnout prevention initiatives further underscore the need for comprehensive reforms to address the unique needs of this overlooked population in long-term care settings.

Timely Yet Long Overdue: Canadian Standards for Long-Term Care Homes

The impact of the COVID-19 pandemic highlighted systemic problems in Canadian long-term care (LTC). While high mortality rates in LTC received significant attention, the pandemic also took an enormous toll on mental health of LTC residents, where mental health conditions, including cognitive disorders, are already much higher than in other community settings. The pandemic resulted in a renewed interest in improving quality of care in LTC and led to the recent development of several National Standards of Canada. The newly available Standards set ambitious targets, but many of the standards are practical and essential to moving beyond a focus on safety and physical needs in LTC and towards one that supports residents as whole persons. While the standards support good mental health indirectly, there is a need to recognize mental health in these settings as a fundamental human right and essential to quality of life, and for this to be reflected in ongoing and future standards development. Ensuring existing and forthcoming National Standards are meaningfully implemented, in whole or in part, will require extensive efforts at multiple levels. The guidance provided by Canadian Standards will shape this transformative process, necessitating aligned federal and provincial investments and policies, and stakeholder engagement to bring about the envisioned high-quality care.

What are the evidence bases for developing models of rehabilitation for older people with mental illness in Australia?

OBJECTIVE

This paper updates clinicians and service leaders on evidence bases relevant to rehabilitation for older Australians with mental illness.

METHODS

Narrative review of literature and relevant public domain data supported by reflections on NSW service development.

RESULTS

There is a paucity of high-quality evidence regarding mental health rehabilitation in older people. Available evidence supports integrating lessons from physical healthcare with adaptations of 'adult' mental health rehabilitation. Adaptation is required to respond to the specific needs, strengths and service use of older people with mental illness. Challenges for older people include ageism, increased physical and cognitive comorbidities, lower access to mental health services and earlier residential aged care entry. Strengths of older people include an ongoing desire for recovery, ongoing developmental change and often closer connections with carers and GPs. Evidence is consistent with evaluation of relevant NSW service models and initiatives including the Pathways to Community Living Initiative. Integration of recovery-oriented practice and wellness models may provide a framework for future innovative inpatient and community-based models.

CONCLUSIONS

There is sufficient evidence to guide development of models of rehabilitation with older people, but innovation and evaluation are essential if older people are to have equal opportunities in their recovery journeys.

Information sharing to support care transitions for patients with complex mental health and social needs

BACKGROUND

Patients with complex behavioral and mental health conditions require significant transitional care coordination. It is unclear how skilled nursing facilities (SNFs) that serve these patients engage in care transfer with hospitals, specifically whether they experience discrepancies in the type of information shared by hospital partners and/or use different approaches to secure needed information.

METHODS

Cross-sectional analysis of a national 2019-2020 SNF survey that collected information on transitional care practices with referring hospitals; respondents were directors of nursing services. We used chi-squared tests and descriptive statistics to characterize hospital information sharing practices experienced by facilities that accept complex patients (e.g., serious mental illness, substance use disorder, and/or medication assisted treatment), and to compare them to facilities that treat a less complex population.

RESULTS

A total of 215 SNFs had sufficiently complete responses for inclusion in the analysis. Of these respondents, 57% accepted two or more types of patients with complex conditions of interest; these SNFs were more likely to be urban, for-profit, and serve more dual-eligible patients. SNFs accepting complex patients experience information sharing on par with other facilities, and are more likely to receive information on behavioral, social, mental, and functional status (25.41% vs. 12.90%; p = 0.023). These facilities are also more likely to consistently use electronic methods (e.g., an online portal, shared electronic health record [EHR] access) to retrieve information from partner hospitals.

CONCLUSIONS

SNFs accepting complex patients demonstrate some evidence of enhanced information retrieval via electronically mediated pathways. Overall, information sharing remains underdeveloped in this care context. Policymakers should continue to prioritize widespread digital infrastructure that supports post-acute care delivery.