As healthcare continues to evolve, so does the overlapping of care specialties. There’s continuing examination that suggests certain health conditions may affect an individual in other areas of health – one condition may cause or further aggravate another. This is why it’s important to provide holistic, whole-person care with a comprehensive approach that addresses the full spectrum of health, including all that relates to physical and behavioral health.
Although any individual may require some type of care at home, seniors are especially susceptible to behavioral and mental health issues as well as substance use and depression in particular. As we get older, we often begin experiencing losses or declines on a variety of levels. Individuals close to us may pass away, our vision or hearing may worsen, leaving us to be less independent as we would like to be, we become less healthy or may experience new conditions or pain that we haven’t experienced before. If we don’t have the right support systems or mechanisms in place to cope with these things that are often inevitable for most, if not all of us, we have a higher chance of experiencing behavioral health challenges.
The “home” part of care at home is significant. Providers are delivering care in a setting where, more often than not, care is not being delivered by a clinician around the clock. The responsibility is often left to the patient to follow any instructions left by the clinician, such as taking medication in certain doses. If an individual experiences cognitive impairments, behavioral issues or depression, it may hinder their ability to follow those instructions, becoming detrimental to their recovery or lead to even worse consequences.
Why Consider Behavioral Health?
It’s no secret that there are connections between behavioral health and physical health. Let’s consider the toll that depression can take on someone who is already experiencing a physical health issue. Some health issues such as diabetes, congestive heart failure or COPD – common conditions treated in home health – already lend themselves to a higher rate of comorbid depression in individuals. Depression in home health patients has been linked to additional medical illness or issues and increased chronic pain. These same patients tend to be at a higher risk for re-hospitalization, poor quality of life and suicidal thoughts.
Simply put, when an individual receiving home healthcare experiences comorbid depression, they tend to have more obstacles throughout their care plan. When they are feeling poorly, sad, anxious or hopeless, they may not be in the right mindset to provide the complete self-care that they need. They may be less engaged or focused, may misinterpret instructions or may not be motivated to follow through with instructions. Not necessarily because they don’t want to, but because their mental health issues may prevent them from doing so.
Integrating Behavioral and Physical Health is Reality.
When it comes to considering an individual’s mental health, it’s not something that is just a recommendation, it’s becoming an expectation. In recent years, Centers for Medicare and Medicaid Services (CMS) announced that cognitive function and mental status be assessed and documented as part of home health quality reporting measures. They also declared that an agency’s Conditions of Participation must include a patient’s mental, psychological and cognitive status.
There’s also the cost of care to consider. Individuals who experience comorbid conditions, including a mental health issue, can expect their total healthcare costs to increase exponentially. Organizations that can identify early and address behavioral health issues often can successfully improve patient outcomes and reduce care costs, see fewer re-admissions and have more engaged consumers. Benefitting the health of the overall population of an agency as well as improving its bottom line are always good things.
What Can Home Health Agencies Do?
Train staff to recognize and understand behavioral health needs. When clinicians have the skills and tools to determine a baseline for a patient’s cognitive and behavioral health status, it better prepares them to identify the right support to implement to help meet the needs of the patient.
Keep open communication. Don’t skim over questions or conversation regarding a patient’s feelings. Look for clues or triggers in their responses or reactions that might signal something more is going on.
Create a plan to manage behavioral health. Ensure your agency has the right assessment tools in place to determine a patient’s risk for behavioral health issues. Help support the appropriate therapies that help improve mental health – medication, self-coping strategies, counseling, occupational therapy, etc.
Make sure the patient is educated on their care plan and on the same page. Is the patient taking their medication correctly? Instead of asking how, ask them to show you how. Sometimes when a patient thinks they have it all figured out, they may not. Something could get lost in translation, so when evaluating their self-care steps, have them show you what they are doing to ensure they are caring for themselves properly.
Include key caregivers or members of the patient’s close circle when possible. It’s all about a team approach. If they have an individual who is involved in their daily living and healthcare plan, include them to ensure that everyone is on the same page.
As behavioral health issues are recognized and addressed, patients are more likely to improve their self-care. As self-care improves, so does the likelihood of successfully managing additional conditions, avoiding hospitalizations and improving quality of life. Home health agencies must begin to consider adding behavioral health to their regular assessments to make sure that their patients remain on the road to achieving the best care outcomes possible.
Interested in learning more? Check out our webinar with Katherine Vanderhorst and Dr. Amy Craven from C&V Senior Care as they dive deeper into understanding how behavioral health can greatly impact home health care.