Dr. El

For most of my 20-plus years as a psychologist in long-term care, I’ve worked with a mix of both short- and long-term residents. Recently, however, I’ve been almost exclusively treating residents on the rehabilitation unit where I have my office. 

For a variety of reasons, it’s an excellent way to meet their behavioral health needs. It will be particularly helpful as PDPM and the focus on trauma-informed care increases the recognition of depression and post-traumatic stress.

It makes sense to have a psychologist located on the rehab unit for practical reasons. In the past, if a short-term resident required psychological attention, my fellow psychologists and I would come to the unit from a long-term floor to try to find the resident amid their rehab schedule, medical appointments, meals, personal care, general exhaustion and other disruptions to their availability. It was hit or miss, mostly miss. 

From the new resident’s perspective, until an initial meeting takes place and rapport is established, the psychologist is just another outside consultant in a chaotic environment showing up at their door looking for their time and attention.

With an office on the short-term floor, however, the psychologist becomes a recognizable face even before a referral is made. Residents observe peers leaving the common area to privately discuss their concerns, thus helping to normalize behavioral healthcare. The psychologist becomes a reassuring presence on the unit, a touchstone during a crisis period.

The psychologist is able to monitor her or his patients between sessions, noting if someone seems particularly upset or is missing from their usual spot in the day room (often a sign of a decline in physical and/or mental health), and cheering on accomplishments and milestones during their rehab stays. Staff members can easily reach out to make referrals or to ask questions about how to handle behaviors. Families are reassured that a doctor is spending time with their loved one and they can become part of the sessions as needed. It becomes truly integrated care.

I concur with my nursing supervisor, who says that “it’s very effective” to offer immediate, consistent, readily available counsel. 

On a personal level, I find that it’s intense, crisis-oriented work that requires strong emotional engagement with a constantly changing set of people. Without the balance of longer-term therapeutic relationships, I’ve had to increase my self-care in order to maintain my effectiveness. 

For LTC psychologists in general, the good news these days is that there’s increased awareness of the behavioral health needs of residents. 

The bad news is that the Centers Medicare & Medicaid Services is considering a 7% reduction in fees for psychologists (concerned individuals can comment on the CMS website by 9/27 — this Friday) and that Medicare “Advantage” plans often have unaffordable mental health copays. The combined effect makes it harder for elders to access services and for facilities to lure providers to the field.

As the healthcare industry deepens its understanding that the behavioral health needs of residents have a significant impact on care quality and costs — from refusing care, to insisting upon unnecessary treatments, to necessitating additional staff time, and on and on — efforts to integrate behavioral healthcare services and to offer appealing, sustainable positions for psychologists become increasingly important.

Eleanor Feldman Barbera, Ph.D., author of The Savvy Resident’s Guide, is an Award of Excellence winner in the Blog Content category of the APEX Awards for Publication Excellence program. She also is a Bronze Medalist for Best Blog in the American Society of Business Publication Editors national competition andGold Medalist in the Blog-How To/Tips/Service category in their Midwest Regional competition. To contact her for speaking engagements and/or content writing, visit her award-winning website at MyBetterNursingHome.com.