Caregivers are going to need a sturdy surfboard

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Mary Gustafson, McKnight's Staff Writer
Mary Gustafson, McKnight's Staff Writer
The good news is that the Affordable Care Act has much to offer people with mental illnesses. The bad news is that even with the law's policies, the U.S. health system is still woefully unprepared to meet the oncoming wave of mental health needs of baby boomers, according to a new Institute of Medicine report.

“There is a conspicuous lack of national attention either to preparing the health care workforce […] or to ensuring sufficient numbers of personnel for the rapidly growing elderly population,” according to the IOM.

Additionally, it warns that 14% to 20% of the nation's overall elderly has one or more mental health conditions or problems stemming from substance misuse or abuse. Depressive disorders, dementia-related behavioral and psychiatric symptoms are the most prevalent, according to the report. The World Health Organization tabs depression as the leading cause of disability in the world. And as any long-term care professional can tell you, it's a disease that plagues nursing home residents.

To see how protracted psychological illnesses play out in long-term care, look no further than Illinois. As part of efforts to reform the state's nursing homes, Gov. Pat Quinn's office had an ambitious plan to transfer 5,000 mental health patients out of nursing homes and into group homes or other community-based settings over a five-year period. But after one year, only 45 residents have been transitioned, falling far short of the original first-year goal of 256 people.

But, as the New York Times pointed out this week, the ACA has the potential to be tremendously helpful for the mentally ill — and ultimately long-term care — in many different ways.

By definition, people with mental illnesses are also people with pre-existing conditions. But since the law no longer allows insurance companies to deny coverage to people with pre-existing conditions, these individuals can gain access to meaningful treatments that they were excluded from before. The ACA's Medicaid expansion also would extend benefits to even more low-income people who, arguably, are at an even greater disadvantage to getting adequate care.

As the author of the Times article, Richard A. Friedman, M.D. points out, the earlier a mental illness is treated, the better the long-term outcomes. Psychiatric illnesses, he points out, are treatable but rarely curable. If a person's illness is diagnosed and treated earlier in life, his or her condition could be well managed by the time long-term care is needed.

“This law has the potential to change the course of life for psychiatric patients for the better, and in that sense it is both humane and right,” Dilip V. Jeste, M.D., president of the American Psychiatric Association, told the Times.

Things start to get dicey, though, in states that stubbornly refuse to participate in the ACA's Medicaid expansion, such as Texas and Florida, despite financial help from the federal government.

As the New York Times argues, mentally ill individuals living in states that reject Medicaid funds could “find themselves in a terrible predicament: They earn too much to qualify for Medicaid, yet not enough to get the federal subsidy to pay for insurance.”

Regardless of how one feels about the merits of the Affordable Care Act, I think everyone can agree that this country can't afford to ignore the needs of such a vulnerable population.

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McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Marty Stempniak.

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