Sherie Friedrich

Spurred by the COVID-19 pandemic, the healthcare industry has experienced a marked shift to home-based care as more and more patients – including seniors – opt to recover at home rather than in a long-term care facility. 

However, as patients make the transition from an inpatient rehabilitation facility, assisted living, or skilled nursing facility (SNF), provider teams must ensure that patients receive the same quality and level of care at home as they did while in an institutional setting. 

An often overlooked component of post-discharge patient care is behavioral health, although 20% of people over the age of 55 have some form of mental health condition, and that percentage is higher in institutional care settings. Readmission rates for patients with behavioral health comorbidities have also been shown to be nearly twice those of patients without a behavioral health comorbidity.

As long-term care providers face census challenges amidst the industry-wide shift to home-based care, it’s increasingly critical that they optimize patient outcomes and minimize 30-day hospital readmissions. One way to achieve these results is by offering patients access to behavioral health services. 

For example, a knee replacement patient may face behavioral health struggles during a stay at a long-term care facility, such as depression. When the patient has rehabilitated from surgery and it is time to be discharged, the discharge planning team, family members or the patient may acknowledge that additional behavioral health services are required upon the return home to ensure a safe and successful recovery. 

To mitigate gaps in patient care, long-term care facilities must make behavioral telehealth services available to patients immediately upon discharge back to the community. A comprehensive care model integrating therapy with medication management will strengthen the support system for the patient, ultimately resulting in higher successful transitions rates. These services benefit not only the patient but also the provider – and ultimately, other stakeholders across the care continuum, as well. 

Increasing access to behavioral healthcare through telehealth

As discharge planners work quickly to ensure a patient’s post-discharge health services are in place, it can be challenging to identify a behavioral health provider accepting new patients. Unfortunately, many long-term care facilities do not have the time or resources to identify and secure timely, accessible behavioral health services for a patient post-discharge. 

Even if discharge planners locate an available provider, the patient will likely need to wait several months – or sometimes even a year – for the next available appointment. There is a critical shortage of mental health professionals, particularly for those that treat the geriatric community; in fact, a future shortage of geropsychologists is anticipated. All too often, patients face gaps in care – particularly for behavioral health services – which are critical in ensuring a patient’s safe and successful recovery at home. 

Through behavioral telehealth services, patients can receive necessary care within a week of their discharge. Behavioral health services provided via telehealth are also beneficial because they eliminate the need for trips into the community for an appointment, reducing the burden on patients and their caregivers. 

Depending upon the reason for a patient’s stay in a long-term care facility, some individuals may have decreased functionality or mobility and be unable to secure transportation to their behavioral health provider. Also, patients who require home healthcare following their inpatient stay may be hesitant to leave home too regularly or for too long while receiving those services. Conducting all behavioral health visits via telehealth avoids these detrimental roadblocks to care. 

Behavioral telehealth: benefiting both patient and provider

Behavioral telehealth is beneficial not only for patients but for providers as well. Leveraging behavioral telehealth, patients receive continuity of care; someone follows up with them to schedule an appointment shortly after discharge, and patients receive the same quality of care within their homes as they were accustomed to within a long-term care facility. 

For recently discharged patients, a “soft landing” and smooth transition back into the community can be the difference between a successful recovery and an unnecessary hospital admission or avoidable ER visit. 

Because behavioral telehealth services are widely accessible and easy to schedule, they may reduce burden on discharge planning teams as they seek post-discharge care for the patient. Behavioral telehealth also offers providers an “umbilical cord,” or safety net, to ensure that patients have access to critical mental health support from the safety of their own homes. These services can also ease the admissions process or increase referrals because – with access to behavioral telehealth at the point of discharge – they have the capabilities to admit a wider swath of patients requiring behavioral health services during their stay and upon their return to the community. 

Incorporating behavioral telehealth into transitions of care 

Post-discharge behavioral health services help streamline a patient’s transition and adjustment from one care setting to at-home care with no disruption to their care plan – creating greater clinical stability for the patient and resulting in more optimal outcomes for all involved stakeholders. 

Elderly patients likely won’t utilize mainstream consumer behavioral telehealth offerings on their own, highlighting the critical need for care coordination services offered directly through providers. This approach allows a patient’s cross-continuum care team to provide a consistent, high touch, warm approach for the well-being of the patient. 

Ultimately, a coordinated care model enables providers to ensure that patients receive necessary care in a timely manner and do not fall through the cracks between the time of discharge and when they arrive home. 

Sherie Friedrich, Psy.D., is chief psychologist at MediTelecare, where she has focused on the growth and development of the Department of Psychology. Friedrich has worked in psychiatric hospitals, community mental health settings and in private and group practice. She also worked as a psychological consultant conducting comprehensive evaluations for state and private institutions.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.