Behavioral health needs are going unmet in as many as one-third of the nation’s nursing homes, while almost half employ staff without adequate behavioral health education.

Those were the major implications culled from a study of nearly 1,100 facilities conducted by researchers at the University of Rochester School of Medicine and Dentistry. They surveyed the randomly selected facilities during a six-month period in 2017, asking questions about available behavioral health services availability, quality, satisfaction, staffing, staff education, turnover and service barriers.

Implementation of some new behavioral health requirements for skilled nursing providers went into effect that year, and yet many providers acknowledged they were under- or unprepared.

Despite new rules calling for multidisciplinary care teams and more social work involvement in every-day care, 30% of homes reported having inadequate coordination of care between nursing home and community providers. In addition, more than 26% had inadequate infrastructure to handle referrals and transportation, researchers reported in the Journal of the American Geriatric Society.

“Inadequate behavioral health education and psychiatric training among nursing home staff were associated with subpar provision of behavioral services in this care setting,” the researchers reported. “New initiatives that increase access to behavioral health providers and services and improve staff education are urgently needed.”

Though the Requirements of Participation began ramping up behavioral health requirements with 2016’s Phase 1, the third phase will trigger yet another round of expectations when it comes to providing appropriate care.

Under a trauma-informed care provision, providers will be expected to provide necessary behavioral healthcare and services to every resident in accordance with a comprehensive assessment and care plan.

Facilities must conduct an assessment to determine their behavioral health staff needs and create an approach that accounts for needed competencies and skills. Services are expected to include treatment of mental and psychosocial illnesses — relying on non-pharmacological interventions when possible.

The study authors noted that staff education was less problematic in nursing homes with Alzheimer’s units, lower RN turnover, and more psychiatrically trained RNs and social workers.

The final phase goes into effect on Thanksgiving Day this year.