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Behavioral Health Integration and Consumer Engagement in MLTSSWhen considering person-centered planning in LTSS, BH is one of the key pillars we must build on.

Initiatives to move state Medicaid funded long-term care services and supports (LTSS) systems away from costly institutional care to settings that promote independence and community can involve a lot of moving parts for aging consumers and their families.

While our expertise is in serving those with intellectual and physical disabilities, we also recognize the ongoing juggling act that coordinating services for an aging loved one with behavioral health issues as well as chronic conditions and/or functional limitations can be. Even accomplished jugglers will tell you, it takes supreme focus and mental energy along with physical skills, to keep all those balls in the air.

Rebalancing efforts are based on core principles of choice, maximum independence in a safe environment, and quality community based services for individuals that meet an individualized plan. All laudable and most welcome, but as laid out in a recent report by the National Coalition on Mental Health and Aging (NCMHA), often falling short in addressing behavioral health needs, a growing concern for the senior population that has direct consequences for family caregivers as well.

Behavioral health needs cut throughout the population and in the development of population health, BH is usually one of the root causes and indicators for declines in wellbeing and readmissions. When considering person centered planning in LTSS, BH is one of the key pillars we must build on.

The NCMHA report, Integrating Older Adult Behavioral Health Into Long-Term Care Rebalancing, raises the alarm on inadequately met mental and behavioral challenges that are major drivers of premature, and perhaps unnecessary, placement in institutional settings, noting that “nearly 50% of individuals receiving long-term care have a mental disorder other than dementia; these disorders frequently co-occur with dementia and/or physical disabilities (and) are associated with poorer health outcomes, increased functional impairment, and decreased adherence to treatment.”

That dovetails with a study in the latest issue of the journal Psychiatric Services. It finds Baby Boomers in particular with mental health conditions not only don’t get the help they need, but are doing worse on measures of health care access and utilization than they were in 2006 — despite the enactment of the Affordable Care Act.

The NCMHA report points up a double-whammy cascade effect of untreated behavioral health issues in the elderly, suggesting, “state long-term care rebalancing efforts must address the behavioral health needs of older people at risk of placement or being transitioned from institutions and of family caregivers who are often under tremendous stress and at high risk of mental health challenges.” (Italics my own.)

The airline safety instructions always direct passengers traveling with children to put their own oxygen masks on first, and THEN tend to getting it on the kids: the caregiver needs to be able to function to deliver care and assistance. Family and informal care providers are part of wrap-around person centered services required to avoid re-institutionalization. Caring for and supporting the caregivers is an essential element assuring community living.

To effectively reduce institutionalization, costs of care, and improve health and functioning, service providers would do well to take into account the emotional and physical well-being of family caregivers. Consumers who receive long term services and supports in the community can direct their services and are able to provide specific and pointed input at the critical junctures when their needs are changing. With their caregivers, these consumers can be active in providing feedback to the health plans and care managers consistently. Technology and telehealth developments make it easy for such communications to take place.

I’ll be addressing these issues and more during my informational session on “Improving Quality Through Consumer-Focused Care Management” at The 2017 OPEN MINDS Strategy & Innovations Institute June 6-7, 2017 in New Orleans, Louisiana. I hope to see you there.


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