Behavioral Health in LTC: Todays Focus and Increasing Need – 4 part series package (recordings & handouts available)

Behavioral Health in LTC: Todays Focus and Increasing Need – 4 part series package (recordings & handouts available)

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(Full series package includes recordings and handouts)

The Centers for Medicare and Medicaid Services (CMS) has been focusing on behavioral health in Nursing Homes since the implementation of the Medicare and Medicaid Programs; Reform of Requirements for Long-Term Care Facilities, a three phased final rule beginning 2016.

The National Partnership to improve Dementia in Nursing Homes provided research, training, and alternatives to utilizing antipsychotic medications and in conjunction with CMS focused on the reduction of these medications in the nursing home. A significant improvement was seen; however, CMS believed more could be accomplished. In 2018, the Late Adopter program was established to provide oversight and enforcement to Nursing Homes who had high levels of antipsychotic use.

As the pandemic moved through our Nursing Homes, social isolation, increased depression and other behavioral conditions have been seen in our facilities. An increased use of antipsychotic medications has occurred, along with documentation concerns related to the use of these medications and use of questionable mental health diagnoses developing in our elderly population. The need for education for our interdisciplinary staff in behavior health has been identified.

The focus of this series of trainings will begin to address educational needs of the nursing home staff related to behavioral health issues frequently observed in the facilities.

Part I:  Behavioral Health Issues – Regulations and What is Being Cited 

The first in the series will review the current regulations for behavioral health and specific guidelines that need to be understood and monitored by the IDT. Frequently cited deficiencies will be identified and reviewed. Tools will be reviewed that could assist the team in monitoring the F tags for Behavioral health.

Objectives:  On completion participants will be able to:

  1. Recognize federal regulations specific to behavioral health
  2. Identify the current deficiencies with a behavioral health care focus by CMS and the OIG
  3. Describe 1-2 tools that could be implemented to enhance behavioral health monitoring

Part II:  Differentiating Behavioral Health Conditions and Psychotropic Medication Use

The interdisciplinary team (IDT) needs to recognize what behavioral health conditions in addition to Dementia are frequently seen in the nursing home, symptoms that may be observed in the varying conditions and understand the medications used to treat these conditions. The team, as well, needs to recognize side effects of these medications and monitor of the effectiveness.

Objectives: On completion participants will:

  1. List 3 – 5 behavioral health conditions frequently seen in LTC
  2. Identify 3 -5 side effects of psychotropic medication usage
  3. Describe methods of monitoring and documenting potential triggers and behaviors

Part III:  Gradual Dose Reduction (GDR) and Abnormal Involuntary Movements (AIMs) – When Required, Monitoring Need and Capturing Results

Residents who are on various psychotropic medications are required to have

GDRs per federal regulation (F758 *Free from Unnec Psychotropic Meds/PRN Use) and AIMS testing when they are on antipsychotic medications to monitor for tardive dyskinesia.

A Key component of this process is documentation. Implementing a GDR of certain medications could cause emotional/psychological pain for our residents. Documentation should reflect the resident’s history, the effect of the GDR, and how the treatment plan will be implemented and/or changed. This information should be captured in the resident’s care plan and include monitoring by the IDT.

Objectives: On completion participants will:

  1. Review F757 – Drug Regimen is Free from Unnecessary Drugs and F758 – Free from Unnec Psychotropic Meds/PRN use
  2. Identify the purpose of GDR and AIMs
  3. Describe what monitoring and documentation is needed when GDRs are implemented

Part IV:  Non- Pharmacological Interventions and Person-Centered Care Planning

Non-pharmacological interventions is a key component when working with residents in need of behavioral health services. Identifying the triggers of the behavior when it occurs and recognizing what interventions work can assist in preventing the use of psychotropic medications. The interventions should be developed based on each resident’s unique needs and a person-centered care plan developed.

Objectives: On completion participants will:

  1. Describe 1-2 methods for identifying a resident’s specific needs related to behavioral health
  2. Identify 2-3 interventions that may assist in reducing a resident’s behavior(s)
  3. Describe how to document a resident’s behavioral health and capture interventions on the comprehensive person-centered plan of care

Returning educators! 

 

 

 

 

 

 

Barbara A. Bates, RN, MSN, RAC-CT, DNS-MT, QCP-MT

 

 

 

 

 

 

Linda Winston, RN, MSN, BS, RAC-CT, DNS-MT, QCP-MT 

Flyer for printing including presenter details 

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May 11, 2022