Life on the road as an LTC shrink

Life on the road as an LTC shrink

Last week I flew from New York City to Indianapolis to speak at a conference on severe mental illness in long-term care. From there, I drove to Chicago to offer my thoughts about behavioral health at a risk management event.

It wasn’t exactly a world tour, but I did come away with some interesting observations regarding our field.

My first stop was the severe mental illness (SMI) conference organized by the Indiana State Department of Health. The goal of this event was to improve care for Indiana residents diagnosed with SMI.

Nationally, rates of severe mental illness in LTC have doubled between 2000 and 20171. At 10%, Indiana has about an average number of SMI individuals, yet, with conferences like this, it’s leading the way in addressing this nationwide problem.

After recognizing that the mental health pendulum went too far in the direction of deinstitutionalization, Indiana has also revamped its psychiatric hospital system and increased the number of beds available, including geropsychiatric beds.

To see the number of residents with schizophrenia and bipolar disorder for your state, county and facility, create a map in one minute on, a fascinating, user-friendly Brown University website.

(By the way, I’m editing this article in my office on the rehab unit and a resident with bipolar disorder just stopped by for the third time this week — and it’s only Tuesday! As I was saying, it’s a national issue.)

One challenge that needs to be further addressed with regulators is how to comply with directives to avoid using individuals “for labor,” while at the same time allowing residents living with mental illness the opportunity to engage in meaningful, esteem-building activities.

Conference attendees told me, for instance, about a resident who enjoyed pulling weeds in the garden, but surveyors perceived this as problematic. Perhaps having more guidance and flexibility around volunteerism would help.

Life on the road as an LTC shrink

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