Nursing Home Research I’d Like to See: An Open Letter to Researchers

Dear Researchers,

I’ve been a nursing home psychologist for the last 14 years, and, while there are many fascinating areas to be studied in the field of geropsychology, I’m writing to you with the hope that we’ll see more research on the medical cost offset of psychological services.
One type of study could look at archival data from Medicare/Medicaid or private insurance companies comparing the medical costs of beneficiaries receiving psychological services with those who do not. I’d expect to see decreased use of medications, and possibly reduced use of aggressive end of life treatments. Studies showing reduced medical expenditures could result in changing regulations to require psychological consults upon nursing home admission, much like therapeutic recreation and dental service evaluations are required, and would increase the likelihood that insurers would promote mental health services in physical health environments.
Another type of study would take place within individual nursing homes, comparing floors or units receiving psychological interventions with those that don’t. Such studies could examine the effectiveness of psychotherapy provided to residents on measures of resident, staff, and family satisfaction, absenteeism, incidents, turnover, etc. Other studies could measure the effects on those variables of a broader application of psychological services, such as team-building on a unit, communication skills training, conflict resolution, establishment of a therapeutic milieu, etc. If research indicated that providing psychological interventions to residents and staff decreased overall costs within individual nursing homes, perhaps we’d begin to see psychologists funded as part of the nursing home budget and able to provide a greater range of services.
If you’re a researcher who’s been working on medical cost offset studies, please contact me if you’d like a blog post about your research. Let’s get the word out.
Dr. El

6 thoughts on “Nursing Home Research I’d Like to See: An Open Letter to Researchers”

  1. Dr. El,

    I, too, would like to see medical cost offset studies of psychological services, but also of recreational services. The provision of recreational programs is a regulatory requirement in long term care, but is not reimburseable. Over the years health care cuts have cut recreation staff to a bare minimum with C.N.A.s expected to pick up the slack, but with all due respect, it is just not the same.

    Additionally, as a licensed art therapist, I would like to add that while CMS recognizes art therapy as a psychological service it is not reimbursable as one; it is very puzzling.

    I am not trying to equate these services, both are necessary and beneficial in their own right, but find it shocking that services that would significantly improve residents lives are so over looked.

  2. New to this blog.

    I have been with my 86 y.o dad since April of this year. He needed full time help. I was with him, and then slowly I've been incorporating pretty good caregivers, in anticipation of a move to a facility where he will take them with him. (He is fortunate to have the resources.)

    Too many questions, but I'll try to narrow it down to this general one about assisted living and skilled nursing levels.

    Do you anticipate a very very very slow awakening and awareness to the overuse of psychiatric meds (sedatives, let's just cut to the chase – even though they may have fancier names) in nursing homes? I ask because I have been doing a LOT of research and self-teaching about them – Dad's on them, I am not – and in the course of this work, have come across a large populace of people who are extremely angry that the establishment is so pro-psych meds right off the bat, so unthinkingly so, too. And I'm wondering if this will generate enough pushback to eventually have an impact on nursing homes? If so, great!

    But wait. If so, what will take their place? In my view of the situation, psych meds in nursing homes are used almost exclusively as labor saving devices. Looking after people IS extremely stressful. So, what's the alternative?

    Thanks for this blog!

  3. Thanks, Anonymous, for your comment. As a psychologist, I don't prescribe psychotropic medications, but I certainly believe there's a place for them in the nursing home and elsewhere. The overuse of sedating medications is something that's monitored by surveyors and should be monitored within facilities. There are many programs that could be put in place which would reduce the use of such medications, and I'm all for this. For residents who are agitated, perhaps related to dementia, and other interventions have failed, it seems unfair to let them be so upset when there are medications that can help to relieve their distress. It's also unfair to the other residents around them who have to live with their agitation and disruptiveness. Everything must be taken on a case-by-case basis: at times I advocate for medication and at times I advocate for medication reduction or elimination. All the best with your Dad.

  4. I agree that medications do have their place. What bothers me so much are all the people that are on anti-psychotics/anti-depressants without ongoing assessment by geriatric doctors or psychologists. At a facility where I volunteered, there was one general practitioner that came in when needed. This Doctor cannot properly assess 160 people that are all on various medications. I found that people that came into the facility were left on whatever medication they were using when they entered long term care. As long as they didn’t cause any problems, the medication was not changed if the family did not question anything. Many of the residents did not get visitors so of course no one would be asking if they were on the right dose. That being said, there were many people without a good quality of life because they were over medicated. Nothing changes because staff do not see a reason to change. Why would they? They do not know the resident and cannot possibly know what is normal behaviour for that person. Unless a resident punches someone or screams a lot, nothing changes medication wise, and in these cases they up the dose. God help you if you are not on the right drug because you will be staying on it until you die. Unfortunately, this is what I have seen in a few nursing homes and it is quite depressing to me.

    • Christine, unfortunately, in many cases you’re right. Which is why it’s so important for family members to be involved and to let nursing home staff know what’s normal behavior for their loved one. Better integration of mental health services in nursing homes is also essential to address this problem.


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