| April 2025 Newsletter The Center of Excellence for Behavioral Health in Nursing Facilities (COE-NF) provides mental health and substance use evidence-based training, customized technical assistance, and resources to certified Medicare and Medicaid nursing facilities that care for residents with a variety of behavioral health conditions at absolutely no cost. To submit a request for assistance, complete the online request form by clicking HERE. | | | | April is alcohol awareness month—a time to raise awareness and understanding of alcohol use and misuse. For nursing facilities, it's important to acknowledge the far-reaching impact of alcohol use on residents. This month serves as an opportunity to educate, promote healthier lifestyles, and offer support to those who may be struggling with alcohol misuse. | |
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For many nursing home residents, excessive alcohol consumption can lead to a range of serious health complications, such as cognitive decline, increased risk of falls, and harmful interactions with medications. These challenges can significantly impact the quality of life for older adults.
Raising awareness and fostering open conversations about
alcohol use can empower residents, care partners, and families to make informed choices. Providing the necessary resources and support ensures that nursing home residents receive the care they need to thrive. | | |
Steps to recognize Alcohol Awareness Month in your facility: - Post the COE-NF Effects of Alcohol on the Body flyer in break rooms and common areas.
- Screen for alcohol misuse using the Alcohol Use Disorder
Identification Test (AUDIT).
- Add information about alcohol misuse to your newsletter. Share key facts, resources, and tips for healthy living with staff, residents, and families.
- Host an event where families can learn more about local resources for addiction. Invite addiction specialists, counselors, or health care providers to discuss alcohol misuse and provide information about available support services.
- Schedule free training on alcohol use disorder with the COE-NF.
- Review resident charts to identify alcohol related conditions.
Together, we can create a more supportive and informed environment for nursing facility residents. | |
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| The COE-NF has developed a step-by-step toolkit to help facilities establish 12-step meetings for residents in recovery. This comprehensive guide provides insights into the 12 steps, offers strategies for launching Alcoholics Anonymous (AA) or Narcotics Anonymous (NA) meetings, and provides practical resources to ensure a sustainable and impactful program. |
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| Establishing 12-step meetings in a nursing facility is a proactive and compassionate way to support residents on their recovery journeys. It fosters a sense of community and strengthens your facility’s commitment to substance use services and a recovery-friendly environment. | |
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Subject Matter Expert Article | | |
| Keeping you up to date with the latest research, advancements and best practices in managing and addressing behavioral health conditions in nursing facilities. | | |
| Alcohol Awareness and Prevention
By Diana Padilla, MCPC, CTSS, CARC, research project manager at Northeast & Caribbean Addiction Technology Transfer Center (NeC-ATTC) | | | Alcohol plays a prominent role in American culture, often associated with joyful gatherings and celebrations like birthdays and weddings. However, for some, alcohol might be used to cope with stressful or difficult situations, providing temporary emotional relief. It is important to note that consuming alcohol at any level can lead to serious health problems. Therefore, the U.S. Department of Health and Human Services and the U.S. Department of Agriculture created guidelines for alcohol consumption. Since some nursing facilities may offer alcohol during social events such as happy hour, it is important to understand these guidelines and the impact alcohol has on the body.
Standard Alcohol Consumption Recommendations
Moderate Drinking: Recommended guidelines suggest no more than one drink per
day for females (not to exceed seven drinks in a week) and no more than two drinks per day for males (not to exceed more than 14 in a week). | | | Alcohol and Potential Impact on Health
Alcohol use at any level can have health consequences. Consumption can impair judgment, motor skills, and decision-making. Drinking outside of the recommended guidelines can increase the risk of cancer and heart disease, worsen depression, cause digestive problems, weaken immune systems, and increase the risk of asymptomatic illnesses such as compensated cirrhosis or alcoholic hepatitis.
Excessive alcohol use can lead to memory problems, such as alcohol-related dementia. In addition, consuming alcohol very quickly can increase the risk of harm, such as blackouts and falls. It can also increase the risk of unpredictable or violent behavior toward other residents or staff members.
Alcohol and Medications
Mixing alcohol with certain
medications can cause nausea, vomiting, headaches, drowsiness, fainting, or loss of coordination. Alcohol can also make some medicines less effective or even harmful to the body.
Unauthorized Alcohol Use
Residents may consume alcohol while away from the facility, on weekend passes, or during an off-campus trip. Some residents may also gain possession of alcohol during visitation without staff knowledge. Click Here to learn how staff can support residents.
Supporting Residents
Facilities play an important part in promoting healthy choices and providing support to residents who consume alcohol above the recommended guidelines. By offering education, standard drink recommendations, and information on the effects of alcohol, encouraging open conversations, and connecting residents to counseling or treatment resources, nursing facilities can
foster a supportive and understanding environment. Regular staff training and collaboration with health care providers can enhance care and improve outcomes. | | | | | | Diana Padilla has worked in the behavioral health field for more than 26 years. Using a
person-centered, recovery-oriented perspective, she teaches how to enhance and tailor strategies and interventions to address health and behavioral health needs, particularly in the intersection of trauma, stress, and substance use. | | | References:
CDC, Alcohol Use and Your Health, January 14, 2025, https://engage.allianthealth.org/e/810993/cohol20use20during20pregnancy-/5zkyl1/2508102279/h/r7khH29iwP5V-0Nbi4R4NkW4te-Y3BdbSswsn7SkeyY
Dietary Guidelines for Americans, 2020-2025,
https://engage.allianthealth.org/e/810993/alcohol-info/5zkyl4/2508102279/h/r7khH29iwP5V-0Nbi4R4NkW4te-Y3BdbSswsn7SkeyY
National Institute on Alcohol Abuse and Alcoholism, (NIH), Alcohol’s Effects on Health, https://engage.allianthealth.org/e/810993/e20several20types20of20cancer-/5zkyl7/2508102279/h/r7khH29iwP5V-0Nbi4R4NkW4te-Y3BdbSswsn7SkeyY
National Institute on Alcohol Abuse and Alcoholism. Harmful Interactions. Mixing Alcohol with Medicines https://engage.allianthealth.org/e/810993/tions-Harmful-Interactions-pdf/5zkylb/2508102279/h/r7khH29iwP5V-0Nbi4R4NkW4te-Y3BdbSswsn7SkeyY
World Health Organization (WHO), Alcohol, June 28, 2024, https://engage.allianthealth.org/e/810993/ted20to20alcohol20consumption-/5zkylf/2508102279/h/r7khH29iwP5V-0Nbi4R4NkW4te-Y3BdbSswsn7SkeyY |
| | | | Nursing Facility Guidance Updates: Focus on Substance Use Disorder (SUD) and Accident Prevention |
| | In addition to the revisions taking effect on April 28, 2025, the Centers for Medicare & Medicaid Services (CMS) have made further updates to the Accident and Hazards Critical Element Pathway regarding concerns related to substance use disorder (SUD). The most notable change involves the assessment of signs and symptoms of substance use and the potential for overuse.
For incidents or accidents related to suspected or known substance use, facilities must ensure that: - The resident’s environment is free from accident hazards, and each resident receives adequate supervision to prevent accidents.
- The resident assessment accurately reflects the resident’s current status.
- The facility has developed and implemented a baseline person-centered care plan within 48 hours of admission. Subsequently, a comprehensive person-centered care plan must be created, which includes measurable objectives and timeframes to address the resident’s medical, nursing, mental, and psychosocial needs, as well as the resident's goals, desired outcomes,
and preferences.
- The facility reassesses the effectiveness of the interventions and reviews and, if necessary, revises the resident’s care plan with input from the resident or resident representative to the extent possible to better meet the resident’s needs.
CMS has included updates to the Resident/Resident Representative Interview section. Interviewers will be prompted to ask: - “Are you aware of the resident using any substances, and do you have any
concerns about their health or safety?”
- “Are you aware of any visitor(s) bringing substances to the resident?”
Additionally, staff interviews will focus on whether staff members are aware of the signs and symptoms of substance abuse (for example, a resident leaving the facility and returning) and how these residents are monitored. Staff will be asked about the interventions or assistance needed (such as safe smoking protocols, fall prevention strategies, and addressing known substance use disorders), the resident’s risk factors for accidents (including smoking, falls, and substance use disorder), how often
assessments and education occur, where this information is documented, and whether the resident or resident representative is involved in decisions regarding interventions, along with specific details on how this involvement occurs.
In the Social Services Interview, questions will include how participants were involved in developing the resident’s behavior management plan to address issues such as altercations, falls, smoking injuries, elopement, or substance use disorder.
During record reviews, surveyors will concentrate on the following additional areas related to substance use: - For residents with SUD, did the facility assess the risk of the resident leaving against medical advice to obtain substances and discuss
those risks with the resident?
- For residents with known SUD who experienced an overdose in the facility, did the facility implement care plan interventions, such as increased monitoring upon the resident's return from leave or after spending time with visitors, and notify the physician?
| | | | The COE-NF stands ready to support your
facility in these guidance areas. Contact us today! | | | | Have mental illness and substance use questions? We have the answers! Join us for office hours to talk with the experts. | | | Managing Substance Use Disorders in Nursing Facilities
Interested in receiving expert answers to substance use challenges you are facing in your nursing facility? Join Dr. Jen Azen and Dr. Swati Gaur, subject matter experts, as they answer questions related to your complex cases. No question is too big or too small!
Join our monthly office hours on the third Friday of each month from 1-1:30 p.m. ET to get answers directly from the experts working in nursing facilities!
Audience: Appropriate for clinicians, nurses, administrators, and social workers. | | | | | The Center of Excellence for Behavioral Health in Nursing Facilities (COE-NF) has developed a range of resources designed to educate nursing facility teams. | | | | | Addressing Alcohol Use in Nursing Facilities
This guide discusses the health effects of alcohol consumption on nursing home residents and provides proactive steps that staff can take when unauthorized alcohol use occurs in nursing facilities. Download Resource | | | | | What Nursing Facilities Should Know about Alcohol Withdrawal
This resource describes signs and symptoms of alcohol withdrawal and provides a guide to detox strategies for nursing facilities. Download Resource | | |
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Interested in accessing additional COE-NF resources for your facility?
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Unlike food, alcohol isn't digested; it rapidly enters the bloodstream and circulates throughout the
body. Alcohol's initial impact is on the brain, followed by the kidneys, lungs, and liver. The specific effects vary depending on factors like age, gender, weight, and the type of alcoholic beverage consumed. | | | | | |
| Enhance your expertise with our April 2025 COE training events! Gain practical strategies and support as we address The Centers for Medicare and Medicaid Services (CMS) Regulatory Guidance on psychotropic medication management, along with essential topics like suicide
prevention, trauma-informed care, and co-occurring disorders.
Don't miss this opportunity - Register today! | | |
Effective Strategies for Managing Psychotropic Medications in Nursing Facilities: Navigating New CMS Requirements of Participation | | |
| Tuesday, April 15, 2025
2-3 p.m. ET 1.0 ACCME & 1.0 NAB credits will be offered.
This training focuses on the recent updates from the Centers for Medicare and Medicaid Services (CMS) guidance to surveyors concerning informed consent and the management of psychotropic medications in nursing facilities. Participants will develop a deeper understanding of how to apply principles of medication stewardship in managing psychotropic medications, as well as how to implement a team approach to enhance the quality of care.
Learning
objectives: - Understand the latest CMS guidelines regarding the use of psychotropic medications and the significance of informed consent to ensure compliance and quality of care.
- Establish and apply protocols for the gradual reduction of psychotropic medications when appropriate, ensuring personalized assessment and ongoing evaluation of residents’ needs.
- Promote teamwork among physicians, pharmacists, nurses, and other
healthcare providers to enhance medication management practices and ensure comprehensive care for residents receiving psychotropic medications.
| | | | | An Easy Pill to Swallow: Nonpharmacological Interventions for Long-Term Care Residents | | | | Thursday, April 17, 2025
2-3 p.m. ET 1.0 ACCME & 1.0 NAB credits will be offered.
While psychotropic medications can be valuable for mental wellness, there are many effective
nonpharmacological interventions available. This presentation will introduce various non-drug approaches for residents in nursing facilities. Attendees will learn about a comprehensive bio-psycho-social-spiritual approach to mental health, illustrated with real-life case examples. The session will also cover the development of person-centered strategies to address mental illness, aiming to improve symptoms and reduce the need for PRN (as-needed) medication requests or emergency hospitalizations.
Learning objectives: - Understand and apply person-centered care principles in geriatric populations.
- Recognize the presence and impact of mental illness on nursing facility residents.
- Develop and implement a comprehensive approach to mental illness using nonpharmacological interventions.
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Building A Better Suicide Risk Assessment: The Nuts and Bolts of the Columbia Protocol C-SSRS | | |
| Wednesday, April 23, 2025
2-3 p.m. ET 1.0 ACCME & 1.0 NAB credits will be offered.
Utilize the Columbia protocol also known as the Columbia-Suicide Severity Rating Scale (C-SSRS) to learn how to utilize the six simple questions to identify whether a resident is at risk for suicide. The
responses will help assess the severity and immediacy of that risk and determine the level of support needed.
Learning objectives: - Whether a resident has thoughts about suicide (ideation).
- What actions a resident have taken to prepare for suicide.
- Whether a resident attempted suicide or began a suicide attempt that was either interrupted by another person or stopped of their own
volition.
| | | Mental Health First Aid (MHFA) | | | | **Registration Closed: This Session is Full** | | | | Friday, April 25, 2025
11 a.m.-4:30 p.m. ET
7.75 NAB credits and 5.5 ACCME credits will be offered after completing the live training.
Mental Health First Aid (MHFA) training provides skills to engage and provide initial help and support to someone developing a mental health or substance use challenge
or experiencing a crisis.
This session provides a MHFA certification for three years.
The training covers: - Common signs and symptoms of mental health and substance use challenges.
- How to interact with a person in crisis.
- How to connect a person with help.
- Expanded content on trauma, substance use and self-care.
The training is divided into three parts:
Part 1 starts AFTER initial registration has been APPROVED by the instructor. Approved registrants will be emailed instructions on how to create an online profile using MHFA Connect and complete a pre-survey/quiz followed by a two-hour self-paced online course. Registrants MUST complete Part 1 no less than 48 hours (two business days) prior to the scheduled Part 2 session.
Part 2 is a 5.5-hour live instructor-led virtual training. Participants are required to be on camera the entire time.
Part 3 participants will return to MHFA Connect to complete the post-test and evaluation, which is
required to receive a certificate of participation. | | | Question, Persuade, Refer (QPR) | | | | Suicide Prevention Training
Registration is limited. | | | Tuesday, April 29, 2025
2-3:30 p.m. ET 1.5 ACCME & 1.5 NAB credits will be offered. QPR training will offer strategies to support your work in
providing suicide prevention and mental wellness to your residents. This 1.5-hour evidence-based instructor-led training is held virtually and will provide a comprehensive review of a three-step approach anyone can learn to help save a life from suicide. This session will provide a one-year certification to attendees.
Key components covered in the training: - How to Question, Persuade and Refer someone who may be suicidal.
- How to get help for yourself or learn more about preventing suicide.
- The common causes of suicidal behavior.
- The warning signs of
suicide.
- How to get help for someone in crisis.
| | | | Improving your physical health is essential for enhancing your quality of life, preventing a range of chronic diseases, and promoting mental well-being. By prioritizing your health today, you’re laying the foundation for a stronger, more resilient you. | | | | | | | | Join our text message list!
Scan the QR code or click the button below to sign up and receive text notifications from
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Stay up-to-date on COE-NF news and events. | | | | | | | Contact us:
For more information, please call 1-844-314-1433 or email coeinfo@allianthealth.org.
To submit a request to inquire about substance use and/or mental health training options for your facility, complete the inquiry form.
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| | | Alliant Health Solutions (AHS) was awarded a three-year cooperative agreement from the Substance Abuse and Mental Health Services Administration (SAMHSA), in collaboration with the Centers for Medicare & Medicaid Services (CMS), to create the COE-NF. AHS has over 50 years of experience working with nursing facilities and behavioral health in nursing facilities.
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| | | | This newsletter was made possible by grant number 1H79SM087155 from the Substance Abuse and Mental Health Services Administration (SAMHSA). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Substance Abuse and Mental Health Services Administration. | | | | | | |
