January 2024 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.
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In This Issue
- COE-NF Grant Year 1 in Review: By the Numbers
- Start the New Year with a Facility Assessment
- CARES Serious Mental Illness On-Line Training
- CARES Serious Mental Illness Office hours
- Buprenorphine in the Long-Term Care Facility – Is There a Place for It?
- What is Behavioral Health Equity?
- Nursing Facility Regulatory Guidance - Navigating Nursing Home Best Practices: Understanding Preadmission Screening and Resident Review (PASRR) for Quality Care
- COE-NF Resource
- COE-NF De-Escalation Toolkit
- Did You Know?
- Register for Upcoming COE-NF Training Sessions
- You Matter – Worker Well-Being Questionnaire
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COE-NF Grant Year 1 in Review: By the Numbers
The Center of Excellence for Behavioral Health in Nursing Facilities (COE-NF) is proud to share the results of its Year 1 grant accomplishments. The COE-NF made tremendous strides in Year 1 of the grant to provide quality behavioral health training, resources, and technical assistance to nursing facilities across the United States and U.S. territories.
The infographic below highlights the significant number of nursing facilities impacted by the COE-NF initiative.
The infographic below highlights the significant number of nursing facilities impacted by the COE-NF initiative.
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Start the New Year With a Facility Assessment
Nursing facilities are required to conduct, document and annually review a facility-wide assessment, which includes the resident population and the resources the facility needs to care for residents (§483.70(e)). There is no better time than the new year to complete the facility assessment and strategize the opportunities for improvement!
No specific tool is required for a facility assessment; however, the Quality Improvement Organizations (QIO) Program has one available that facilities can use.
No specific tool is required for a facility assessment; however, the Quality Improvement Organizations (QIO) Program has one available that facilities can use.
Stay tuned for next month’s newsletter, where the COE-NF will share a behavioral health needs assessment to assist nursing facilities in evaluating their behavioral health needs.
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CARES Serious Mental Illness (SMI) Online Training Opportunity
The COE-NF is making CARES® Serious Mental Illness™ Online Training Program available to all CMS-certified nursing facilities at no cost. CARES SMI focuses on how to develop care strategies for individuals diagnosed with a serious mental illness and how it differs from dementia.
This program has four modules (four hours). The modules include:
This program has four modules (four hours). The modules include:
- Introduction to Serious Mental Illness
- Understanding Serious Mental Illness
- Living with Serious Mental Illness
- The CARES® Approach and Providing Appropriate Care
A two-year certification is provided upon completion and passing of the certification examination. To register for CARES SMI, submit a request here.
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CARES Serious Mental Illness (SMI) Office Hours
Interested in learning more about CARES SMI before committing or have general questions about the program? Join our monthly office hours meeting starting January 24, 2024, from 2:30-3 p.m. ET for an open discussion on implementation, benefits, case studies, and successes.
Office hours will occur on the fourth Wednesday of each month from 2:30-3 p.m. ET.
Office hours will occur on the fourth Wednesday of each month from 2:30-3 p.m. ET.
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Buprenorphine in the Long-Term Care Facility – Is There a Place for It?
Article contributed by Dr. Melissa Cheng, MD MOH, MHS
Buprenorphine has gained notoriety as a medication for opioid use disorder (OUD). However, before it was FDA-approved for OUD in the early 2000s, it was approved as a chronic pain medication in 1995.
Buprenorphine is a partial opioid agonist, which means it has very similar analgesic effects to opioids but without many of the side effects. It causes less respiratory depression, less hyperalgesia and improved coverage for neuropathic pain.
Buprenorphine is an ideal pain medication in many ways. First, it has a long half-life, which means dosing is one to three times a day and provides a steadier state of pain control. It is less euphoric, and the risk of diversion is less. Buprenorphine comes in several different formulations, including a seven-day dermal patch or oral tablet/film.
Substance use disorder, including OUD, is often missed in older adults. Some red flags to watch out for in residents living in the long-term care facility include taking more prescribed medication than directed; having extra pills in their purse or hiding them; being defensive about their opioid use; becoming more withdrawn, angry, or confused; and avoiding social or recreational activities. Often, family members may even express concern about the behavior of their loved ones.
Buprenorphine is a great medication to use for chronic pain or if there is chronic pain and suspicion of an OUD. If you have questions or want to learn more about Buprenorphine, please contact the COE-NF for assistance.
Buprenorphine is a partial opioid agonist, which means it has very similar analgesic effects to opioids but without many of the side effects. It causes less respiratory depression, less hyperalgesia and improved coverage for neuropathic pain.
Buprenorphine is an ideal pain medication in many ways. First, it has a long half-life, which means dosing is one to three times a day and provides a steadier state of pain control. It is less euphoric, and the risk of diversion is less. Buprenorphine comes in several different formulations, including a seven-day dermal patch or oral tablet/film.
Substance use disorder, including OUD, is often missed in older adults. Some red flags to watch out for in residents living in the long-term care facility include taking more prescribed medication than directed; having extra pills in their purse or hiding them; being defensive about their opioid use; becoming more withdrawn, angry, or confused; and avoiding social or recreational activities. Often, family members may even express concern about the behavior of their loved ones.
Buprenorphine is a great medication to use for chronic pain or if there is chronic pain and suspicion of an OUD. If you have questions or want to learn more about Buprenorphine, please contact the COE-NF for assistance.
Melissa Cheng, MD, MOH, MHS, is board-certified in addiction medicine and practices at the University of Utah Hospital Addiction Consult Service and is also a medical director at Comagine Health. In addition to her medical practice, Dr. Cheng works on various projects to improve the quality and access to care for individuals with OUD.
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What is Behavioral Health Equity?
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), behavioral health equity is the right of all individuals, regardless of race, age, ethnicity, gender, disability, socioeconomic status, sexual orientation, or geographical location, to access high-quality and affordable health care services and support.
The Centers for Medicare and Medicaid Services (CMS) is working to ensure that high-quality behavioral health care is provided to beneficiaries. The CMS Behavioral Health Strategy focuses on three key areas: 1) SUD prevention, treatment, and recovery services; 2) ensuring effective pain treatment and management; and 3) improving mental health care and services.
As nursing facilities admit more residents with behavioral health conditions, they are uniquely positioned to coordinate behavioral health services to support not only the residents’ physical and medical needs but also their emotional and mental well-being.
The Centers for Medicare and Medicaid Services (CMS) is working to ensure that high-quality behavioral health care is provided to beneficiaries. The CMS Behavioral Health Strategy focuses on three key areas: 1) SUD prevention, treatment, and recovery services; 2) ensuring effective pain treatment and management; and 3) improving mental health care and services.
As nursing facilities admit more residents with behavioral health conditions, they are uniquely positioned to coordinate behavioral health services to support not only the residents’ physical and medical needs but also their emotional and mental well-being.
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Nursing Facility Regulatory Guidance
Navigating Nursing Facility Best Practices: Understanding Pre-Admission Screening and Resident Review (PASRR) for Quality Care
In the ever-evolving landscape of health care, focusing on the well-being of individuals seeking long-term care is paramount. Central to this process is the Preadmission Screening and Resident Review (PASRR), a federal mandate designed to prevent inappropriate nursing home placements. The following underscores nursing home best practices in PASRR, emphasizing its crucial role in advancing person-centered care.
PASRR outlines three core principles for Medicaid-certified nursing facilities. First, a comprehensive evaluation for Serious Mental Illness (SMI) and/or Intellectual Disability (ID) is mandated through the initial Level I screen, which is crucial for identifying individual needs. Positive Level I results lead to a more in-depth Level II evaluation, which assesses psychological, psychiatric and functional needs to determine the most appropriate setting—whether it’s community, nursing facility, or acute care. Once the suitable setting is identified, PASRR ensures tailored care aligning with person-centered care planning, echoing the vision of the Americans with Disabilities Act.
Specific to regulatory compliance, the F645 requirement is the mandate for pre-admission screening of residents in nursing facilities with specified conditions. Completing this mandate identifies individuals with SMI/ID should undergo further Level II evaluation to determine the necessary care and services in the most suitable integrated setting. Recommendations from Level II evaluations should be incorporated into the resident's care plan, and significant changes trigger a review.
Examining the correlation between PASRR practices and F Tag requirements underscores their integration in nursing homes, impacting regulatory compliance and resident well-being. Professionals are urged to comprehend and advocate for these best practices to ensure quality care delivery. PASRR aligns with regulations and contributes to a broader vision of person-centered care, enabling tailored support in suitable settings.
Every state Medicaid agency has unique processes for Level I and Level 2 screens, and it’s crucial to review your state's specific requirements. The CMS State Operations Manual is a comprehensive resource for further information.
PASRR Level II evaluations must be used by the facility when developing the care plan, conducting assessments of the resident, and when transitions of care occur.
In the ever-evolving landscape of health care, focusing on the well-being of individuals seeking long-term care is paramount. Central to this process is the Preadmission Screening and Resident Review (PASRR), a federal mandate designed to prevent inappropriate nursing home placements. The following underscores nursing home best practices in PASRR, emphasizing its crucial role in advancing person-centered care.
PASRR outlines three core principles for Medicaid-certified nursing facilities. First, a comprehensive evaluation for Serious Mental Illness (SMI) and/or Intellectual Disability (ID) is mandated through the initial Level I screen, which is crucial for identifying individual needs. Positive Level I results lead to a more in-depth Level II evaluation, which assesses psychological, psychiatric and functional needs to determine the most appropriate setting—whether it’s community, nursing facility, or acute care. Once the suitable setting is identified, PASRR ensures tailored care aligning with person-centered care planning, echoing the vision of the Americans with Disabilities Act.
Specific to regulatory compliance, the F645 requirement is the mandate for pre-admission screening of residents in nursing facilities with specified conditions. Completing this mandate identifies individuals with SMI/ID should undergo further Level II evaluation to determine the necessary care and services in the most suitable integrated setting. Recommendations from Level II evaluations should be incorporated into the resident's care plan, and significant changes trigger a review.
Examining the correlation between PASRR practices and F Tag requirements underscores their integration in nursing homes, impacting regulatory compliance and resident well-being. Professionals are urged to comprehend and advocate for these best practices to ensure quality care delivery. PASRR aligns with regulations and contributes to a broader vision of person-centered care, enabling tailored support in suitable settings.
Every state Medicaid agency has unique processes for Level I and Level 2 screens, and it’s crucial to review your state's specific requirements. The CMS State Operations Manual is a comprehensive resource for further information.
PASRR Level II evaluations must be used by the facility when developing the care plan, conducting assessments of the resident, and when transitions of care occur.
The COE-NF is available to support your facility in any of these guidance areas. Contact the COE-NF today:
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COE-NF Resource
The COE-NF developed the following resource that nursing facilities can use to educate the team about behavioral health conditions.
De-Escalation Toolkit
COE-NF De-Escalation Toolkit can help nursing facility staff address the unique challenges of supporting residents during behavioral expressions of distress. Download Resource
COE-NF De-Escalation Toolkit can help nursing facility staff address the unique challenges of supporting residents during behavioral expressions of distress. Download Resource
Interested in accessing additional COE-NF resources for your facility?
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Approximately a million Americans are nursing home residents, and over 30% have a psychiatric diagnosis. Nursing facilities should assess and coordinate specialized services to address the behavioral health needs of residents.
Source: Gerlach, L.B., & Maust, D.T. (2023). Falling off a cliff: Psychiatric care of nursing home residents. Journal of the American Geriatrics Society, 71(4), 1014-1016. https://doi.org/10.1111/jgs.18249
Source: Gerlach, L.B., & Maust, D.T. (2023). Falling off a cliff: Psychiatric care of nursing home residents. Journal of the American Geriatrics Society, 71(4), 1014-1016. https://doi.org/10.1111/jgs.18249
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The Center of Excellence for Behavioral Health in Nursing Facilities (COE-NF) has six training opportunities in January.
These sessions are being held at no cost to you.
Click the REGISTER HERE buttons below each training to sign up.
See you there!
These sessions are being held at no cost to you.
Click the REGISTER HERE buttons below each training to sign up.
See you there!
Thursday, January 11, 2024
2-3 p.m. ET
ACCME & NAB credits will be offered.
2-3 p.m. ET
ACCME & NAB credits will be offered.
This training will provide an opportunity to enhance your self-awareness in response to distress. Participants will use their personal experiences to explore empathy, transference and reactivity as they practice strategies to de-escalate and prevent distress.
Learning Objectives:
- Practice de-escalation using key tools (grounding, OARs, etc.)
- Identify your fixing reflexes and how to contain them.
Tuesday, January 16, 2024
2-3 p.m. ET
ACCME credits will be offered.
2-3 p.m. ET
ACCME credits will be offered.
Diversity-informed practice and trauma-informed care are so intertwined that nursing facilities can't effectively have one without the other. In this session, we consider the importance of cultural responsiveness - individually and systemically - to those who have experienced trauma.
Learning Objectives:
Learning Objectives:
- Explain the significance of bringing diversity-informed practices into trauma-informed care for nursing facilities.
- Consider structural and systemic inequities as retraumatizing experiences.
- Discuss how different cultural groups may perceive and respond to trauma.
Wednesday, January 17, 2024
2–3 p.m. ET
ACCME & NAB credits will be offered.
2–3 p.m. ET
ACCME & NAB credits will be offered.
Despite the demands of working in a nursing facility, staff are dedicated to their craft and gain deep satisfaction from helping to care for residents. The other side of the job brings pressures that can increase susceptibility to exhaustion, leading to compassion fatigue and other occupational hazards.
This interactive training identifies and defines often elusive work-related conditions and the emotional and physical toll that can occur over time. Content includes strategies to prevent and cope with compassion fatigue through building resiliency and practicing self-care.
Nursing facility staff will learn prevention efforts they can engage in to take care of themselves, both personally and professionally, and consequently, residents in their care.
Learning Objectives:
This interactive training identifies and defines often elusive work-related conditions and the emotional and physical toll that can occur over time. Content includes strategies to prevent and cope with compassion fatigue through building resiliency and practicing self-care.
Nursing facility staff will learn prevention efforts they can engage in to take care of themselves, both personally and professionally, and consequently, residents in their care.
Learning Objectives:
- Review work dynamics affecting a nursing facility staff’s ability to care for themselves.
- List potential effects that staff’s secondary trauma can have on their residents.
- List warning signs of the dedicated but stressed-out nursing facility staff.
- List practical strategies for building resiliency.
Thursday, January 18, 2024
2-3 p.m. ET
ACCME & NAB credits will be offered.
2-3 p.m. ET
ACCME & NAB credits will be offered.
This training provides an opportunity to enhance your self-awareness in response to distress. Participants will use their personal experiences to explore empathy, transference and reactivity as they practice strategies to de-escalate and prevent distremnj\ss.
Learning Objectives:
- Use knowledge related to personality disorders to avoid reactivity and empathy fatigue.
- Develop strategies for reviewing and preventing incidents of distress with your team using root cause analysis (cause-and-effect diagram) and behavioral analysis.
Tuesday, January 23, 2024
11 a.m.-4:30 p.m. ET
11 a.m.-4:30 p.m. ET
ACCME & NAB credits will be offered.
This session provides a MHFA certification for three years.
The training covers:
- Common signs and symptoms of mental health challenges 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.
Wednesday, January 31, 2024
2-3:30 p.m. ET
2-3:30 p.m. ET
ACCME & NAB credits will be offered.
This 1.5-hour evidence-based live instructor-led training provides a comprehensive review of a three-step approach that anyone can learn to help save a life from suicide. This session will provide a two-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
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You Matter - Caring for Yourself in the Face of Challenging Work
Worker Well-Being Questionnaire (WellBQ)
Taking the time to assess your residents’ behavioral health is important, and so is taking the time to evaluate your own well-being! Facility leadership and staff can start the new year off with a commitment to improving worker well-being by taking the first step of the Impact Wellbeing movement and administering the National Institute for Occupational Safety and Health Worker Well-Being Questionnaire (NIOSH WellBQ). The questionnaire measures “worker” well-being as a holistic construct rather than simply “workplace” or “work-related” well-being. It takes about 15 minutes to complete, can be administered as a whole or only on specific topics, and is completely free to use. Note: Watch Introducing the NIOSH WellBQ to learn more about the development of the questionnaire and practical applications.
Source:
https://www.cdc.gov/niosh/impactwellbeing/
NIOSH [2021]. NIOSH worker well-being questionnaire (WellBQ). By Chari R, Chang CC, Sauter SL, Petrun Sayers EL, Huang W, Fisher GG. Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, DHHS (NIOSH) Publication No. 2021-110 (revised 5/2021), https://doi.org/10.26616/NIOSHPUB2021110revised52021
Taking the time to assess your residents’ behavioral health is important, and so is taking the time to evaluate your own well-being! Facility leadership and staff can start the new year off with a commitment to improving worker well-being by taking the first step of the Impact Wellbeing movement and administering the National Institute for Occupational Safety and Health Worker Well-Being Questionnaire (NIOSH WellBQ). The questionnaire measures “worker” well-being as a holistic construct rather than simply “workplace” or “work-related” well-being. It takes about 15 minutes to complete, can be administered as a whole or only on specific topics, and is completely free to use. Note: Watch Introducing the NIOSH WellBQ to learn more about the development of the questionnaire and practical applications.
Source:
https://www.cdc.gov/niosh/impactwellbeing/
NIOSH [2021]. NIOSH worker well-being questionnaire (WellBQ). By Chari R, Chang CC, Sauter SL, Petrun Sayers EL, Huang W, Fisher GG. Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, DHHS (NIOSH) Publication No. 2021-110 (revised 5/2021), https://doi.org/10.26616/NIOSHPUB2021110revised52021
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Click below to answer two (2) questions and share your thoughts on this month's newsletter.
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Stay up to date on COE-NF news and events.
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Stay up to date on COE-NF news and events.
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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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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.
Was this email forwarded to you? If so, please subscribe HERE.
Want to opt-out from receiving news from us? Click HEREto unsubscribe.
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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 a COE-NF. AHS has over 50 years of experience working with nursing homes and behavioral health in nursing homes.
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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.
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