November 2023 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 who 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
- Seasonal Affective Disorder – An In-depth Look
- How Seasonal Changes Affect Nursing Home Residents
- Seasonal Affective Disorder and Nursing Facility Regulatory Guidance
- COE-NF Resources for Nursing Facilities
- Seasonal Affective Disorder: Fact Sheets
- Bipolar Disorder Bite-sized Learning: Understanding and Recognizing the Signs and Symptoms
- Bipolar Disorder Learning Module: Recognizing and Treating Bipolar Disorder in Nursing Facilities
- Bipolar Disorder Facts
- Did You Know?
- Register for Upcoming COE-NF Training Sessions
- You Matter - Setting Boundaries
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Seasonal Affective Disorder: An In-Depth Look
Seasonal Affective Disorder (SAD) occurs when there is a change in seasons. People who have major depression or bipolar disorder are at increased risk of seasonal affective disorder. Nursing facility staff who are aware of the signs and symptoms of SAD and familiar with interventions and treatment options can provide a higher quality of care to residents impacted by this seasonal condition.
What is SAD?
The Substance Abuse and Mental Health Services Administration (SAMHSA) defines SAD as a condition in which people experience a significant mood change when the seasons change. SAD is a type of depression. SAD typically starts in late fall or early winter and goes away during the spring or summer. Although less common, SAD can also occur during the spring and summer months. The condition is more prevalent in women.
Symptoms of SAD vary but can include:
Source: SAMHSA Seasonal Affective Disorder (SAD)
What is SAD?
The Substance Abuse and Mental Health Services Administration (SAMHSA) defines SAD as a condition in which people experience a significant mood change when the seasons change. SAD is a type of depression. SAD typically starts in late fall or early winter and goes away during the spring or summer. Although less common, SAD can also occur during the spring and summer months. The condition is more prevalent in women.
Symptoms of SAD vary but can include:
- Sad, anxious or empty feelings
- Feelings of hopelessness, guilt, worthlessness or helplessness
- Loss of interest or pleasure in activities previously enjoyed
- Fatigue and decreased energy
- Difficulty concentrating, remembering details and making decisions
- Thoughts of death or suicide
- Oversleeping
- Overeating, particularly with a craving for carbohydrates
- Weight gain
- Social withdrawal (feeling like hibernating)
- Difficulty sleeping
- Lack of appetite
- Irritability and agitation
Source: SAMHSA Seasonal Affective Disorder (SAD)
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How Seasonal Changes Affect Nursing Facility Residents
Seasonal changes affect nursing facility residents in positive and negative ways. Some experience joy in watching the leaves change color and saying goodbye to some seasonal allergies during the fall. Some, however, experience sadness, low mood, and depression, also called “winter depression.” This type of depression typically begins in late fall and early winter and ends by spring. This is due to days getting shorter and sunlight exposure decreasing. This is very common in nursing facility populations and is generally mild. A diagnosis of seasonal depression can be made after two consecutive occurrences of depression that occur and end at the same time every year, with the symptoms subsiding the rest of the year. However, for some residents, this turns into major depression.
Ways to reduce the impact of seasonal changes on the mood of nursing facility residents.There are several ways to reduce the negative impact of seasonal changes on the mood of nursing facility residents.
- Education: Provide residents and their families with education and resources about SAD and how it manifests. Education can also be provided in group settings and during activities. Share resources from trusted organizations like the Center of Excellence for Behavioral Health in Nursing Facilities.
- Environmental considerations: Place comfortable chairs near large windows with lots of natural light. Consider this feature for all new nursing facility designs. Pull curtains open to also allow more natural light.
- Group activities: Conduct group activities in rooms with large amounts of natural light. Hold activities on an outdoor patio or courtyard when weather permits.
- Vitamin D: Vitamin D supplements can help boost serotonin activity.
- Monitor: Routinely and periodically monitor residents for depression once a month starting in November and more frequently in residents with a known history of SAD. The Patient Health Questionnaire 2 or 9 is an effective screening tool.
- Referral: If there are signs and symptoms of significant depression, refer the resident to a qualified healthcare provider for a more thorough assessment and diagnosis.
- Prevention and Treatment: SAD follows a predictable pattern. Therefore, preventative measures can be taken to reduce the symptoms, including:
- Increase exposure to sunlight by having the resident sit close to a window that provides natural light for at least 30 minutes a day. It doesn’t have to be all at once. If feasible, brief outdoor sunlight exposure is recommended.
- Use bright light therapy/light therapy – use a lightbox with at least 10,000 lux exposure. Duration is individualized and can be from 30 minutes a day to two hours. It doesn’t have to be all at once.
- Antidepressants, individual counseling, behavioral activation, and other evidence-based interventions may also be needed if the resident has major depressive symptoms as part of SAD.
Article contributed by Dr. Abhilash Desai, Board Certified Geriatric Psychiatrist and Adjunct Associate Professor in the Department of Psychiatry at the University of Washington School of Medicine.
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SAD and Nursing Facility Regulatory Guidance
F656: Comprehensive Care Plans
The CMS State Operations Manual (SOM) does not explicitly reference SAD, but a facility should consider it when evaluating residents’ care and interventions, particularly around the winter months. Since SAD is considered a type of depression, facilities should assess for the signs and symptoms of depression, in addition to creating person-centered care plans with appropriate interventions.
The SOM for FTag 656 states that facilities must develop and implement a comprehensive person-centered care plan for each resident. The care plan must include measurable objectives and timeframes to meet a resident’s medical, nursing, mental, and psychosocial needs.
A comprehensive care plan must include the following:
Other FTags can be linked to SAD and depression, including F740, F741, F743, F745.
Source:CMS Appendix PP State Operations Manual,Pg. 237
What Can You Do Today?
The CMS State Operations Manual (SOM) does not explicitly reference SAD, but a facility should consider it when evaluating residents’ care and interventions, particularly around the winter months. Since SAD is considered a type of depression, facilities should assess for the signs and symptoms of depression, in addition to creating person-centered care plans with appropriate interventions.
The SOM for FTag 656 states that facilities must develop and implement a comprehensive person-centered care plan for each resident. The care plan must include measurable objectives and timeframes to meet a resident’s medical, nursing, mental, and psychosocial needs.
A comprehensive care plan must include the following:
- Services that are furnished to attain or maintain the resident’s highest practicable physical, mental, and psychosocial well-being
- Cultural preference
- Any specialized services that the nursing facility will provide in response to PASARR recommendations
Other FTags can be linked to SAD and depression, including F740, F741, F743, F745.
Source:CMS Appendix PP State Operations Manual,Pg. 237
What Can You Do Today?
- Assess residents on admission and during planned assessments and care plan reviews for signs or symptoms of SAD.
- Involve the Interdisciplinary Team (IDT), including the resident, resident’s family and/or representative and clinician, in the development and implementation of clinically appropriate and person-centered interventions for SAD.
- Recognize that a facility must provide behavioral health services for residents showing signs or symptoms of depression.
- Be sure to include the clinician in the discussions when evaluating a resident for SAD.
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 Resources
The COE-NF developed the following resources related to MDD and co-occurring disorders. Nursing facilities can use these resources to educate the team about these mental illnesses.
Seasonal Affective Disorder: Fact Sheet
This fact sheet defines SAD and steps nursing facilities can easily take to help residents manage the illness.
This fact sheet defines SAD and steps nursing facilities can easily take to help residents manage the illness.
Seasonal Affective Disorder: Nursing Facility Checklist
This fact sheet outlines proactive steps nursing facilities can use to reduce the impact of SAD on residents.
This fact sheet outlines proactive steps nursing facilities can use to reduce the impact of SAD on residents.
Seasonal Affective Disorder: Don’t Be SAD
This document brings awareness of the signs and symptoms of SAD and symptom management strategies.
This document brings awareness of the signs and symptoms of SAD and symptom management strategies.
Bipolar Disorder Bite-sized Learning: Understanding and Recognizing the Signs and Symptoms
This five-minute bite-sized learning video can be used to educate staff on bipolar disorder and how to identify common symptoms. The examples shown in the video will help staff learn to recognize the extreme highs and lows associated with bipolar disorder. The bite-sized learning provides foundational information to staff that can be further built upon with COE-NF training. Watch Video
This five-minute bite-sized learning video can be used to educate staff on bipolar disorder and how to identify common symptoms. The examples shown in the video will help staff learn to recognize the extreme highs and lows associated with bipolar disorder. The bite-sized learning provides foundational information to staff that can be further built upon with COE-NF training. Watch Video
Bipolar Disorder Module: Recognizing and Treating Bipolar Disorder in Nursing Facilities
This 20-minute in-depth learning module educates staff on the definition of bipolar disorder, how to identify common symptoms and treatment options, and how to recognize other medical conditions that may present with bipolar disorder or be misdiagnosed as bipolar disorder. Watch Module
This 20-minute in-depth learning module educates staff on the definition of bipolar disorder, how to identify common symptoms and treatment options, and how to recognize other medical conditions that may present with bipolar disorder or be misdiagnosed as bipolar disorder. Watch Module
Bipolar Disorder Fact Sheet
This fact sheet provides nursing facility staff with the knowledge to better understand and care for residents diagnosed with bipolar disorder. CLICK HERE.
This fact sheet provides nursing facility staff with the knowledge to better understand and care for residents diagnosed with bipolar disorder. CLICK HERE.
Interested in accessing additional COE-NF resources for your facility?
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Typically, the further you live from the equator, the more at risk you are for seasonal depression.
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The Center of Excellence for Behavioral Health in Nursing Facilities (COE-NF) has four (4) training opportunities in November.
These sessions are being held at no cost to you.
Click the REGISTER HERE buttons below each training to sign up.
See you there!
Wednesday, November 14, 2023
2-3:30 p.m. EST
2-3:30 p.m. EST
Duration: 90 minutes
This evidence-based live instructor lead 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 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
PART 4:
Thursday, November 16, 2023
2-3 p.m. EST
Duration: 60 minutes
Tools for Creating Calm in Times of Distress (Part 4) will provide an opportunity to further enhance your self-awareness in response to distress. Participants will use their personal experiences to further explore empathy, transference, and reactivity, as they practice strategies to de-escalate and prevent distress.
Learning Objectives:
Thursday, November 16, 2023
2-3 p.m. EST
Duration: 60 minutes
Tools for Creating Calm in Times of Distress (Part 4) will provide an opportunity to further enhance your self-awareness in response to distress. Participants will use their personal experiences to further explore empathy, transference, and reactivity, as they practice strategies to de-escalate and prevent distress.
Learning Objectives:
- Use motivational interviewing (OARS, Engage, Focus, Evoke & Plan) to respond to and resolve distress.
- Gain familiarity with open-ended questions as a strategy for engagement.
Tuesday, November 28, 2023
11 am. - 4:30 p.m. EST
11 am. - 4:30 p.m. EST
Mental Health First Aid (MHFA) training provides skills to contact and provide initial help and support to someone who may be developing a mental health or substance use challenge or experiencing a crisis.
This session provides a MHFA certification for three years.
The training covers:
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
The training is divided into three (3) parts:
Part 1 starts AFTER initial registration has been APPROVED by the instructor. Approved registrants will be emailed instructions on how to create an on-line profile using MHFA Connect and completing a pre-survey/quiz followed by a 2-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, required to receive a certificate of participation.
TO REGISTER: Please send your name, email address, agency and training date to coeinfo@ allianthealth.org by Friday, November 17, 2023.
Thursday, November 30, 2023
1 - 1:30 p.m. EST
1 - 1:30 p.m. EST
Duration: 30 minutes
This training is designed to equip nursing facility staff with the knowledge, skills, and tools necessary to provide effective and compassion care to residents diagnosed with an opioid use disorder.
Learning Objectives:
This training is designed to equip nursing facility staff with the knowledge, skills, and tools necessary to provide effective and compassion care to residents diagnosed with an opioid use disorder.
Learning Objectives:
- Discuss assessment of residents before starting opioid analgesic treatment for pain.
- Create evidence-based strategies for practicing opioid stewardship
- Evaluate residents for opioid use disorder in nursing facilities.
- Discuss safe taper of opioids and alternative therapies for pain.
You Matter - Setting Boundaries
Boundaries are expectations and needs that help you maintain your physical, mental, and emotional well-being. You may need to work on setting boundaries if you feel overwhelmed, resentful, avoidant, burned out, or have no time for yourself. Work can be a difficult place to set boundaries, but it’s important for your health and for the health of the residents for whom you care.
How to Set Boundaries at Work:
- Identify areas where you need to set boundaries.
- Give yourself permission to have boundaries at work.
- Do work only at work and only during work hours.
- Start setting boundaries right away; don’t wait.
- Teach others how to respect your boundaries by consistently respecting them yourself.
- “I cannot work past five o’clock.”
- “I need more assistance with my workload.”
- “I don’t talk about personal subjects at work. It makes me uncomfortable.”
- “I’m not available to help you with your request after hours. I like to focus my time on my family.”
- Arrive at work on time and leave work on time.
- Take your lunch break away from your workstation.
- Be direct about ending conversations that distract you from working.
- Use all your allotted vacation days and do not work while on vacation.
- What is one boundary that you can start implementing at work this month?
- Ex: schedule, workload, vacation, etc.
- Given what you know about the people you work with, what is the best way to set this boundary with them?
- How do you think you’ll benefit from setting this boundary?
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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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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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