Older adults living in nursing homes and assisted living facilities are at a very high risk for mental illness, including dementia and delirium. Though their setting and care may be appropriate and of top quality, they are still subject to mental illness risk factors including change in health status, chronic illness, multiple medications, recent losses, loss of independence, change in levels of social contact and community support, cognitive changes, sensory deficits and loss of control over life decisions.

Mental health assessment and treatment services,provided by geriatric mental health professionals should be available to older adults.

Nursing homes should provide mental health assessment and treatment services on-site. Residents of assisted living facilities may receive on-site care or be transported to service providers in the community.

Mental health care is not a routine part of care for all residents. Iin Maryland there is a shortage of geriatric mental health care providers to cover all long-term care settings and reimbursement for their services may be tricky. However, our State recognizes the right for all long-term care residents to have their mental health needs met – so become an advocate, ask about mental health care access and push for the services that you or a loved one needs.

If you are told that the primary care physician will provide mental and behavioral health care assessment and treatment, speak to the physician directly and ask about his or her training in psychiatry. Primary care physicians often limit their role to the prescribing of medication for mental illness and behavioral problems. There are many more aspects to mental and behavioral health care that are necessary. Other services that should be available include initial psychiatric evaluations, psychological and cognitive assessments, medication management and dose reduction oversight, indivdual and group therapy, staff / family consultation and education, and behavioral management planning and intervention.

The types of geriatric mental health specialists who provide such services include: Psychiatrist, Neuropsychologist, Psychiatric Advanced Practice Nurse, Psychiatric Social Worker and Psychologist.

Administrators, managers and nursing staff should know procedures for accessing mental health services. Staff should be trained in mental and behavioral health care including risk factors and symptoms of mental illness; dementia and delirium; early identification and intervention; procedures for reporting cognitive, behavioral and mood changes; effective communication skills; appropriate behavioral interventions and staff stress management.

Ask about staff training for mental health and dementia care and the availability of qualified providers of mental health services, preferably before a commitment is made to establish residence.

Look for or ask about activities to keep residents interested and engaged. The lack of meaningful roles and social isolation are significant risk factors for depression. People with dementia might be particularly challenged in this way, but a good long term care setting is one that is flexible and creative to meet the activity needs of residents at varying levels of physical and cognitive abilities.