The demand for behavioral health services was rising even before the COVID-19 pandemic. As a result, more home health providers have been wondering what it takes to step into the space.
Over the past 12 months, the public health emergency has taken a considerable toll, worsening mental or behavioral health conditions for many people in the U.S. due to widespread social isolation. In fact, about four in 10 adults experience symptoms of anxiety or depressive disorder, compared to one in ten in 2019, according to data from Kaiser Family Foundation.
Additionally, psychological distress among Americans was as prevalent during the first month of COVID-19 as it was for the entire year prior, a RAND Corporation study found.
In turn, 52% of behavioral health organizations have seen a spike in the demand for their services, according to a survey from the National Council for Behavioral Health.
With the pandemic far from over, more home health providers have considered setting up a behavioral health division to address the lack of mental health services for seniors who are homebound, Katherine Vanderhorst, president of C&V Senior Care Specialists, told Home Health Care News.
“We get calls all the time from providers in post-acute care, especially home health, to train and help people manage behavioral health, … and I feel it’s due to the fact that individual clients are so isolated. They haven’t been able to get out to medical providers or see their families. We’ve seen a real increase in agencies, managing depression, anxiety and suicidal patients.”
C&V Senior Care Specialists is a Williamsville, New York-based behavioral health and dementia care training consulting company. The company works with home health providers as well as assisted living operators, home care agencies, skilled nursing facilities (SNFs) and continuing care retirement communities (CCRCs) to offer training, marketing and operational support.
Vanderhorst noted that she has seen at least a 50% increase in home health providers contacting C&V Senior Care Specialists looking to incorporate behavioral health into their home health business.
“Prior to COVID-19, if you looked at the U.S., less than probably 10% or 20% of the agencies provided behavioral health care,” she said. “We’ve had a real resurgence of people interested in providing that.”
In many ways, the home setting offers many advantages when it comes to providing behavioral health services. Along with giving homebound seniors access to care, offering care in the home improves patient outcomes and decreases higher utilization of hospital and ER services, according to Vanderhorst.
At Angels Care Home Health, having a behavioral health business line lets the company provide holistic treatment to their patients, Tony Miller, COO of AngMar Medical Holdings, told HHCN.
“We’ve seen through our own patient data, that if a patient has a diagnosis of depression or anxiety, it can be a barrier to their medical healing,” Miller said. “Patients with behavioral health diagnoses have a higher prevalence of ER visits and urgent care visits. They are a population that can interfere with the outcomes of hospitals and home health companies. We feel it’s important to address those behavioral health issues … in order to facilitate good healing.”
Angels Care Home Health, an AngMar Medical Holdings Company, is a provider with 70 locations in Arizona, Florida, Indiana and seven other states. The company currently serves 9,000 patients daily.
There are a number of advantages for providers looking to implement behavioral health services.
“From a business standpoint, there is potential growth — patient admission volumes and census,” Miller said. “We noticed a 20% growth in our behavioral health patient population and admission volume.”
Indeed, offering a behavioral health service line can help a company gain a competitive advantage against industry peers while increasing revenue. It can also be an avenue to develop new referral partners.
“It opens up a huge amount of interface with additional referral sources, and it can create a lot of partnerships,” Vanderhorst said. “A lot of the agencies we work with form partnerships with insurance companies, assisted living facilities, ACOs — because they can provide behavioral health care, especially during the [public health emergency].”
Still, home health providers looking to move into the behavioral health space may run into some challenges.
“First and foremost is staffing,” Miller said. “You need nurses with the right type of experience. We’ve experienced a higher turnover rate with this nursing population, and I think that’s primarily due to the types of patients they treat on a daily basis. The patients our behavioral health nurses treat demand more attention and care.”
Miller noted that home health providers in this space should constantly be recruiting new talent and checking in with current staff to avoid nurse burnout.
“Our behavioral health director has weekly calls with our teams so that we can keep our finger on the pulse of our staff,” he said.
Another challenge is that providers are often concerned about taking on a new patient population.
“They get nervous about the types of patients they’re going to get,” Vanderhorst said. “Probably the two most prominent diagnoses they will have are patients with some type of depression or anxiety disorder.”
Some providers are also unsure if they have the resources built into their electronic medical records to support behavioral health.
“We teach all the clinicians how to use evidence-based tools to assess depression, assess anxiety and assess their cognitive functions,” Vanderhorst said. “One of the things we hear is we don’t know if we have the tools in our electronic medical records to support behavioral health. That’s another area where we help.”
Ultimately, Miller believes that delivering behavioral health services as a home health provider is addressing a vital need that exists in many communities across the country.
“We feel like it’s important to serve this population,” he said. “In many instances, if we weren’t there, they would have no other options. These patients would most likely not get the opportunity to spend as much time in their own homes as they could, … so they’d end up spending a greater amount of time inside of a facility, which isn’t where they want to be.”
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