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Mental and physical health are vital components of overall wellbeing and can influence each other in many ways. Yet, individuals with mental health conditions may encounter challenges in accessing adequate health care, which can impede their ability to manage their physical health. Home health care providers, however, are increasingly stepping in to bridge this gap.
In-home behavioral health care provides specialized support to promote mental wellness for individuals with a wide range of behavioral or psychiatric disorders. Those who qualify may be experiencing depression, anxiety, agoraphobia, difficulties associated with aging in place, struggles with substance use or problems coping with trauma. Mental health at-home support aims to improve these patients’ access to quality care.
“Untreated mental illness or behavioral health issues can significantly increase the risk of worsening mental conditions, the progression of chronic medical conditions, and the development of heart disease, stroke, dementia and a weakened immune response,” Barbara Andazola, vice president of clinical practice, strategy and programs at Amedisys (Nasdaq: AMED), told Home Health Care News.
Amedisys, headquartered in Baton Rouge, Louisiana, provides home health care, hospice, palliative and high-acuity care in 38 states.
“Most adult patients receiving home health services have a chronic or life-altering illness that can affect their mental wellness, which is crucial for how they think, feel, cope, make health-related decisions and determine how they will participate in their care,” Andazola continued. “Providing person-centered care and achieving quality clinical outcomes is impossible without addressing patients’ mental wellness needs, especially in home health, where clinicians directly observe the impact of mental and physical health on a patient.”
Many home health providers see behavioral health as a natural extension of their mission to help seniors successfully age in place.
At the same time, as value-based care measures become more prominent, making sure seniors are as mentally fit as possible also becomes more important from a business perspective.
“Behavioral health care is a crucial offering for home health providers because it allows for continuity of care across lifespan and settings, especially for individuals with dual diagnoses or developmental disabilities,” Dallas Star, regional director for Bayada Home Health Care, told HHCN. “Home health providers can leverage their expertise in home-based care to deliver specialized behavioral health therapies such as applied behavioral analysis (ABA) in the comfort of the client’s home. This personalized approach can help clients generalize skills and improve the overall quality of life.”
Bayada provides home health, home care and hospice services in 23 states, as well as in Canada, Germany, India, Ireland, New Zealand, South Korea and the U.K.
Psychiatric registered nurses (RNs) usually provide services for this patient population, sometimes with the aid of a licensed clinical social worker.
Those with Medicaid or a limited income may qualify for in-home behavioral health care at no cost. Most providers will work with clients to seek approval and evaluate needs to determine coverage available through insurance providers.
To initiate services, clients must speak with their physician or mental health professional who can provide a referral and work with the home health care provider to develop a personalized care plan. The duration of care depends on individual needs and goals.
Psychiatric nurses conduct an initial assessment and collaborate with the physician to develop an individualized care plan. The nursing services outlined in the care plan typically include evaluating, teaching and administering medications; managing situational crises; conducting self-harm assessments; teaching self-care and promoting mental and physical wellbeing; providing supportive counseling and delivering psychotherapeutic interventions such as education on disease processes, symptom management, safety, coping skills and problem-solving.
If a patient needs additional services or a different level of care, home health clinicians, with the approval of the patient’s physician, will coordinate with local community resources to ensure the patient receives the necessary services to remain safely at home. If this is not feasible, they will arrange to transfer care to an appropriate outpatient or inpatient facility.
“Similar to patients receiving other types of in-home services, those receiving behavioral health care are satisfied with their outcomes and appreciate the ability to receive care in the comfort and safety of their own homes,” Andazola said.
States mobilize crisis intervention teams to further address access to care
The Centers for Medicare & Medicaid Services (CMS) recently approved New Hampshire’s Medicaid State Plan Amendment for community-based mobile crisis intervention teams to provide services for people experiencing a mental health or substance use disorder crisis.
New Hampshire can now connect Medicaid-eligible individuals in crisis to a behavioral health provider 24 hours a day, 365 days a year. This approval marks 20 states and the District of Columbia that have expanded access to community-based mental health and substance use services under a new Medicaid option created by the Biden-Harris American Rescue Plan.
Mobile crisis intervention teams provides screening and evaluation; stabilization and de-escalation; and coordination with and referrals to health, social and other services, as needed. This helps states better integrate behavioral health services into their Medicaid programs.
Providing fast, appropriate care to someone in crisis may reduce the need for costly inpatient services, and this new option will help states expand access to behavioral health professionals as the initial contact for someone in crisis. New Hampshire can now receive Medicaid funding for mobile crisis response crisis planning, directly connecting people to specialized services, referring ongoing supports, and follow-up check-ins for individuals experiencing a mental health or substance use disorder crisis.
Though home health providers often have behavioral health capabilities – and sometimes even specific service lines for that care – there are still barriers to implementation.
“There is a clear need for ongoing behavioral health services as a standard offering for home health patients,” Andazola said. “However, the shortage of psychiatric-trained RNs and the specific experience requirements set by Medicare for reimbursement limit the expansion of these services. The Medicare home health benefit excludes occupational therapy (OT) as a qualifying clinician discipline. Despite OTs being highly skilled and capable of addressing functional limitations often experienced by behavioral health patients due to mental illness or cognitive deficits, they can only provide these services if the patient’s condition also requires skilled nursing physical or speech therapy. Until CMS addresses these and other requirements, expanding behavioral health services for home health patients will remain limited.”
