Increase in Long-Term Care Residents with Serious Mental Illnesses Presents Challenges for Facilities and Staff: Case Reports
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Abstract
Background. The increase in the number of residents with severe mental illness and/or substance use disorder in long-term care facilities in the United States presents serious challenges to those seeking admission to these facilities, their staff, and facility administrators.
Aims. Our purpose is to illustrate the situations for which long-term care facilities have been cited for failure to meet standards of care related to their residents' psychosocial well-being and behavioral expressions.
Methods. Publicly available data was accessed from several U.S. Centers for Medicare and Medicaid Services (CMS) data centers. Data obtained included the percentage of facilities that received citations for seven F-tags (a federal coding system) most relevant to effectively addressing residents' psychosocial well-being and behavioral expression needs. Case reports related to each of the selected standards (F-tags) were identified and summarized, and data on the facility involved was obtained for each case report.
Results. In the first half of fiscal year 2024, 25% of the long-term care facilities surveyed were cited for deficiencies related to protecting residents from abuse or neglect, and 19% were cited for failing to keep residents as free as possible from unnecessary psychotropic medication. The case studies illustrate the wide range of behavioral expressions that need to be addressed, from severe withdrawal and attempts to self-harm to sexual approaches to other residents to purposeful soiling of bed linens and aggression toward staff or other residents. In many instances, it was clear that facility staff did not know the requirements for an adequate response to the situation or how to respond effectively.
Conclusions. The case studies and related data reveal multiple, often interacting, assessment and care challenges that many long-term care staff are not prepared to handle effectively. They demonstrate the adverse impacts of untreated negative behavioral expressions and consequently suggest that staff may be unprepared to manage these multifaceted conditions. Poorly resourced facilities need support to adequately respond to this ever-growing, complex mix of service needs, less than generous reimbursement structures, and resident demographics.
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