Long-term Care’s COVID Challenge

April 30, 2020

By Parikshit Deshmukh, MD

In early March, long-term care facilities such as nursing homes started to sound the alarm.  

It was becoming clear that the elderly and those with comorbid conditions were predisposed to COVID-19.  Medicare officials announced that visitors to long-term care facilities were no longer allowed.  Essential personnel only.  But the facilities had to decide who those essential personnel were.  

Their decisions have consequences for my patients, residents with mental illness or mental health comorbidities.

As you might imagine, a national pandemic makes for a stressful environment.  Residents can no longer sit together or have group activities or share meals in the facility dining room.  Visits from family members, pet therapy, religious services and entertainers are prohibited, and residents are discouraged from going out.  Alone in their rooms, many residents find themselves watching TV, which offers a steady stream of negative news about the coronavirus.  While social distancing and precautionary measures are necessary to protect residents’ physical health, they could also impact residents’ mental health.  

In light of this reality, some facilities are recognizing psychiatric care as essential.  They continue to allow mental health professionals like me to visit and provide services to residents.

At other facilities, it’s a different story.  Some decided that residents should be treated only if they demonstrate severe problems.  This typically means residents being physically aggressive or combative, exhibiting impulsive behaviors or conveying suicidal intentions.  Only then do staff call the psychiatrist.  The result is that many patients are losing access to mental health services at a time when they need them most.

Telehealth can help to bridge the gap.  In the past we have occasionally used video consultations for acute situations, incidents like those described above.  Now policy changes are allowing health care providers like me to use telemedicine more during the COVID-19 outbreak.  

The Centers for Medicare and Medicaid Services is expanding telemedicine in ways that may lighten the load on staff, improving access to care for seniors in long-term care facilities.  For example, the agency announced that patient assessment, evaluation and management via telephone will now be allowed, not just video consultations.  This helps simplify the process, making it less daunting and less time intensive for facility staff or residents.  

It’s not a wholesale solution.  We still need clarification on “essential personnel” to ensure residents have appropriate access to care.  But it’s an exciting and promising step forward.

And that’s just what we need from policymakers, flexible solutions that allow us to protect long-term care residents during unprecedented times.  These men and women already have made sacrifices and life changes just by moving to long-term care facilities.  Many already have psychiatric problems, dementia and limited coping skills.  They cannot advocate for their own needs. By improving residents’ access to care, Medicare’s expansion of telemedicine will help us protect these people’s physical safety as well as their mental health services.

This is a stressful time.  Mental health, and access to mental health care for some of the most vulnerable among us, is more important than ever.

Parikshit Deshmukh, MD, is a board-certified psychiatrist and a member of the Alliance for Patient Access.

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