Advertisement

Preparing Long-Term Care Staff to Meet the Needs of Aging Persons With Serious Mental Illness

      Abstract

      Objectives

      Individuals with serious mental illness (SMI; schizophrenia spectrum disorders and affective psychoses) are increasingly aging into older adulthood and are overrepresented in residential long-term care settings. The present study aimed to examine the preparedness of staff in these settings to care for individuals with SMI.

      Design

      A multidisciplinary US Department of Veterans Affairs (VA) workgroup of professionals with expertise in geriatric mental health collected voluntary feedback via online questionnaire as part of a quality improvement project.

      Setting and Participants

      Respondents were mental health providers (N=51) embedded in VA nursing homes called Community Living Centers (CLCs).

      Measures

      The questionnaire contained multiple-choice, Likert-type scale, and open-ended questions regarding the opportunities and challenges associated with caring for Veterans with SMI in CLCs.

      Results

      Respondents identified a lack of training of front-line staff as a key challenge in providing high-quality care to residents with SMI. Specifically, respondents indicated a need to increase staff knowledge about SMI symptoms and diagnoses, to improve staff communication and interactions with residents with SMI, and to decrease mental illness stigma among staff.

      Conclusions/Implications

      The present study revealed significant areas of training need for front-line staff in nursing homes. Many perceived staff training needs overlap with the knowledge and skill set required to provide high-quality dementia care. Integrating training regarding the care of residents with SMI into dementia care training efforts may be a fruitful future direction. Strategies for this and a suggested curriculum are provided.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of the American Medical Directors Association
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Cohen C.I.
        • Meesters P.D.
        • Zhao J.
        New perspectives on schizophrenia in later life: Implications for treatment, policy, and research.
        Lancet Psychiatry. 2015; 2: 340-350
        • Seitz D.
        • Purandare N.
        • Conn D.
        Prevalence of psychiatric disorders among older adults in long-term care homes: A systematic review.
        Int Psychogeriatr. 2010; 22: 1025-1039
        • Grabowski D.C.
        • Aschbrenner K.A.
        • Feng Z.
        • Mor V.
        Mental illness in nursing homes: Variations across States.
        Health Affairs. 2009; 28: 689-700
        • Samus Q.M.
        • Onyike C.U.
        • Johnston D.
        • et al.
        12-month incidence, prevalence, persistence, and treatment of mental disorders among individuals recently admitted to assisted living facilities in Maryland.
        Int Psychogeriatr. 2013; 25: 721-731
        • Rosenblatt A.
        • Samus Q.M.
        • Steele C.D.
        • et al.
        The Maryland Assisted Living Study: Prevalence, recognition, and treatment of dementia and other psychiatric disorders in the assisted living population of central Maryland.
        J Am Geriatr Soc. 2004; 52: 1618-1625
        • Andrews A.O.
        • Bartels S.J.
        • Xie H.
        • Peacock W.J.
        Increased risk of nursing home admission among middle aged and older adults with schizophrenia.
        Am J Geriatr Psychiatry. 2009; 17: 697-705
        • Miller E.A.
        • Rosenheck R.A.
        Risk of nursing home admission in association with mental illness nationally in the Department of Veterans Affairs.
        Med Care. 2006; 44: 343-351
        • Aschbrenner K.A.
        • Cai S.
        • Grabowski D.C.
        • et al.
        Medical comorbidity and functional status among adults with major mental illness newly admitted to nursing homes.
        Psychiatr Serv. 2011; 62: 1098-1100
        • Li Y.
        Provision of mental health services in U.S. nursing homes, 1995-2004.
        Psychiatr Serv. 2010; 61: 349-355
        • Grabowski D.C.
        • Aschbrenner K.A.
        • Rome V.F.
        • Bartels S.J.
        Review: Quality of mental health care for nursing home residents: A literature review.
        Med Care Res Rev. 2010; 67: 627-656
        • Levinson S.
        Preadmission screening and resident review for younger nursing facility residents with serious mental illness.
        Office of Inspector General, Department of Health and Human Services, 2007 (Available at:) (Accessed May 23, 2018)
        • Mechanic D.
        • McAlpine D.D.
        Use of nursing homes in the care of persons with severe mental illness: 1985 to 1995.
        Psychiatr Serv. 2000; 51: 354-358
        • Rahman M.
        • Grabowski D.C.
        • Intrator O.
        • et al.
        Serious mental illness and nursing home quality of care.
        Health Serv Res. 2013; 48: 1279-1298
        • Bowersox N.W.
        • Szymanski B.J.
        • McCarthy J.F.
        Associations between psychiatric inpatient bed supply and the prevalence of serious mental illness in veterans affairs nursing homes.
        Am J Public Health. 2013; 103: 1325-1331
        • Bartels S.J.
        Commentary: The forgotten older adult with serious mental illness: The final challenge in achieving the promise of Olmstead?.
        J Aging Soc Policy. 2011; 23: 244-257
        • Aschbrenner K.
        • Grabowski D.C.
        • Cai S.
        • et al.
        Nursing home admissions and long-stay conversions among persons with and without serious mental illness.
        J Aging Soc Policy. 2011; 23: 286-304
        • Li Y.
        • Cai X.
        • Cram P.
        Are patients with serious mental illness more likely to be admitted to nursing homes with more deficiencies in care?.
        Med Care. 2011; 49: 397-405
        • Temkin-Greener H.
        • Campbell L.
        • Cai X.
        • et al.
        Are post-acute patients with behavioral health disorders admitted to lower-quality nursing homes?.
        Am J Geriatr Psychiatry. 2018; 26: 643-654
        • Kim H.M.
        • Banaszak-Holl J.
        • Kales H.
        • et al.
        Trends and predictors of quality of care in VA nursing homes related to serious mental illness.
        Med Care. 2013; 51: 659-665
        • Cai X.
        • Cram P.
        • Li Y.
        Origination of medical advance directives among nursing home residents with and without serious mental illness.
        Psychiatr Serv. 2011; 62: 61-66
        • Brennan P.L.
        • SooHoo S.
        Psychiatric disorders and pain treatment in community nursing homes.
        Am J Geriatr Psychiatry. 2014; 22: 792-800
        • Brennan P.L.
        • Greenbaum M.A.
        • Lemke S.
        • Schutte K.K.
        Mental health disorder, pain, and pain treatment among long-term care residents: Evidence from the Minimum Data Set 3.0.
        Aging Mental Health. 2018; : 1-10
        • Campbell S.
        U.S. Nursing Assistants Employed in Nursing Homes: Key Facts [Report].
        Premier Healthcare Institute, Bronx, NY2017 (Available at:) (Accessed June 3, 2018)
        • Corrigan P.W.
        • Phelan S.M.
        Social support and recovery in people with serious mental illnesses.
        Community Ment Health J. 2004; 40: 513-523
        • Sengupta M.
        • Harris-Kojetin L.D.
        • Ejaz F.K.
        A national overview of the training received by certified nursing assistants working in U.S. nursing homes.
        Gerontol Geriatr Educ. 2010; 31: 201-219
        • Street D.
        • Molinari V.
        • Cohen D.
        State regulations for nursing home residents with serious mental illness.
        Community Ment Health J. 2013; 49: 389
        • Corrigan P.W.
        • Watson A.C.
        Understanding the impact of stigma on people with mental illness.
        World Psychiatry. 2002; 1: 16-20
        • Molinari V.A.
        • Merritt S.S.
        • Mills W.L.
        • et al.
        Serious mental illness in Florida nursing homes: Need for training.
        Gerontol Geriatr Educ. 2008; 29: 66-83
        • Karlin B.E.
        • Zeiss A.M.
        Transforming mental health care for older veterans in the Veterans Health Administration.
        Generations. 2010; 34: 74-83
        • Elo S.
        • Kyngäs H.
        The qualitative content analysis process.
        J Adv Nurs. 2008; 62: 107-115
        • American Geriatrics Society and American Association for Geriatric Psychiatry
        Consensus statement on improving the quality of mental health care in US nursing homes: Management of depression and behavioral symptoms associated with dementia.
        J Am Geriatr Soc. 2003; 51: 1287-1298
        • Vasse E.
        • Vernooij-Dassen M.
        • Spijker A.
        • et al.
        A systematic review of communication strategies for people with dementia in residential and nursing homes.
        Int Psychogeriatr. 2010; 22: 189-200
        • Kuske B.
        • Hanns S.
        • Luck T.
        • et al.
        Nursing home staff training in dementia care: A systematic review of evaluated programs.
        Int Psychogeriatr. 2007; 19: 818-841
        • Seitz D.P.
        • Brisbin S.
        • Herrmann N.
        • et al.
        Efficacy and feasibility of nonpharmacological interventions for neuropsychiatric symptoms of dementia in long term care: A systematic review.
        J Am Med Dir Assoc. 2012; 13: 503-506
        • Hobday J.
        • Roker R.
        • Kunik M.
        • et al.
        Impact of serious mental illness online training for certified nursing assistants in long term care.
        Gerontol Geriatr Educ. 2017; 38: 359-374
        • Amirsadri A.
        • Pizzuti A.
        • Smith D.
        • et al.
        Training for direct support staff at group homes for people with chronic mental illness.
        Community Ment Health J. 2018; 54: 54-57
        • Friedman J.
        • Harvey P.D.
        • Coleman T.
        A six-year follow-up study of cognitive and functional status across the life-span in schizophrenia: A comparison with Alzheimer's disease and healthy subjects.
        Am J Psychiatry. 2001; 158: 1441-1448
        • Whiteman K.L.
        • Naslund J.A.
        • DiNapoli E.A.
        • et al.
        Systematic review of integrated general medical and psychiatric self-management interventions for adults with serious mental illness.
        Psychiatr Serv. 2016; 67: 1213-1225
        • Karel M.J.
        • Teri L.
        • McConnell E.
        • et al.
        Effectiveness of expanded implementation of STAR-VA for managing dementia-related behaviors among Veterans.
        Gerontologist. 2016; 56: 126-134
        • Zimmerman S.
        • Dobbs D.
        • Roth E.G.
        • et al.
        Promoting and protecting against stigma in assisted living and nursing homes.
        Gerontologist. 2016; 56: 535-547
        • Dobbs D.
        • Eckert K.J.
        • Rubinstein B.
        • et al.
        An ethnographic study of stigma and ageism in residential care or assisted living.
        Gerontologist. 2008; 48: 517-526
        • Alzheimer's Association
        2013 Alzheimer's Disease Facts and Figures.
        2013
        • Corrigan P.W.
        • Michaels P.J.
        • Vega E.
        • et al.
        Key ingredients to contact-based stigma change: A cross-validation.
        Psychiatr Rehabil J. 2014; 37: 62
        • Davidson L.
        • Bellamy C.
        • Guy K.
        • Miller R.
        Peer support among persons with severe mental illnesses: A review of evidence and experience.
        World Psychiatry. 2012; 11: 123-128
        • Jeste D.V.
        • Maglione J.E.
        Treating older adults with schizophrenia: Challenges and opportunities.
        Schizophr Bull. 2013; 39: 966-968
        • Zimmerman S.
        • Sloane P.D.
        • Williams C.S.
        • et al.
        Dementia care and quality of life in assisted living and nursing homes.
        Gerontologist. 2005; 45: 133-146