National Survey Evidence Shows Behavioral Health Services Inadequate in Most U.S. Nursing Homes

Researchers at the University of Rochester School of Medicine started surveying randomly selected skilled nursing facilities in 2017, asking questions about the types of behavioral health issues residents have, available behavioral health services, quality, satisfaction, staffing, staff education, turnover and service barriers. Now complete, the results of the study were published in the Journal of the American Geriatrics Society on June 5, 2019 and show that mental health disorders can affect up to 90 percent of nursing home residents in as many as a third of the nation’s nursing homes and community-based care facilities.

In this first review of its kind, researchers measured four different outcomes:

  1. Adequacy of behavioral health staff education
  2. Ability to meet resident behavioral health service needs
  3. Adequacy of coordination/collaboration between nursing home/community providers
  4. Availability of necessary facility infrastructure

“Inadequate behavioral health education and psychiatric training among nursing home staff were associated with subpar provision of behavioral services in this care setting,” the researchers reported. “New initiatives that increase access to behavioral health providers and services and improve staff education are urgently needed.”

The study authors also noted that behavioral health staff education was less of an issue in nursing homes with Alzheimer’s and dementia units, where staff turnover tends to be lower, and more psychiatrically trained RNs and social workers are present. In all though, access to care for those with special cognitive conditions is generally considered concerningly inadequate and Medicaid reimbursement rates are generally low to help pay for these services.

Examples of Mental and Behavioral Health Issues for Nursing Home Residents

Certain behavior conditions can’t be eliminated but can be managed with the right service providers, therapies, and at times, carefully prescribed and administered medications. Some of the more serious mental and behavioral health issues residents may have include:

  • addiction
  • dementia
  • paranoid personality disorder
  • post-traumatic stress disorder
  • hoarding
  • depression
  • bipolar disorder
  • schizophrenia

Antipsychotics shouldn’t be used for behavioral problems that can be managed without medications. And for residents who have been appropriately assessed and behavioral health needs rightfully determined, the Centers for Medicare & Medicaid Services (CMS) recently had a lot to say about treatment options other than chemical restraints and medicated interventions when possible.

Also, facilities that take patients with behavioral issues without ensuring an adequately trained staff and experienced professionals may be putting themselves and other residents at risk. Sometimes worrisome outcries or a resident’s unwanted behavior could be their natural response to fear, overstimulation, sickness, pain, fatigue, confusion, hunger and thirst, boredom, or even medication side effects. These are all serious symptoms of nursing home neglect or abuse and should not be ignored. 

Levin & Perconti: Attorneys for Nursing Home Residents with Behavioral Issues 

If someone you love is lacking the services necessary to treat their mental health conditions and has been injured as a result, please contact the Chicago nursing home abuse and neglect attorneys of Levin & Perconti. Let us help you and your loved one receive the justice deserved. Call us now (312) 332-2872 or complete our online case evaluation form for a FREE consultation with one of our nursing home abuse attorneys.

Also read: Regulators Release New Guidelines to Reduce Antipsychotic Use for Residents Living with Dementia

Source: Orth, J. & Simning, A. & Temkin-Greener, H. (2019). Providing Behavioral Health Services in Nursing Homes Is Difficult: Findings From a National Survey. Journal of the American Geriatrics Society. Retrieved from