Post-acute care patients’ physical and mental wellness are critical to their healing journey.
By Jenna Hughes
As a result of the healthcare industry-wide shift toward value-based care, post-acute care providers such as skilled nursing facilities, long-term acute care hospitals (LTACHs), and home health agencies (HHAs) are increasingly emphasizing care for both a patient’s physical health and emotional well-being needs throughout the duration of a stay in a post-acute care facility.
One such post-acute provider, Louisville, Kentucky-based ScionHealth operates approximately 70 long-term acute care hospitals (LTACHs) across the country, under the brands Kindred Hospitals, Cornerstone Specialty Hospitals and Solara Specialty Hospitals. Patients come to ScionHealth’s facilities with serious conditions, including respiratory failure, sepsis, stroke, congestive heart failure, or a combination of many acute conditions.
“ScionHealth’s specialty hospitals provide specialized care and rehabilitation for medically complex patients who are recovering from serious injury or illness, with many patients coming to us directly from the ICUs of traditional, short-term acute care hospitals,” said Loren Perona, Vice President of Clinical Operations and Care Coordination at ScionHealth.
Patients’ conditions in LTACHs may be complicated by existing health problems, including COPD or diabetes, with many requiring treatments such as mechanical ventilation, dialysis, IV therapy, and more. Lengths of stay at an LTACH may vary depending on the patient’s care plan needs, but the average length of stay is 25 days, compared with an average of a year or more in settings such as skilled nursing facilities.
“All patients as ScionHealth specialty hospitals are treated by a physician-led, interdisciplinary care team that includes rehabilitation therapists, pharmacists, dietitians, nurses, respiratory therapists, case managers and more,” said Perona. “All the key players meet with the patient and their family at least once a week to make sure that we’re supporting the plan of care that the physician has outlined for them.”
For patients with multiple conditions and many physical needs, consideration for patients’ mental health and emotional well-being is a critical component of healing.
Mental wellness initiatives can be directly integrated into patients’ care plans. According to The American Case Management Association (ACMA), integrating behavioral health tools such as psychosocial assessments and social determinants of health (SDOH) into post-acute care settings helps to create a holistic care approach that supports overall patient recovery and reflects the changing healthcare environment.
A focus on both emotional and physical well-being serves to improve post-acute care patient recovery rates through personalized care plans, reduced hospital readmissions, enhanced patient satisfaction, and a contribution to overall greater health equity.
Growing mental health challenges
Mental health care is a vital aspect of post-acute care, especially for patients going through long stays at their facilities.
For medically complex patients admitted to ScionHealth specialty hospitals, a timely transfer from an intensive care unit (ICU) to the LTACH may reduce a patient’s risk of developing post-intensive care syndrome, which is a collection of physical and cognitive symptoms associated with a stay in an ICU, and improve patients’ whole-health outcomes.
“There are two types of benefits to a patient being admitted to a long-term acute care hospital versus remaining in the hospital,” said Perona. “For patients, we can take them directly from short-term acute care ICUs and continue to provide the specialized acute care they need relating to ventilator management, complex wound care, or cardiac care. Our LTACHs are licensed as specialty acute care hospitals.”
Whereas short-term acute care hospitals diagnose and stabilize patients, the function of long-term acute care hospitals is to sustain and complete care for patients who require a longer stay in a hospital.
“We also take patients whom our skilled nursing facility partners cannot accommodate yet,” said Perona. “Patients who come to our LTACHs may have more advanced pharmaceutical needs, or they may require specialized respiratory therapy or additional nursing hours per patient day.”
Mental health in long-term residential care
Long-term care residents in skilled nursing facilities often stay in facilities longer and have more complex and evolving emotional needs than those in other post-acute care facilities.
Depression, anxiety, and social isolation are common among nursing facility residents, according to the National Library of Medicine’s “Suffering and Mental Health Among Older People Living in Nursing Homes” report.
Residents of skilled nursing homes without cognitive impairment comprise only a minority of facility populations and are more likely than in traditional hospitals to experience stressful events such as the loss of spouse, relatives and friends and reduced quality of life because of illness and injury. Due to this, older patients in long-term care may experience increased rates of suffering that impact both their mental and physical health.
The development of mental illness has become more common among older adults living in long-term care (LTC) facilities. According to the National Library of Medicine, data indicates that the proportion of new nursing home admissions with a mental illness other than dementia, including major depression and serious mental illness, has overtaken dementia alone in its prevalence.
The National Library of Medicine, in a 2010 study, outlined a need for greater attention to LTC residents’ suffering related to anxiety, depression, and psychosocial stressors. Caring for patient’s physical and mental health within skilled nursing facilities provides ongoing wellbeing intervention opportunities through counseling and therapy, support groups, cognitive stimulation and social engagement, and trained staff monitoring in LTC settings.
Mental health in a post-acute environment
The COVID-19 pandemic shed light for many clinicians in the post-acute care industry on the demands of serious illness on patients and staff. For many health systems, pandemic challenges led to a distinct awareness of infection control and its impact on patient well-being.
“The pandemic demonstrated how much of a strain that complex diseases can have on patients and families, and it reinforced our belief in the importance of educating the patient and family about their disease and care plan,” said Perona. “Our hospitals offer a patient-family conference at the very beginning of their stay. We also give a bedside shift report every shift, and families are more than welcome to attend. We talk with the patient about what happened during the shift, and what’s going to happen or needs to happen during the next shift.”
The prevalence of physical multimorbidity (the presence of two or more chronic diseases, including mental health disorders), is expected to rise, according to a 2023 National Library of Medicine report.
This rise is due to both a growing aging population and increased environmental exposure to risk factors for chronic conditions. Long-term physical conditions and mental health problems often co-occur, act synergistically, and can have negative effects on a patient’s level of care needed, which may contribute to longer hospital stays and increased costs and mortality, according to the report. A multidisciplinary approach to care for mental illness is necessary to improve the physical, mental and social outcomes of patients in care settings.
“Thankfully, mental healthcare does not have as much of a stigma as it used to, so conversations about it are now much more open,” said Perona. “Patients want to deal with their mental health and their needs and their emotions, and they’re often much more articulate and forthcoming about what they need. The advent of telehealth helps us have much more access to psychologists and psychiatrists if needed for a patient. If a visit can’t take place in person, we can often arrange for telehealth visits, which are very effective.”
“Our primary goal for our patients is to discharge to home, if possible, and we want them to be able to sustain wellness after they leave our facility,” said Perona. “We are constantly teaching them and their families about their diagnosis, about their disease, so that they can better accommodate for themselves as they get well.”
In control of healthcare
To emphasize patient involvement in care, interdisciplinary care conferences are very patient-centered at ScionHealth specialty hospitals, focusing on talking with the patient and their loved ones. Perona says “the best caregivers are the ones who really incorporate the patient into conversations and really understand what the patient needs in the moment and in the long-term.”
“Through it all, our staff always emphasizes patient teaching,” she said. “If patients understand what they’re supposed to be going through or what they might go through, they have a little bit more control in anticipating how things may play out, and then they can expend their energy working toward a recovery goal. When we set goals for patients or they set goals for themselves, it helps their mental health a lot. Then, when they achieve a goal, we celebrate that with them.”
“You can imagine how good a patient feels when they meet a goal (being liberated from the ventilator, walking with a walker, swallowing independently, etc.) that a patient may have wondered if they were ever going to achieve,” said Perona.
Perona said ScionHealth caregivers do whatever they can to help patients feel well-informed and in control of their recovery.
“There is a better chance of patients becoming well if they are able to be in control of their destiny,” said Perona. “Being in control of their care journey helps patient’s mental acuity and mental health to work through the healing journey.”