mental health awareness month paper
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For years, Jennifer Drake drove by a man in a wheelchair sitting outside a McDonald’s restaurant with a blue tarp on his head. But when the population on that corner grew to 50 and a neighborhood park bloomed with 135 tents housing well more than 200 homeless individuals, it no longer was something she could ignore.

As a community safety net provider, Cascade Senior Living Services in Tacoma, WA, looked at the community need and asked how it could help be part of the solution. Then it realized that older adults with mental health issues already were living in-house with them.

Cascade operates independent living, assisted living and memory care communities as well as adult day centers. Drake, the organization’s director of business development, said during a Monday LeadingAge membership call that many undiagnosed mental health issues — including anxiety and depression — already are at play in senior living communities. Most providers, however, are “haphazardly” approaching related resident care, she said. 

“All of us can do a better job by becoming experts in the arena of mental health,” Drake said. 

But the financial challenges to that care are daunting, she said. Washington state, where Cascade is based, pays for hands-on activities of daily living assistance that is provided, but it does not pay providers to take on behavioral care. And low Medicaid reimbursements were leading many providers to close up shop, she said.

Uncommon contracts, specialty partnerships

So Cascade got creative by pursuing uncommon contracts and specialty partnerships to serve people living with significant mental health or dementia diagnoses. 

The catalyst for a partnership with the state, she said, came when federal funding for the state psychiatric hospital was pulled. The state approached Cascade, with its experience in memory care, to take on the care of individuals living with advanced dementia and severe mental health overlays.

In return for caring for individuals with mental health and dementia diagnoses, Cascade receives funding to hire a social worker and employs the services of a psychiatric nurse practitioner. The arrangement, Drake said, now is permanent, and the organization is able to use the social worker and nurse to address the needs of its residents as well.

Cascade contracted with the state to conduct a pilot program, then opened the program up to other hospitals, offering a medical respite program. The provider often works with hospitals to remove individuals from chemical and physical restraints before accepting them into the community program, Drake said. Within nine to 15 months, most participants are off of all of the antipsychotic medications they previously were taking, she said.

“We do this strategically and slowly, with a goal to remove antipsychotic medications,” Drake said.

Hospitals are “bursting at the seams” with people taking up hospital beds who clinically shouldn’t be there, and Medicaid providers are closing due to low reimbursement rates, she said. 

Cascade itself was in danger of not making payroll one year before it found its niche in the behavioral health memory care model, Drake said. Today, the provider is acquiring other Medicaid providers that are on the verge of collapse and is expanding its services.

“What a chance to create, to build, to save,” Drake said. “Now, we’re financially stable and expanding.”

Getting started

Many of Cascade’s private-pay counterparts report seeing a large uptick of mental illness and addictions in their areas, she said. 

“If it’s in-house already, what are you doing to address it?” Drake asked, admitting that Cascade “ignored a fair amount” of those issues in residents in the past.

Providers looking for a starting point to begin offering services first need to do an audit of their community population to identify conditions already at the community, she said. Cascade already has identified needs related to addiction and housing with services and is already working to determine how to address those issues, Drake said.