Therapist running support group with male patient during session at home office
(Credit: Maskot / Getty Images)

Fear of losing autonomy and mistrust of providers lead to unmet mental health needs of residents in Medicaid-funded assisted living communities, according to the results of a new study.

The researchers, from the New York University Rory Meyers College of Nursing and Hartford Institute for Geriatric Nursing, and the Icahn School of Medicine at Mount Sinai in New York, concluded that changes in the legal, policy and financial sectors are necessary to address disparate structural factors that impede access to mental health services.

Specifically, they said, policymakers should support public financing of predominantly minority-supporting communities in racially and financially segregated neighborhoods. The researchers also recommended providing a living wage to ensure adequate staffing, expanding access to Medicaid waiver services and creating new avenues to improve mental health resources.

For the study, published in JAMDA, the journal of Post-Acute and Long-Term Care Medicine, the investigators examined the mental health needs of residents and barriers to care in Medicaid-funded assisted living communities.

The study looked at 13 residents in a Bronx, NY, community and found that although resources were available, residents opted to use nontraditional resources or to remain isolated rather than pursue traditional mental health services. 

Fears over losing their autonomy, mistrust of the community and a lack of resources were identified as barriers to residents’ mental health needs for depression, anxiety and stress being met. The study is the first to provide resident perspectives of mental health needs in Medicaid-funded assisted living communities, according to the researchers.

“Residents use unconventional resources to address needs that may be neither efficient nor effective,” the authors wrote. “Novel mental health interventions and processes are needed to improve mental health access and should prioritize residents’ desire for autonomy and the unique circumstance of living” in a Medicaid-funded assisted living community.

The authors stated that their findings are an “essential first step” to developing interventions and processes that improve quality of life for residents of Medicaid-funded assisted living communities and optimize their healthcare use. They also stated that their findings align with a call to “reimagine assisted living” due to the growing complexity of assisted living residents’ care needs.

“New processes and interventions are needed to transform ALFs with traditional social supportive models to ones that acknowledge and address complex medical needs of older adults,” the authors wrote. 

Given that such residents often turn to community resources for support, the authors noted that future navigation models using community health workers who can break down barriers to care should be considered as a bridge to residents’ social and medical needs. 

“Their independence from [community] management, cultural expertise and knowledge of local resources may provide a better way to assess and address the concerns of M-ALF residents that addresses residents’ concerns about autonomy and privacy,” the authors wrote.