Providing Behavioral Health Support for Older Adults

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Tom Haederle
According to the World Health Organization, behavioral health conditions among older people are often under-recognized and undertreated, and the stigma surrounding these conditions can make people hesitant to seek help when they need it. West Virginia based Broaddus Hospital, a critical access hospital that is part of the Davis Health System, has created Senior Life Solutions, an intensive outpatient program designed to fit the needs of patients 65 and older.

00;00;35;10 - 00;01;10;10
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA communications. Although the overall population of Broaddus Hospital's rural community has decreased over time, the population of older adults has steadily increased. What wasn't increasing, however, was the availability of behavioral health services for this population. Recognizing that there were many older community members who needed help managing depression, anxiety, social isolation and grief, the team at Broaddus Hospital decided to get to work to create a treatment program that address their unique needs.

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Tom Haederle
In this podcast, hosted by Jordan Steiger, senior program manager of Clinical Affairs and Workforce with the AHA, she is joined by two leaders who share how this hospital-based program has benefited not only patients who seek care through their program, but the community overall. Dana Gould is CEO, Broaddus Hospital, and Donetta McVicker is program director of Senior Life Solutions with Broaddus Hospital.

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Jordan Steiger
Dana and Donetta, thank you so much for being with us today on our AHA Advancing Health podcast. We're really excited to talk to you today and to hear your perspective about some of the work that you've been doing.

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Dana Gould
Thank you for having us.

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Jordan Steiger
So tell us a little bit about Broaddus Hospital and the community that your hospital is in.

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Dana Gould
It's a critical access hospital, 72 bed facility. We have 12 acute care swing beds as well as a 60 bed nursing home. We're located in Philippi, West Virginia, a pretty rural area. And so this is a nice facility to have here in our small community.

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Jordan Steiger
It's great. And you know, how many communities does your hospital serve? Is it just in your town or does it kind of serve a bigger, rural population?

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Dana Gould
We serve our surrounding counties there, about five different surrounding counties that we serve, in addition to Barbara County, West Virginia.

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Jordan Steiger
You know, that's really nice to hear. And I think something that other, you know, rural listeners can resonate with, you know, serving that big population, that big, area, you know, in your community and not just the people that may be live next door to you, but also the people that kind of live just in your region. And, we know that a lot of communities really depend on the work of rural and critical access hospitals to get care.

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Jordan Steiger
So, we're really excited to learn more today. What are some of the common, you know, kind of like population health issues that face your community, especially related to behavioral health and substance use?

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Dana Gould
Well, we do our annual community  - not annual, and we do it every three years - our community health needs assessment. And so for the last several years when we've completed that, we've found that behavioral health is one of the areas of greatest need in our community. We also have a pretty large percentage, around 20 some to 22% of population

00;03;29;11 - 00;03;49;25
Dana Gould
that's over 65 years of age. And we're finding that even though the population of our county has decreased or remained relatively flat, the population of those 60 and 65 or older, have has increased. So, there is of an increasing need for behavioral health in our community.

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Jordan Steiger
I think that leads us into exactly what we're here to talk about today. So, your hospital has a really strong, geriatric, intensive outpatient program. And I think that's really unique and something that our listeners are going to be really interested in just because, as you mentioned, a lot of communities I think, are kind of facing that same issue of aging populations and maybe not having enough care in the area to help them with their behavioral health issues.

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Jordan Steiger
And it sounds like what you've done has really enhance the quality of life for the older adults and their families in your community. So I'd love if you could tell us a little bit more just about your program.

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Donetta McVicker
Okay, I guess I will step in there. My name is Donetta McVicker. I am the program director here at Senior Life Solutions at Broaddus Hospital. Senior Life Solutions is an outpatient behavioral health program here at Broaddus Hospital. It's designed to meet the unique needs of older adults, typically 65 and older, who are experiencing issues such as depression, anxiety, or other mental health challenges associated with the changes that accompany the aging process.

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Donetta McVicker
Our services include group therapy, individual therapy, family therapy, and medication management.

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Jordan Steiger
That's great. Can you tell us more about maybe some of the skills that patients learn? Maybe in group therapy or individual therapy?

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Donetta McVicker
Yeah, absolutely. Our therapy sessions occur in small groups and are facilitated by our licensed therapist. Patients typically attend group sessions three days a week, at first, and then they titrate to two or one day per week as they progress through the program. The program usually uses various skills to support patients in achieving their personal therapy goals, such as mindfulness, grounding skills, progressive muscle relaxation, self-care, social and communication skills.

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Jordan Steiger
That's great. And you know, I know, one thing that we talked about when I initially learned about your program is that you've seen maybe that there's been an increase in, you know, socialization of the older adults in your community from meeting each other in this program. And can you talk about maybe some of kind of the positive byproducts that have come out of having this kind of group therapy setting?

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Donetta McVicker
Our patients typically experience a lot of isolation and loneliness. So once they engage in the program, they meet new people who are experiencing similar issues that they are currently experiencing themselves. So they relate with one another, and they become friends. A lot of times, once they're discharged, they still remain in contact with the people that they met in group.

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Donetta McVicker
They've created these relationships with the other clients, and they will call each other on the weekends, or they'll arrange an outing and have coffee together or something like that. And that really increases their socialization and, really improves, some of their mental health issues.

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Jordan Steiger
I think that is an incredible thing to highlight here because obviously, you know, we're looking for in a program like this, you know, positive clinical outcomes, reduced depression, reduced anxiety, things like that. But, you know, really having that decreased loneliness and socialized relation, especially in older adults, I mean, we know that that has so many positive mental and physical health outcomes.

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Jordan Steiger
So I think the fact that you're providing that in your community is such a great thing.

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Donetta McVicker
Yeah, absolutely I agree.

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Jordan Steiger
So one thing that we know is on everyone's mind across the country, whether it's, you know, small critical access hospital or a big health system is workforce. And having the right workforce available in the community and in the hospital to fulfill and, you know, continue programs like this. So who do you need to be successful in this program?

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Jordan Steiger
Do you have, you know, a psychiatrist? Do you have social workers? Tell the audience a little bit more about who's on your team.

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Donetta McVicker
Yeah. Our program is made up of multidisciplinary cast or, staff. We have a registered nurse. We have a licensed social worker. We have a psychiatrist and other clinical staff that support the patients such as CNAs and things like that, NAs.

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Jordan Steiger
I think that multidisciplinary approach is always helpful in behavioral health and, you know, gives our listeners an idea maybe what it would take for them, you know, to put something like this in place, knowing that they're going to need lots of different people, lots of different moving parts to kind of make this a success.

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Donetta McVicker
Yeah.

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Jordan Steiger
So one thing I know, we hear a lot about and, you know, the behavioral health world in general, and especially with aging adults and rural communities is stigma. You know, stigma around seeking care, stigma about actually admitting that you need help with your mental health. is this something that you found to be true, when you're seeing people coming into your geriatric IOP program?

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Donetta McVicker
Yes. Of course. You know, one thing that we tell our patients or anyone considering the program is that there is no shame or stigma in providing good self-care. Mental health care should be no different than physical health care. There are nearly 58 million adults aged 65 and older living in the United States, yet we continue to lack services specifically for that population.

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Donetta McVicker
Unfortunately, the aging process does not come with an instructional manual. However, our program helps to provide resources and the tools, both emotionally and socially, to be better equipped on ways to overcome some of these challenges that often accompany this journey.

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Jordan Steiger
I love what you said about aging doesn't come with the manual. I think that's, you know, something to keep in mind, you know, here and nobody knows exactly how it feels as people are getting older. It's a really great thing I think, that you have something in your community to provide some structure and provide some guidance.

00;10;10;20 - 00;10;32;14
Jordan Steiger
And, like you said, there is no stigma. There should be no stigma around seeking care, especially when it can improve the quality of your life as much as you've seen for your patients. So that's really, really great. Speaking of that, how has your geriatric IOP program positively impacted your patients, families and community?

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Donetta McVicker
I actually have a few testimonials if I may be permitted to read some of them.

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Jordan Steiger
Absolutely.

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Donetta McVicker
All right. So I have: "Since retirement, I needed to reassess who I am and how I occupy my mind. I found the direction and the support with this program." Another client wrote, "I lost my grandchild and found myself in a dark place. I didn't know how I would make it through without the support that I needed. With the help of this program

00;11;06;21 - 00;11;38;00
Donetta McVicker
I have made friends and found ways to celebrate her life." And then lastly, one client stated, "I have learned a lot about myself and how to cope with my current health conditions." So as you can see, there are many different ways that patients have experienced an increase in their knowledge of themselves, of their, newly occurring health conditions, which seems like once you're 65 or older, those seem to be more rapidly occurring in their life.

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Donetta McVicker
And then, you know, losing a loved one seems to happen more frequently in the ages of 65 and older. And unfortunately, it doesn't just stop with the spouse or a friend or a relative or something like that. What we're seeing a lot here is they're losing their adult children or even their grandchildren to things like substance abuse and accidents and things like that.

00;12;04;23 - 00;12;30;07
Donetta McVicker
So we're seeing a lot of grief in our program. It's really nice that, you know, that testimony about losing her grandchild. It's really nice to hear that we were able to help her really change her perspective on that grief and flip it around to say how she now has found ways to celebrate that life instead of mourning the loss of that individual.

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Jordan Steiger
Yeah. I mean, we know that community is such a powerful tool in addressing grief. And, I love that you brought in some patient perspective and you know, testimonial. I think that really kind of brings to life the importance of this program in your community. And I'm sure our listeners are also going to be really impacted by those testimonials as well.

00;12;51;22 - 00;13;09;01
Jordan Steiger
So as we kind of wrap up our conversation today, if there is another rural or critical access hospital out there who, you know is hearing the work that you're doing and hearing your story and is like, wow, I would love to have something like that in my community. What advice would you give them as they were getting started?

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Donetta McVicker
You know, honestly, I would start off and say, take a look around your community. Do you have resources readily available for your most vulnerable populations? The aging process has a host of challenges. So the population often experiences things like grief and financial struggle, isolation, loneliness, chronic health conditions, and just an overall lack of support. A program like Senior Life Solutions can help accommodate those needs.

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Donetta McVicker
I know that through our program, it didn't take a whole lot to get started here. It's a small staff. Like I said, we have a registered nurse, a CNA, a licensed therapist, and a psychiatrist. And with that small multi-disciplinary staff, we're able to, you know, do really big, important things for our clients.

00;14;02;28 - 00;14;20;18
Jordan Steiger
That's great. And I think, you know, the message that it doesn't maybe take a lot to get this off the ground, I think is important. And, you know, of course it's going to take effort to start a new program or something like that. But I think the payoff from what you've said is totally it's worth the work, right, to provide those services to your community.

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Jordan Steiger
Dana, any closing thoughts from an administrative perspective?

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Dana Gould
Sure. Financially, the program has been beneficial for us. Since we are a critical access hospital, our reimbursement is, at least for Medicare, is primarily based on our cost. So this allows you to be fully reimbursed for the cost of the program because the majority of the patients are Medicare patients and then also assist with some of the allocated costs that that go to the program.

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Dana Gould
Some of your overhead costs can be allocated and reimbursed. So financially, it is a very good program for critical access hospital.

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Jordan Steiger
That's great. That's really important to mention I think, because of course we can't avoid that conversation talking about the finances and how to keep these programs running. So I'm glad that it has been a financially viable program for you and that it continues to be successful. So thank you both so much for sharing your insights with us today.

00;15;22;27 - 00;15;31;19
Jordan Steiger
I think that our members at the AHA really going to learn a lot from this conversation, and we really appreciate that you took the time to share with us.

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Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and write us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.