Service Area Strategic Plan
4/24/2014   5:45 pm
Department of Behavioral Health and Developmental Services (720)
Biennium:
Service Area 1 of 1
Geriatric Care Services (720 430 06)
Description

Geriatric Care Services include a variety of clinical services and inpatient interventions that are specifically designed, implemented, and funded to address the unique and complex recovery, treatment, and support needs of older adults (65 years of age and older). These include psychiatric assessment and stabilization; medication management; nutritional management; psycho-social rehabilitation programming; psychiatric and rehabilitative therapies; and, in collaboration with the CSBs, discharge planning. Specialized inpatient interventions for older adults include, but are not limited to communication skills, reminiscing, physical fitness, leisure skills, relaxation skills, community outings, kitchen activities, music, money management, individual and family psycho-education, symptom management, and independent living skills. These services and interventions are intended to promote optimal performance in areas of behavioral management, cognition, interpersonal skills, self-care, and leisure time development.

Specialized inpatient geriatric care services are provided by Eastern State Hospital in Williamsburg, Southwestern Virginia Mental Health Institute in Marion, Catawba Hospital near Salem, and Piedmont Geriatric Hospital in Burkeville.
Background Information
Mission Alignment and Authority
  • Describe how this service supports the agency mission
    Inpatient geriatric services provided in state hospitals are an integral component in the continuum of care in Virginia. These services are provided to persons who are in crisis, who present with acute or complex conditions, or both, and who require the highly intense and structured environments of care only available in the inpatient setting. Inpatient geriatric services are person-centered, flexible, and sensitive to the cultural and age-related needs of individuals.
  • Describe the Statutory Authority of this Service
    Chapter 3 of Title 37.2 of the Code of Virginia establishes the Department of Behavioral Health and Developmental Services.
    • § 37.2-304 outlines the duties of the Commissioner, including supervising and managing the Department and its state facilities, including geriatric services for older adults.

    Chapter 7 of Title 37.2 of the Code of Virginia authorizes the Department to perform certain functions related to the operation of state facilities, including geriatric services for elderly individuals.
    • § 37.2-702 authorizes the Department to establish and operate a separate geriatric unit within each state facility that serves significant numbers of older adults;
    • § 37.2-707 authorizes the Commissioner to employ state facility directors; and
    • § 37.2-711 authorizes the Department and state facilities to exchange consumer-specific information for former and current consumers with CSBs to monitor the delivery, outcome, and effectiveness of services.
Customers
Agency Customer Group Customer Customers served annually Potential annual customers
Older adults (65 and older) receiving state hospital services Older adults (65 and older) receiving services in state hospitals 701 785

Anticipated Changes To Agency Customer Base
o Virginia’s population is increasing, becoming more culturally diverse, and growing older. The customer base for state geriatric facilities and programs will change to reflect these demographic trends.

o Almost 20 percent of the population 55 and older, or an estimated 1,758,655 Virginians (2008 Population Estimates), experience specific mental disorders that are not part of “normal” aging process. Older Virginians are among the fastest growing age groups in the Commonwealth and nationally. The accelerated growth of the older adult population and its proportionately greater and more expensive healthcare needs is likely to place increased pressure on Virginia’s behavioral health and developmental services system, including state facilities, to provide specialized treatment to older adults with behavioral health disorders.

o State geriatric hospitals and programs will serve proportionately greater numbers of older adults with significant or complex service needs who will require specialized treatment services and ongoing preventive care.

o State geriatric hospitals and programs will serve proportionately greater numbers of older adults with co-occurring disorders (mental illnesses and substance use disorders, intellectual disability and/or other developmental disabilities), increased individual acuity, and complicated acute and chronic medical needs.
Partners
Partner Description
Community service boards and behavioral health authorities: Geriatric care services staff work collaboratively with CSBs to plan, develop, and implement discharge planning activities and provide assistance to CSBs, as necessary, in reintegrating individuals receiving services into the community so they might participate as fully as possible in all aspects of community life and relationships.
Individuials receiving services, families, guardians, or authorized representatives: Geriatric care services staff work with individuals receiving services and family members or authorized representatives in providing care, treatment, rehabilitation, and psycho-education services during an individual’s inpatient stay. Individuals and family members are actively and meaningfully involved in all aspects of treatment, treatment planning, discharge planning, and community placement.
Local hospitals, nursing homes, and assisted living facilities: Geriatric care services staff, in coordination with individuals receiving services, family members, and appropriate community placement staff, plan, develop, coordinate, and monitor community placements to insure a successful community transition and adjustment.
Office of Inspector General The Office of the Inspector General periodically monitors all the state geriatric facilties.
State and local agencies: Geriatric care services staff develop and coordinate service delivery with multiple state and local agencies that provide health care, social services, and housing assistance to older adults. Agencies such as local area agencies on aging, local health departments, and local departments of social services are often key partners in treatment planning and coordination.
Virginia institutions of higher education (universities, colleges, and community colleges): Academic medical centers and other academic programs of colleges and universities work with the geriatric facilities to train students, interns, and residents who may be entering the behavioral health arena. They also train the facilities’ existing workforce and promote the implementation of evidence-based and promising practices.
Products and Services
  • Factors Impacting the Products and/or Services:
    o There has been a shift in cultural perspectives on aging. Society once assumed that older adults required no more than custodial or end-of-life care. Now, with increased longevity; a renewed respect for the social, political, and economic contributions of this population; and the demand for more appropriate treatment choices by individuals who receive services, there are strong pressures on state hospitals and community service providers to develop new treatment models.

    o Virginia lacks adequate behavioral health and developmental services infrastructure to meet the current needs of older adults. The provision of services to older adults is complicated by the limited number of specialized community-based programs in Virginia and lack of providers trained to serve individuals with mental health or substance use disorders or intellectual disability.

    o The Department and CSBs have worked together and with other stakeholders to develop regional model programs in Northern Virginia and Eastern Virginia to provide innovative direct care services for older adults in their home communities with the goal of reducing the need for psychiatric hospitalization. These initiatives are collaborating with local service area providers to expand “aging in place” community and home-based services that will enable older adults with mental health or substance use disorders to live in their own residences. Services being developed through this initiative include: specialized services and supports that incorporate evidence-based and best practices, including on-site geriatric psychiatric services provided through a PACE program, partial hospitalization, intensive outpatient services and adult day care extensive outreach services, education/support and participation in advocacy; regional specialized behavioral health mobile teams and assisted living and nursing home teams; discharge assistance funding; regional private bed purchase funding; and strategic planning activities.

    o The reluctance of older adults to seek behavioral health services and the poor service coordination among agencies providing services to this population often results in a more complicated clinical picture when a person finally does present for services and increased demand for inpatient services. Efforts to better integrate behavioral healthcare into primary care and other generalist settings will enable primary care physicians, nurses, pharmacists, social workers, or other health care professionals to intervene earlier and provide brief interventions to older adults whose mental health or substance use disorders might otherwise progress until hospitalization is required.

    o Clinical, environmental, and administrative standards set by the Centers for Medicaid and Medicare (CMS) and by The Joint Commission are likely to continue to become more complex, burdensome, and more expensive to oversee and implement.
  • Anticipated Changes to the Products and/or Services
    o Construction of a new, state-of-the-art Hancock Geriatric Treatment Center at Eastern State Hospital was completed in early 2008.

    o State geriatric hospitals and units providing specialized geriatric services will continue to implement best practices and clinical practice guidelines and evidence-based approaches in their care of older adults.

    o State geriatric center partnerships with private and university-affiliated psychiatric facilities have resulted in a system where acute care is increasingly provided in community hospitals and longer-term treatment is provided in state geriatric centers.

    o State geriatric hospitals and units providing specialized geriatric services will continue to respond to increasing demands for geriatric education and outreach and consultation services from local healthcare facilities, including nursing homes and assisted living facilities.

    o State geriatric centers partnerships with private nursing homes around the state have resulted in the centers' provision of services and supports that encourage the transition of individuals residing in state geriatric centers to the community. Centers are providing teams of clinical staff that provide telephone consultation, site visits, and other supports to community caregivers following an individual's discharge. State geriatric center psychiatrists also provide psychiatric services, including medication reviews, through direct communication with receiving nursing home psychiatrists and medical directors.
  • Listing of Products and/or Services
    • Psychiatric and medical assessment
    • Psychology, medical, nursing, dental, social work, and ancillary services
    • Recreational, physical, and occupational therapies
    • Individualized treatment planning
    • Medical and psychiatric medication management
    • Rehabilitation, including psychosocial rehabilitation and active treatment mall services
    • Discharge planning and coordination
Finance
  • Financial Overview
    This service area is funded with 100 percent non-general funds. Non-general funds are derived from the collection of fees from Medicaid, Medicare, private insurance, private payments, and Federal entitlement programs related to patient care.

    Note: The information on the following table is presented at the service area level. However, funding by fund source is appropriated at a higher program level. This results in the allocation of non-general fund amounts to the various service areas within the program level in accordance with reasonable allocation methodology. Such methodology has been applied and is represented in these amounts.
  • Financial Breakdown
    FY 2011    FY 2012
      General Fund     Nongeneral Fund        General Fund     Nongeneral Fund  
    Base Budget $0 $36,416,373    $0 $36,416,373
    Change To Base $0 $0    $0 $0
               
    Service Area Total   $0  $36,416,373     $0  $36,416,373 
Service Area Objectives
 
  • Offer a comprehensive array of person-centered inpatient geriatric treatment and rehabilitation services that promote self-determination, recovery, and community participation and achieve the vision of a consumer-driven system of services.
    Objective Description
    This objective conforms to the Department's responsibility to operate state facilities. Geriatric care services staff must continue to actively monitor and evaluate key hospital processes, such as assessment, treatment planning and service organization and delivery, to insure their consistency with the Department’s values of self-determination, participation, empowerment, and recovery. Falls are one of the most common geriatric syndromes threatening the independence of older persons and consequently are commonly used as a measurement for quality of care.
    Alignment to Agency Goals
    • Agency Goal: Expand and sustain services capacity necessary to provide services when and where they are needed, in appropriate amounts, and for appropriate durations.
    • Agency Goal: Obtain sufficient numbers of professional, direct care, administrative, and support staff with appropriate skills and expertise to deliver quality care.
    Objective Strategies
    • Continue to integrate self-determination and empowerment values into the day-to-day activities of individuals receiving inpatient geriatric services.
    • Enhance the provision of specialized geriatric services and use of best practice guidelines and evidence-based approaches in the treatment and care of older adults within the state geriatric hospitals and units.
    • Increase efforts to offer a comprehensive array of treatment, rehabilitation and enrichment activities by continuously assessing the services and activities that are offered and adjusting according to patient needs and interests.
    • Increase the numbers of individuals and family members who receive education on wellness and recovery.
    • Maintain sufficient numbers of trained staff in each geriatric facility and program to ensure services are appropriate to the populations served and sufficient to provide quality services and assure the safety of individuals receiving services.
    • Implement a career path for direct service associates to improve recruitment and retention efforts.
    • Support efforts of CSBs to establish specialized services and supports that respond to the behavioral health services and support needs of older adults.
    • Enhance partnerships with community hospitals and university-affiliated psychiatric facilities that enable community hospitals to accept TDOs and provide acute treatment to individuals who otherwise would have been admitted to state geriatric centers for much longer average lengths of stay and to transfer individuals who need longer-term services from private and university-affiliated hospitals to the geriatric centers.
    • Enhance partnerships with private nursing homes around the state and provide services and supports that allow for the successful transition of individuals residing in state geriatric centers to the community.
    • Provide assistance, training, and clinical support to nursing homes and assisted living facilities on the effective management of behaviors such as wandering and aggression that may result in referrals to state geriatric centers.
    • Promote and provide geriatric behavioral health education, outreach, consultation, and technical assistance to various local constituencies, including older adults and their family members, area agencies on aging, local health care providers, nursing homes, and assisted living facilities.
    • Support the efforts of the OIG to monitor the progress of state facilities in improving quality of care.
    Link to State Strategy
    • nothing linked
    Objective Measures
    • Rate of falls by geriatric care patients
      Measure Class:
      Other
      Measure Type:
      Outcome
      Measure Frequency:
      Annual
      Preferred Trend:
      Down
      Measure Baseline Value:
      5
      Date:
      6/30/2007

      Measure Baseline Description: Number of falls per 1,000 patient bed days

      Measure Target Value:
      4.75
      Date:
      6/30/2012

      Measure Target Description: Number of falls per 1,000 patient bed days

      Data Source and Calculation: Numbers of individuals reported to the Department's Office of Facility Operations by the geriatric facility staff. The measure is calculated by dividing the total number of falls in the geriatric centers by the number of bed days of service, divided by 1,000. The measure is calculated by the using the total number of falls which includes the following breakouts: "Found on Floor", transfers; slipper surface, improper shoe surface/no shoe surface, obstacle, falling during change of position -sitting to standing and environmental. Breaking out the causal factor will enable the facility staff to target and implement a preventative intervention and action plan to reduce falls in their facility.


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