Improving Serious Mental Illness Care in Nursing Homes

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DESCRIPTION (provided by applicant): Abstract Caring for residents with Severe Mental Illness (SMI) is an issue that impacts every nursing home in the country. Recent research indicates that individuals with Serious Mental Illness comprise approximately 10% of all nursing home residents (over 150,000 residents), which does not include those with less severe cases of mental illness, those residents in assisted living facilities, or those being cared for in their homes. Unfortunately, research also suggests that nursing home staff often feel ill-prepared to address the unique mental health needs of this population, and there is evidence in the literature that more staff training is needed. In phase I, investigators will develop an Internet-based SMI training intervention with state-of the-art instructional methodology. A team of national experts will be assembled to guide this process, especially in terms of differentiating how the behavior problems of residents with SMI are both alike and dissimilar to residents with dementia. Ten planned modules will be developed during Phase I and II that address common behavior problems, how to deliver care in a culturally sensitive manner to this population, and how to work with both formal and informal caregivers to achieve better mental health and health outcomes. The completed Phase I intervention will be evaluated by Certified Nursing Assistants in a limited Randomized Controlled Trial (RCT). Pre- post quantitative and qualitative analyses will be conducted as part of a Phase I experimental design study. Findings will inform Phase II research and development. Investigators anticipate a set of three commercializable modules as a result of this effort that will improve the quality of care and quality of life of residents with SMI living in the nursing home setting. PUBLIC HEALTH RELEVANCE: Narrative Ten percent of all nursing home (NH) residents have Serious Mental Illness (SMI), and this group routinely over-utilizes costly services such as hospital emergency care, public health commitment proceedings, and frequent transfers to and from NHs, where they may be frequently over-medicated and where behavioral management strategies are unfortunately not often used (Christy & Molinari, in submission). Because Certified Nurse Assistants (CNAs) report feeling both inadequately trained for and fearful of managing the care and behaviors of residents with SMI, this proposed intervention addresses these widespread public health concerns by educating CNAs about SMI and proper care strategies. Investigators' calculations in the proposal show implementation of this intervention at a single NH facility could save tens of thousands of dollars annually, potentially lowering public health costs related to SMI by over $900 million per year nationally, if adopted as a national training standard.