The COVID-19 pandemic put seniors in the spotlight for one of the most urgent public health challenges in recent memory: behavioral health in skilled nursing facilities. Magnified by social isolation, visitation restrictions, and the disruption of daily routines, seniors experienced some of the highest rates of behavioral health conditions during the pandemic. Anxiety, depression, and other mental health challenges surged, and while the public health emergency has eased, many of these difficulties persist.
Yet despite this growing need, access to behavioral health in skilled nursing facilities remains limited for seniors. For decades, SNFs have primarily focused on physical care—managing chronic conditions, post-acute rehabilitation, and other medical needs—leaving behavioral health services underdeveloped. The lack of adequate mental health and substance use disorder (SUD) support in these settings represents a significant gap in care.
Encouragingly, the landscape is beginning to shift. Federal funding, policy changes, and innovative provider initiatives are increasingly focused on integrating behavioral health in skilled nursing facilities. Catholic Care Center in Bel Aire, Kansas, serves as a prime example of this shift. Cindy LaFleur, executive director at Catholic Care Center, explained the growing demand: “There’s always been a strong need, but as we see the baby boomer population [aging], it’s growing even more. I think it’s a real unmet need in our sector of nursing homes.”
The Challenge: Behavioral Health Needs Among Seniors
Research consistently shows that mental health concerns among seniors in nursing homes are widespread. Up to 30% of residents experience some form of depression, ranging from mild to severe. Yet between 20% and 40% of facilities nationwide report that providing even basic behavioral health in skilled nursing facilities is “difficult” or “very difficult,” according to research from the University of Rochester School of Medicine and Dentistry. Factors such as limited staff training, inadequate funding, and a lack of mental health specialists contribute to these challenges.
Behavioral health needs in SNFs are not limited to depression and anxiety. Cognitive decline, grief, trauma, and substance use disorders—particularly opioid use disorder (OUD)—also impact residents’ well-being. Without adequate support, these conditions can worsen, leading to higher rates of hospitalization, longer recovery times, and diminished quality of life.
A Model for Integration: Catholic Care Center
Catholic Care Center is taking proactive steps to address these challenges by creating an acute geriatric behavioral health facility on its campus. The initiative is part of a broader effort to provide comprehensive care across multiple senior-focused services, including skilled nursing, independent living, assisted living, long-term care, memory care, and an adult day program.
Market studies conducted by the center in 2019 and 2021 highlighted behavioral health resources as critical to residents’ overall health and well-being. A dedicated on-campus behavioral health facility would make it easier for seniors to transition into care, reducing the need for emergency room visits—a particularly important consideration given that geriatric psychiatry patients can sometimes wait over a day in the ER before admission.
LaFleur emphasized the importance of providing care in a less clinical, more home-like environment: “We can care for those seniors in a less sterile environment and in a more home-like environment. We believe that we can do it on this campus, where it’s an easier transition and it’s a real natural fit for what we do.”
The new geriatric psych unit, expected to open in June 2023, will serve patients 55 and older with mental health and substance use conditions. The $13 million project reflects the growing recognition that behavioral health in skilled nursing facilities is integral to overall senior care, not a separate or optional service.
Educating Staff and Reducing Stigma
Integrating behavioral health in skilled nursing facilities requires more than just infrastructure—it also requires education and culture change among staff. Many caregivers are well-equipped to handle physical conditions but feel uncertain when confronted with mental health or SUD issues. LaFleur explained: “We’re going to have to train our teams. Instead of throwing up their hands saying, ‘I can’t care for this individual,’ we have that opportunity to adjust the medications appropriately and help the staff understand how to deal with the situations just like any other medical condition. My whole goal is to de-stigmatize that whole aura around behavioral health.”
By providing training and ongoing support, SNFs can help staff feel confident in addressing behavioral health challenges. This approach not only improves outcomes for residents but also strengthens staff retention and job satisfaction, as caregivers are better prepared to handle complex cases.
Addressing Substance Use Disorders in SNFs
Behavioral health needs in SNFs extend beyond mental health to include substance use disorder treatment. Opioid use disorder, in particular, is becoming increasingly common among older adults, yet many SNFs are not equipped to manage these patients. Research shows that up to 81% of patients hospitalized for opioid-related issues are rejected from post-acute care.
Molly McGrath, author of a recent Health Affairs article, emphasized the importance of expanding access to methadone and other treatments for older adults in SNFs: “By addressing the issue of discrimination by expanding access to methadone at skilled nursing facilities, it would actually benefit a much larger population of adults that may have opioid use disorder.”
McGrath suggested several policy changes to improve access, including:
- Aligning Medicare reimbursement for opioid treatment providers under SNFs’ consolidated billing system
- Allowing addiction medicine physicians to prescribe and dose methadone outside of traditional opioid treatment programs
- Covering methadone for OUD through Medicare Part D
Additionally, operators like Boston Medical Center are piloting training programs to enhance post-acute care for patients with SUD, providing staff in SNFs with the tools and knowledge to deliver effective treatment.
Federal Support and Funding
Federal initiatives are also recognizing the urgent need for behavioral health in skilled nursing facilities. In May, the Department of Health and Human Services (HHS) announced a $15 million, three-year grant to support behavioral health care for residents in nursing and long-term care facilities. Administered through the Substance Abuse and Mental Health Services Administration (SAMHSA) and funded by the CMS Civil Money Penalty (CMP) fund, the program aims to provide prevention, treatment, crisis intervention, and pain management services.
CMS Administrator Chiquita Brooks-LaSure highlighted the importance of these efforts: “Making behavioral health care a priority in nursing homes and other long-term care facilities supports a person’s whole emotional and mental well-being, promotes person-centered behavioral health care, and advances our CMS Behavioral Health Strategy.” This federal support not only provides funding but also signals a broader commitment to integrating behavioral health into senior care at a national level.
The Path Forward
As the senior population continues to grow, addressing behavioral health in skilled nursing facilities is no longer optional—it is essential. Comprehensive mental health and SUD services, staff education, policy changes, and federal support can collectively create environments where seniors receive the care they need without leaving their long-term care communities.
Catholic Care Center’s initiative demonstrates that integrating behavioral health into SNFs is achievable and can set a standard for the industry. By prioritizing mental health alongside physical health, SNFs can improve outcomes, reduce unnecessary hospital visits, and enhance quality of life for some of the most vulnerable members of our population.
Behavioral health in long-term care is a complex challenge, but with targeted investments, thoughtful planning, and ongoing training, skilled nursing facilities can transform into environments that nurture the whole person—mind and body.
