Even as the “graying” of the American population continues to increase at unprecedented levels, fewer than 50 new geriatric psychiatrists graduate from domestic universities each year, says Michael Hasselberg, Ph.D., RN, PMHNP-BC, director of telepsychiatry and director, Project ECHO, University of Rochester Medical Center (URMC).
Hasselberg will present a session, “Leveraging Technology to Transform Behavioral Health Integration into Long-Term Care," at the Telemed Leadership Forum 2019, April 3-5 in Washington, DC.
Between 2012 and 2050, the United States will experience considerable growth in its older population, according to a May 2014 report issued by the U.S. Census Bureau. In 2050, the population aged 65 and over is projected to be 83.7 million, almost double its estimated population of 43.1 million in 2012. The baby boomers are largely responsible for this increase in the older population, as they began turning 65 in 2011. By 2050, the surviving baby boomers will be over the age of 85.
Closer to home for Hasselberg, the number of adults age 65 or older will almost double from 2.5 million in 2016 to 4 million by 2030 in New York state, and the number of elderly patients with mental illness is expected to rise from 495,000 to 772,000 by that time, according to the New York State Office of Mental Health.
Clearly, the number of skilled geriatric psychiatrists in the pipeline is in no way ready to meet the demand of an aging population in New York or, indeed, nationwide.
Further complicating the situation, treating depression, dementia and other mental health issues in the geriatric population, presents unique challenges for professionals in the field. “There’s a big difference treating a 30-year-old who might be about to go on his or her first medication for depression compared to an 80-year-old with 30 medications and 15 medical comorbidities,” Hasselberg says.
Telehealth is emerging as a big part of the solution, he reports. His organization has partnered with Project ECHO, or the Extension for Community Healthcare Outcomes, a telehealth distance-learning model that helps rural clinicians acquire new expertise and provide evidence-based healthcare to underserved patients by consulting with experts in major cities.
The ECHO model was created by grantee Sanjeev Arora, M.D., a professor of medicine at the University of New Mexico, where it was first used to improve care for rural patients with hepatitis C.
URMC’s ECHO program connects rural clinicians to URMC specialists via virtual clinics. These telehealth sessions have helped New York State primary care clinicians provide mental health treatment to elderly patients in rural areas. The initiative has reduced emergency department (ED) visits by 20 percent and cut costs by 24 percent since 2014, according to Hasselberg.
Unnecessary emergency room visits and services for geriatric patients represent “a big driver of expense,” he says. By using telehealth technology to bring expertise on site via video screen, nursing home staff are better trained not to default to emergency room treatment inappropriately. Sometimes, of course, an ED visit is required. However, in many instances, the patient is suffering from a general dementia issue that can be handled without ED involvement because newly trained onsite nursing home staff have been given the tools to better assess and address the situation.
“It is also helping nursing homes prepare for value-based reimbursement,” Hasselberg says. “There’s a lot of steam” driving the success of this model, he says, evidenced by the fact that he’s recently inked participating deals with another 30 nursing homes in the southern part of New York state including Manhattan.
Further, telehealth has shown success helping nursing homes raise their Centers for Medicare & Medicaid Services (CMS) quality measures which are measured with 1-5-star ratings. Nursing home facilities have financial incentives to increase their scores. CMS bases its rating on several factors, including citations during inspections, and types and quantities of medicines prescribed. “Understaffed nursing homes are notorious for over-medicating,” Hasselberg says. Another plus: Telehealth can help with gradual dose consultations to reduce dosages or take patients completely off medications when possible.
And if imitation is the highest form of flattery, Hasselberg could be excused for taking great pride in an overture from the Pacific Northwest. The state of Oregon recently brought him in as a consultant to begin to replicate the success of the URMC ECHO program. For Hasselberg and his team, the goal is clear, “We want it to be the gold standard delivering quality behavioral health services into long-term care settings.”