Managing Behavioral Health and Dementia Risks in Senior Care

Susan Lucot, MSN, RN, MLT (ASCP), CPHRM

The senior care and senior living fields face many challenges, especially in the aftermath of COVID-19. Issues include decreased quality in management and staffing, reduced adherence to resident selection and retention criteria, increases in state survey deficiency citations, and rising medical malpractice claims. A particularly alarming concern is the growing number of younger adults with behavioral health disorders (e.g., psychiatric conditions and substance use disorders) that are admitted to various types of senior care facilities.

Research illustrates the burden of behavioral health issues in the United States. In 2023, 58.7 million adults (22.8 percent of the population, or 2 in 9 adults) had a mental illness.¹ Serious mental illness (defined as a mental, behavioral, or emotional disorder interfering with one or more major life activities) affects 11.6 percent of adults ages 18–25, 7.6 percent of adults ages 26–49, and 3 percent of adults age 50 or older.²

Compounding this crisis is the number of behavioral health patients compared to the number of available inpatient psychiatric beds nationwide. Data show that only 10.8 psychiatric beds per 100,000 people are available — and forensic patients (those involved in the criminal justice system) occupy about half of those.³ As a result, behavioral health patients may turn to senior care facilities, where they will live with older residents who have a range of physical and cognitive conditions, including dementia. Data trends for the United States show that more than half of nursing home residents are living with dementia.⁴

Notably, behavioral disorders differ significantly from dementia and its various forms, but both can lead to aggression, psychosis, and violence. This creates serious safety and liability risks for senior care organizations. Some of the most pressing issues include:

• Co-mingling of residents who have behavioral health and cognitive disorders
• Lack of admission and discharge criteria and/or lack of adherence to criteria
• Inadequate staff in quantity, quality, experience, and training
• Lack of meaningful resident activities
• Environmental and infrastructure hazards
• Inadequate staff safety measures

To learn more about each of these issues, including recommendations for how to address them, click the links above. For more information about dementia care and behavioral health, see MedPro’s Risk Resources: Dementia Care in Senior Care Organizations and Risk Resources: Behavioral Health in Senior Care.

Endnotes

¹ USAFacts. (n.d.). How many people have mental illness in the United States? Retrieved from https://usafacts.org/answers/how-many-people-have-mental-illness-in-the-united-states/country/united-states/

² National Institute of Mental Health. (n.d.). Mental illness. Retrieved from https://www.nimh.nih.gov/health/statistics/mental-illness

³ Lovett, L. (2024, January 26). Psychiatric bed shortages reach crisis levels as occupancy rates skyrocket. Behavioral Health Business. Retrieved from https://bhbusiness.com/2024/01/26/psychiatric-bed-shortages-reach-crisis-levels-as-occupancy-rates-skyrocket/

⁴ Population Reference Bureau. (2021, October 21). Fact sheet: U.S. dementia trends. Retrieved from www.prb.org/resources/fact-sheet-u-s-dementia-trends/

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