Senior Living Providers See Opportunity to Expand Behavioral Health Services

Chelsea Senior Living is breaking the mold in assisted living by offering mental health services to residents in a dedicated area on its campus.

The program also provides one example of a rising industry trend, as other senior living providers — such as Bloomfield, New Jersey-based Juniper Communities and Pathway to Living, which is headquartered in Chicago — look for new ways to offer behavioral or mental health services to residents at a cost they can afford.

On the whole, the need for more mental and behavioral health services in the U.S. is great. In 2017, nearly 47,000 Americans committed suicide, another 70,000 died from drug overdoses and a whopping 17.3 million had at least one depressive episode, according to statistics cited in a May 16 Bloomberg Businessweek story. No doubt, some of those sufferers were older adults, who often struggle with loneliness, depression, anxiety and other conditions.


‘We saw a need’

For nearly two decades, Chelsea Senior Living has managed a program called Crossings at one of its senior living communities in East Brunswick, New Jersey. The program is unique in that it gives older adults a place to recoup after experiencing an acute psychiatric episode.

Crossings, which is paid for through a private-pay model, provides an extended recovery program that combines assisted living services with specialized care for people who are managing chronic mental illness, depression, anxiety or have complex medication management needs. The program is specifically designed to aid up to 25 older adults at a time who have recently suffered an acute psychiatric episode, according to Ann Sullivan, regional health services director with Chelsea Senior Living. The company currently operates 17 communities throughout New York, New Jersey and Pennsylvania, and is acquiring four more senior living communities in the Empire State later this year.


“It provides them a safe place to go in the transition period back to the larger community or back to assisted living,” Sullivan told Senior Housing News. “Referrals generally come from inpatient stay facilities … but we do get referrals from word of mouth, as well.”

Residents of Crossings have their own dedicated staffers, program schedule and dining venue, but can also mingle with the larger community’s residents if they feel comfortable enough to do so. They also can receive medication management services or general therapy from a social worker or visiting psychiatrist.

Crossings first began in the year 2000, and may be the only program of its kind at an assisted living community in the Northeast, according to Sullivan.

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“We saw a need for it based on the residents that were being admitted to assisted living,” Sullivan said. “They would go back into their communities, and within months or days they would be back in short-term psychiatric because they weren’t taking their medications or having structure.”

While Crossings is usually a temporary program for residents, there are a few who have stayed in the program for as long as a decade.

“If they do transition out, a lot of residents go home, but some are still there after 10 years,” Sullivan said. “Others will transition to assisted living based on their stability.”

Overall, the need for more mental and behavioral services in senior living is great, according to Dr. Rajeev Kumar, who works as chief medical officer for Symbria, a therapy, rehab and pharmacy services company that works with around 150 post-acute and long-term care providers across the U.S. Kumar is also a board member and secretary of AMDA – The Society for Post-Acute and Long-Term Care Medicine.

“Because of the high prevalence of cognitive and psychological illnesses among this population as the residents age in place, the senior living industry is constantly trying to catch up,” Kumar told SHN.

While most of Symbria’s clients care for residents living with behavioral or mental health conditions, there are not many that have programs which exclusively cater to those residents, Kumar said.

“This [Crossings] program definitely is unique,” Kumar said. “While there are similar models elsewhere in the senior living landscape, this is by no means a common theme.”

One of those models is offered at Pathway to Living, which has 32 communities spread across the Midwest. Pathway partners with local behavioral and mental health practices to provide those services to residents living with conditions like anxiety or depression, according to Jane Beatty, director of wellness for Pathway.

“We help residents with behavioral health services to adjust [to living at a Pathway community], develop coping mechanisms and develop a relationship with a behavioral health expert,” Beatty told SHN. “That may be a social worker, a counselor, a psychologist or a psychiatrist.”

Those services are paid through Medicare, and the clinicians are the ones doing the billing, not Pathway, Beatty added.

“I see Pathway continuing to engage behavioral health services for our residents for transitions and for new challenges that arise in their life,” she said. “It’s part of our normal way to look at a resident’s health and wellness.”

Lessening the burden

While the Crossings program helps fill a crucial service gap, it’s also offered solely on a private-pay basis and is generally more expensive than the larger community’s assisted living services, Sullivan said. On the whole, however, there may be ways that other providers can lessen the behavioral health burden for residents through federal or state health care benefits.

One such example is Juniper Village at the Spearly Center, a 135-bed skilled nursing facility run by Juniper Communities in Denver. The SNF serves residents with behavioral and mental health needs, and about half of the facility’s residents are older adults, according to Susan Pappas, the facility’s administrator.

“We’re almost like two facilties,” Pappas told SHN. “We have all the clinical complexity of a skilled nursing facility while, simultaneously, all of the residents that we serve also have behavioral or mental health conditions.”

The program’s behavioral health services are funded through the Colorado Department of Health Care Policy and Financing (HCPF). Outside of the Centennial State, providers and their residents may also be able to rely on assistance from the Centers for Medicare & Medicaid Services (CMS).

In particular, the federal agency last year added behavioral health as a billable code to its Chronic Care Management (CCM) program. The program is meant to improve health outcomes and drive down the cost of care for people living with multiple chronic conditions, including behavioral health conditions.

CMS also has the Psychiatric Collaborative Care Model (CoCM), which enhances primary care in two ways: care management support for people receiving behavioral health treatment and adding to the primary care team regular psychiatric interspecialty consultation.

The new payment codes could help enable better care management, which has a potential impact on community-based services, according to Juniper founder and CEO Lynne Katzmann. And, overall, they could help boost quality of life and length of stay for senior living residents, especially those who already live with non-acute mental health conditions, such as chronic depression.

Juniper is one of three senior living providers to launch The Perennial Consortium, which will offer Medicare Advantage plans tailored to the senior living population. Katzmann is heartened by the new payment options for behavioral health and sees it as a sign of things to come.

“It’s an acknowledgement that there’s a relationship between behavioral health and the incidence and exacerbation of chronic illness,” Katzmann told SHN. “And because of that, the government, on a fee-for-service basis and by logical extension Medicare Advantage, is now finding ways to pay for those services because the outcomes justify the payment.”

Senior living providers would do well to explore these and other benefits in looking for new ways to serve residents living with mental or behavioral conditions. There is also likely a significant financial upside for senior living providers who embrace care coordination and Medicare Advantage (MA).

Already, Juniper is exploring how it can use these payment codes to offer some of these services to more of its residents.

“Behavioral issues, ones that aren’t thought to be acute, are important,” Katzmann said. “This is a new understanding of an existing issue and we’re provided some new tools to work with it.”