The Issue
The Centers for Medicare and Medicaid Services (CMS) requires nursing homes to screen patients for dementia, depression, and other psychosocial problems using a standardized instrument known as the Resident Assessment Instrument Minimum Data Set, or the MDS 3.0. But CMS provides little guidance on methods for conducting more in-depth assessments and creating plans of care. As a result, many nursing home residents receive suboptimal care for problems related to cognition, mood, and pain. The authors of this Commonwealth Fund–supported article convened a panel of experts from diverse disciplines and organizations to identify and evaluate resources available to nursing homes and make recommendations to improve psychosocial care.
What the Study Found
- The experts identified resources and care protocols for addressing seven domains of psychosocial care: delirium, cognition, psychosocial well-being, mood state, behavioral symptoms, pain, and ability to return to community. Among these, they emphasized the importance of prevention and treatment of delirium; assigning professionals to address mood states; and defining staff roles related to the assessment and treatment of pain.
- They noted that although all nursing home staff need additional training in psychosocial care—particularly on the topics of shared decision-making, skill-building, and cultural competence—nursing homes may benefit from having a professional point person to guide and oversee psychosocial care and ensure the inclusion of families and residents in psychosocial care assessment, planning, and implementation.
Conclusions
To meet patients’ psychosocial needs, nursing homes must provide staff with the necessary skills, clinical training, and tools to conduct more thorough assessments and develop and implement appropriate care plans.