Leaders at Norristown, Pa.-based Suburban Behavioral Health Campus of Roxborough Memorial Hospital are trying to fill a growing gap in behavioral health: inpatient care for older adults.
Older adult behavioral health patients often are 55 years or older and can have a range of mental health conditions, including depression, anxiety, bipolar disorder, schizophrenia, and neurocognitive disorders such as dementia. Patients are often referred to the system through nursing homes, memory care units and emergency departments.
“Patients typically require a primary mental health diagnosis, which often intersects with medical conditions,” Steve Wonsiewski, RN, director of the psychiatric services at Suburban Behavioral Health and Philadelphia-based Roxborough Memorial Hospital, told Becker’s. “For example, an individual who has experienced a stroke or heart attack may develop depression as a result of losing their independence. This overlap is quite common among seniors.”
Recently, Suburban Behavioral has moved to expand access to older adult behavioral health care after two hospitals in Delaware County, Pa., shut down their inpatient behavioral units for older adults.
Earlier this year, Suburban Community Hospital closed its acute medical services to become a standalone behavioral health facility with a dedicated 15-bed older adult unit. The decision was part of Prime Healthcare Foundation’s national strategy to expand behavioral health services.
Hospital leaders are now looking at opening an outpatient office in the facility to improve access to medication management and on-site therapy. They are also considering the use of transcranial magnetic stimulation to treat depression and post-traumatic stress disorder, as an alternative to electroconvulsive therapy.
“I’d love to see Suburban Behavioral Health Campus become a standalone psychiatric center by expanding our current 15 senior behavioral health beds, potentially adding adult and adolescent units,” Mr. Wonsiewski said. “This would position us as the central hub for mental health treatment in Montgomery County, representing a significant advancement for our community.”
But before the hospital can expand further, it is grappling with certain needs and challenges for older adult patients:
Note: responses have been lightly edited for length and clarity.
Question: What are some of the growing demands and services you’re working on meeting right now?
Steve Wonsiewski: There has been a notable increase in demand for behavioral health services due to the closure of several hospitals in our area. One significant change we are preparing for is the acceptance of involuntary commitments. Each state has its own mental health laws and regulations, and until this past spring, senior behavioral health units in Pennsylvania were able to admit patients signed in by family members with a medical power of attorney. However, since spring, we have had to pause these admissions, creating challenges, particularly for dementia patients. Many counties are hesitant to involuntarily commit individuals solely for dementia, leaving families unable to admit their loved ones to inpatient psychiatric facilities as they previously could under the medical power of attorney. This situation poses a significant obstacle, as many memory care units or nursing homes will not accept new residents without a recent inpatient psychiatric stay to clarify diagnoses and address behavioral concerns.
To address this, we’re working toward becoming a court-approved provider for multiple counties in the Philadelphia area. That would allow us to accept involuntary commitments at both our Roxborough and Suburban campuses, ensuring these patients receive the treatment they need.
Q: What are some of the differences in needs for older adults versus younger patients?
SW: One of the biggest differences is in discharge planning and placement. Many seniors are referred due to self-care deficits. For them, an inpatient stay often leads to a transition into assisted living or nursing home care.
There are also regulatory requirements. In Pennsylvania, for example, if it’s a patient’s first inpatient psychiatric admission, they need a letter confirming they’re safe to return to a nursing home level of care. That process can sometimes be challenging.
I speak with our social workers daily about patients who may have suicidal ideation or thoughts of self-harm. It’s difficult to place a new nursing home or assisted living resident when that patient has expressed those kinds of thoughts. Sometimes it means keeping a patient on the behavioral health unit for several extra days while we work with facilities — maintaining contact, having admissions directors visit, evaluate and speak with the patient.
Building mutual trust with both the patient and with referral sources is essential. Nursing homes need accurate, thorough information from us about the patients we refer, and we rely on the same from them when we admit patients. This transparency ensures better continuity of care and safer placements.
