Coronavirus in Context: Home Care in the Setting of Mental Health Disease

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You're watching Coronavirus in Context. I'm Dr. John Whyte, chief medical officer at WebMD. Today, let's spend a few minutes talking about home care. There's been a lot of information in the news about what's happening in our nursing homes, in terms of what's happening in-- in terms of the availability of home care. So I've asked you two experts to join me. Tom Koutsoumpas is the president and CEO of Capital Caring Health, and Ken Duckworth. He's the chief medical officer of the National Alliance for Mental Illness. Gentlemen, thanks for joining me.

Thank you so much for the opportunity. Glad to be here.

I want to start off with a recent report that talked about over 40,000 deaths tied to nursing homes. What impact does that have on the national psyche, as-- as we think about care for the elderly?

Uh, what's happened in the nursing home setting during this period, uh, has been, um, uh, beyond tragic. Uh, what it has really done is underscored the importance of getting care in the home. And what we're seeing as a result of that is the interest in actually delivering care directly to the home, as opposed to in a facility. So there's a-- a tremendous interest and shift in thinking about the importance of that.

And we know from many studies-- you've been a leader in this-- that people prefer to be at home, their loved ones prefer them to be at home, but they often don't know what resources are available. So it's easy to say, well, let's try to-- to keep them at home, but then when it comes time to actually providing care, it hasn't always been available. But COVID has changed that, to some degree. Is that right?

TOM KOUTSOUMPAS: Without question. And-- and I think, you know, John, that's one of the most, uh, uh, uh, disheartening is-- issues we face, is the lack of information about the availability. So for instance, at Capital Caring Health, and at many of my, uh, colleague programs at the National Partnership for Hospice Innovation, we are doing primary care at home. So we actually go into the home with a team led by a primary care physician, but provide all the services that you need in the home setting. But getting the word out that that's available has been, uh, part of the challenge to-- to folks to understand it is available, and how it works.

Ken, I want to ask you about the impact of mental health disease, in terms of the ability to care for people at home. It's one thing taking care of people with cancer. It's another aspect in terms of taking care of people with dementia or depression and anxiety. How does that play into the ability to care for loved ones at home?

Mental health, uh, conditions are common. And, uh, doing care at home presents additional challenges for caregivers. It's well-established that caregivers report stress and are at higher risk for depression and anxiety as a result of their role. A well-deployed clinical team and caregiver support, creating a peer environment, can be really important to help people stay at home.

And Tom, I think it's really important to-- let's be practical for-- for viewers.

OK.

In terms of-- like, what are the services they can get? When you think about it, there's the medical services, right?

Yes.

And there's the support services. And you and I have talked about that folks often just aren't aware of what's--

Yes.

--available, and the scope. Can you help explain to viewers, you know, what might be available, recognizing that it could vary based in, you know, geography?

So there are very core services, which are, again, led by the clinical team, a physician, a nurse practitioner, a social worker, a psychosocial support, uh, as well. And then in addition to that-- so all of the clinical services are available in the home, uh, including, uh, testing, uh, blood draw. All the things that you would really need to be cared for at home are available without having to leave. Uh, in addition, we have what we call stay-at-home support services. And those services add additional elements of support to allow people to remain and age in place at home. And there's no reason that you can't be at home during this period of your life.

Ken, what guidance do you have for those folks that say I want to do it on my own, or I don't want people to know how my loved ones are do-- are doing?

Well, I think everybody's trying to balance safety, connection, and support. And I think this is just a variation on that conversation. So I would encourage you to talk to your clinical team, your primary care provider. Try to understand what the care needs are, what the potential risks are, how they could be mitigated, and what other supports you have in your own life.

So if you can get support through a psychotherapy Zoom visit, or you have a local NAMI chapter so you can talk about your loved one's bipolar disorder and not feel alone, for example, might make it easier for you to sustain yourself over time. But I think there are some situations where you may need to decide I can accept the risks of having a clinical team because my long-term well-being and that of my loved one will do so well over time.

Can I add one thing there, as well, that we've done, and we've really been aggressive to make sure that the use of telecare and telehealth is available. So all of our clinicians, all of our support services, uh, can be conveyed through the telecare program. So we use that regularly. And what it's done, it's really enhanced the ability to interact on a daily basis, but it's taken that element of concern around safety away. So we've doubled down with respect to communication. And I think that communication has really helped with the ability to provide those services without fear.

But some services are gonna have to be provided--

Absolutely.

--in the home. And so how are-- how are you dealing with that?

Well, we-- we, uh, use, you know, certainly all the protective, uh, uh, uh, initiatives that are ones suggested by the CDC and more. All of our staff use PPE. Uh, we are very careful about testing, and make sure that everyone is tested on a regular basis at home, as well, for the patient. And so when we, uh, go into the home, they're completely safe with respect to the use of protective, uh, equipment and covering. So we're very careful. We-- we're proud to say, uh, during this period, uh, no one has been, uh, has gotten COVID through that transmission. It's-- not at all. So it's a very safe approach that we're careful about.

And do you think these services, in terms of actually coming in the home, as opposed to telemedicine to help provide--

Yes.

--support, are those available all around the country, or is it tends to be in-- in pockets? And where could people go for more information?

Yes. So, uh, they really are becoming available around the country. And I work with a group of other not-for-profit community-based palliative care, advanced illness providers and hospice providers at the National Partnership for Hospice Innovation. And that group, uh, almost all of the members-- and there are 75 throughout the nation-- provide some support services, stay-at-home, palliative care at home, as well as primary care at home.

They're really becoming more and more available. And what we've done is, really, we're all working together to advance these opportunities so people can get this care at home wherever. The hospice benefit has always been at home. But now, these additional services for people with advanced illness are really becoming quite prevalent, which is really exciting.

Uh, John, I'd like to add that the American mental health field has never been accused of being rapid-acting, uh, but it did undergo its fastest pivot in American mental health history. Uh, virtually every clinician in America went to 100% virtual within two or three days of the national emergency. And what we found is that people like it.

Mhm.

Uh, and I think that we're looking forward to a world where, after the epidemic is over, people have been tossed into the deep end of the pool and have found that they like the water there, that, uh, it's more convenient, people don't have to drive, fight traffic, pay for parking. And so it may be an efficiency play that you can receive mental health care, but not, uh, be, uh, committing a half a day of your time, uh, to seeing a clinician or a psychiatrist, if that's something that you need.

Yeah. And COVID certainly has taught us the importance of home care, uh--

Yes.

--services. Let's shift a little to talk about-- you-- you mentioned, Tom, hospice and palliative care.

Yes.

Let's talk about grieving and--

Yes.

--the support that we give to families in terms of grief counseling.

You know, John, it's so important. And I'm-- I'm proud to say one of the, uh, core benefits of the-- of the hospice benefit, the Medicare benefit, and when we wrote that and I was participating in that in 1982, and really developing the first home-based care team approach that included psychosocial and spiritual as a component of the benefit, bereavement is required. So hospices provide bereavement to families for a year after, uh, uh, a loved one has deceased.

And you know, it's such a core part of our benefit. Uh, it's such a core part of what we do. But what we're finding right now, particularly during COVID-- and this is why I'm working so closely with Ken and NAMI, because we're seeing the impact of mental health support, and the need for that to really be incorporated for the caregiver, for the family so that, as we provide our care at home, we make sure that we include, uh, that mental health support as a component of it.

And I think that's the critical part as we move forward in providing home services, to make sure that not only are these core functions provided, but that we recognize the needs of the family, uh, the caregiver, and how do we help with the mental suppor-- health support. And we're working closely with NAMI to develop that partnership so that we can make sure those services are available.

What would you say is what's really preventing people from, you know, getting these services?

John, it's an excellent question. We have seen an increase in demand for mental health services. And that's result partly of improved attitudes towards acceptability of seeking mental health, although that's not true for everyone. We've also seen with Mental Health Parity, which was federal legislation, that health plans have been required to treat mental health and addiction coverage the same way they treat medical and surgical.

But I think the other challenge we face is that the supply of mental health practitioners has not grown to meet the demand. So we're gonna have to get creative in terms of how we find ways to deploy our mental health practitioners, because demand has increased substantially. So John, I think you're raising a great point. Half of Americans who have mental health challenges still don't get care. And that remains a core challenge for us all who are interested in mental health and public health. And I think that, as attitudes continue to improve, we're just gonna need more supply and more creative ways. Telehealth may be one such way that we can have more efficiency in the delivery of care.

Well, tell us where viewers can go for more information. As-- as we think about mental health illness, can-- where-- where should people go?

There's a couple things to think about. Uh, because America is a patchwork quilt of health coverage and mental health coverage, I encourage people to start with their health plan, their primary care provider, or, if you're fortunate enough to work with Tom's organization, contact them what the benefits are, what the co-pays are, what the network is.

If you don't have health insurance, or you have more general questions, the National Alliance on Mental Illness is the largest group of individuals who live with mental health conditions and the people who love them. And their number is 1-800-950-NAMI, N-A-M-I. And the help line is staffed with people frequently with lived experience, who are successfully living with mental health conditions. And they can be resources to help direct you.

JOHN WHYTE: From a-- a national perspective, recognizing that viewers are all over, what do you suggest they do, in terms of finding out more information, or where can they go?

Yes, thank you, John. There are a couple of ways. I think certainly, uh, in the Washington, DC, area for Capital Caring, we have our 800 number, which is 800-737-2508 and capitalcaring.org. But, uh, in-- in the nation, we also have a wonderful toll-free number, as well, for the National Partnership, NPHI, for Hospice Innovation. It's 844-438-6744. And through that number, we can connect you with providers throughout the nation that are providing these services. And it's a wonderful opportunity, uh, to, uh, uh, to identify, uh, support services in locations throughout the nation.

You've got a lot of stuff behind you, Tom. You got a crystal ball behind you somewhere? Take-- take out the crystal ball and tell us, what is home care going to look like a year from now?

Yes. I-- I'm-- I'm pleased to do that. I'm looking carefully in my crystal ball. I think it's gonna be robust. I think we're gonna see, uh, because of the COVID experience, in addition to the work that we're all doing to advance it, that we're gonna see it grow tremendously. I think people are gonna want to be cared for at home, they're going to want to understand what resources are available, including the, uh, mental health support, as well as the physical support. And I think, working together, uh, we're gonna really advance that. And, um, uh, it's really important, uh, to spread the word. Information, education, and working, uh, to spread that word is gonna be a critical part of what we're gonna do, as well. But it's gonna grow tremendously.

Well, gentlemen, thank you for joining me. And thank you for providing your insights and-- and guidance in terms of helping folks know where they can get, um, you know, services, uh, within the home, as well as to-- help for patients with mental illness.

Thank you so much, John, for the opportunity. Really, it's a great honor to be with you today.

Thank you, John. It was a pleasure, and we appreciate you taking up this important topic.

And thank you for watching Coronavirus in Context. I'm Dr. John Whyte.

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