Healthcare providers across Connecticut are trying to position themselves to meet the psychiatric needs of the state's aging population.
Since just last year, several hospitals have invested millions of dollars adding capacity to their geriatric psychiatry inpatient units, trying to address what experts say is a critical and growing need.
The latest development came this month, when Bristol Hospital opened its new $3.4 million, 15-bed inpatient behavioral-health unit for seniors.
Last fall, Manchester Memorial Hospital opened a geriatric psychiatry unit with up to 21 beds, part of a $1 million renovation.
In addition, Waterbury Hospital informed state regulators recently that it wants to make all of its 30 inpatient psychiatry beds available to adult and geriatric patients during periods of low demand for adolescent services.
More geriatric psychiatry patients are expected at Connecticut hospitals as people live longer and as awareness and acceptance of mental illness grows, said Dr. Ava Pannullo, chief medical officer and medical director at The Hospital at Hebrew Senior Care in West Hartford.
“We're all living longer and as we live longer, we change physiologically, medically and psychiatrically, cognitively,” said Pannullo, board-certified in internal medicine and geriatric medicine.
Psychiatric problems people coped with when they were middle-aged can be tougher to deal with in their 80s as cognitive abilities decline, she said.
Dementia is a complicating factor when combined with psychiatric issues like depression, schizophrenia, anxiety, bipolar or personality disorders that people might have had throughout their life, in addition to other medical conditions seniors face, Pannullo said.
Hebrew Senior Care says most of its behavioral-health patients have dementia.
Assessing the need
Psychiatric hospitalization is seen as a treatment of last resort for patients who need intensive care, and who perhaps did not receive effective treatment before becoming critically ill.
The Virginia-based Treatment Advocacy Center characterizes psychiatry hospitalization as “the equivalent of the cardiac ICU for heart patients.”
Dr. Genevieve Henry, a geriatric psychiatrist that Bristol Hospital hired to lead its new unit, said the number of older patients seeking psychiatric and other medical care continues to grow.
“We're kind of at the tip of the iceberg right now with the Baby Boomers, so we're just beginning to feel the tremors of what's to come,” Henry said.
Publicly available data doesn't indicate exactly how many geriatric psychiatry beds exist in Connecticut. But it does indicate that utilization is high — 87 percent of the 629 staffed adult psychiatry beds at acute-care hospitals were filled in 2015, according to a 2016 report by the state Department of Mental Health and Addiction Services (DMHAS).
In fiscal year 2015, more than 33,000 patients were discharged from Connecticut hospitals for inpatient mental disorder treatment, DMHAS data shows. Psychiatric units also exist at state-owned facilities and organizations such as Hebrew and Masonicare
Dr. Martin Cooper — a geriatric psychiatrist and medical director at Farmington's Connecticut Mental Health Specialists, which provides senior behavioral-health services at about 100 nursing homes and assisted-living facilities in Connecticut, and who is medical director in the behavioral health unit at Hebrew Senior Care — hasn't seen good historic data on Connecticut's geriatric psychiatry bed trends, but said he has first-hand experience of the growing demand.
“I just know that there are many times when we're full and we can't take people and they sit in emergency rooms,” Cooper said of Hebrew Senior Care's 22 behavioral health beds.
“The other bit of soft data I can tell you is that we're often getting patients from very far away, like Stamford or Groton, which usually means that we're the closest place to them that has a bed,” he added.
The Treatment Advocacy Center did a national study of state-owned adult psychiatry beds two years ago, finding that Connecticut had 615 in 2016, down from 741 in 2010. That equates to just over one-third of the beds medical experts recommend per capita, yet Connecticut's per-capita bed count was still considered the sixth most sufficient in the country.
Meanwhile, DMHAS data shows that state hospital beds for people 65-plus have been relatively constant since fiscal 2013, about 4.5 percent of total beds in the system.
Hospitals, however, charged the Medicare program nearly $310 million for mental disorder inpatient stays in fiscal year 2015, up 32 percent from 2011.
Psychiatrist shortage
Cooper said he is happy hospitals are investing in new facilities and beds for older patients with mental illness.
But hospitals need psychiatrists to staff new facilities, and there's a shortage — one that Cooper worries will create a serious imbalance as Connecticut's and the nation's population grays and additional geriatric psychiatrists retire.
“It's a crisis already, it's going to be a catastrophic crisis in another 10 years,” Cooper said.
Until reimbursements for geriatric psychiatry services improve, the situation is unlikely to get better, Cooper said.
“Am I optimistic that it's going to change? No, I'm not, especially with what seem to be the governmental priorities these days — it's not human services,” he said.
Correction: This print version of this story contained a comment from Bristol Hospital CEO Kurt Barwis stating that geriatric psychiatry was unprofitable for the hospital due to reimbursement rates. Barwis was referring to outpatient psychiatry practices, not inpatient. His comment has been removed from the online version of the story.