What is the Role of the Psychologist in Long-Term Care (LTC) Settings?

CHE Behavioral Health Services has been providing psychological services in skilled, rehabilitation, and other long-term care facilities for over 25 years. At CHE, we recognize that best practices in behavioral health in LTC settings requires a “systems-level” approach. To that end, CHE psychologists, clinical social workers, and other qualified mental health specialists work to support not only the resident, but those invested in the resident’s care and quality of life, including staff and family caregivers. By working as an essential and integral part of the interdisciplinary care team, the psychologist supports person-centered, individualized treatment recommendations that help maximize positive outcomes and improve the resident’s emotional and physical well-being.

CHE psychological services provided in the nursing home reflect a comprehensive behavioral health practice that include initial diagnostic assessments, individual psychotherapy, group psychotherapy, family/couples therapy, cognitive/neuropsychological assessments, participation in interdisciplinary care plan meetings, and staff training.

Why are Residents Referred to the Psychologist?

Most residents admitted to LTC or rehabilitation setting experience difficult emotional and/or behavioral symptoms at some point during their admission. If we take a minute to put ourselves in the shoes of a persons admitted to a LTC or rehabilitation facility, we quickly appreciate the emotional challenges they face. Common reasons for referrals include:

  • Recent traumatic medical events (e.g. falls, fractures, serious illness) that impact independent functioning and increase health related anxieties
  • Chronic pain or difficulty coping with chronic illnesses that impact emotional and physical well-being
  • Difficult emotions related to a change in living environment, family support, routines, or other significant changes
  • Persons struggling with significant losses and complicated grief reactions or feeling overwhelmed by a life stressor or difficult situation
  • Persons with a pre-existing history of clinically significant depression, anxiety, trauma, or other mental health conditions, which may me exacerbated by recent and ongoing medical and psychosocial stressors.

When the resident, family, or staff caregiver identify clinically significant indicators of emotional distress, the patient’s physician will often make a referral to the CHE psychologist for a more comprehensive assessment and follow-up treatment if indicated.

What are Signs of Emotional Distress?

While some people verbalize feeling depressed or anxious, others report different symptoms when experiencing emotional distress. These include feeling more irritable, chronic fatigue, emotional exhaustion, worsening experience of body aches and pains or other physical symptoms, and difficulty sleeping and eating. Further, residents in older cohorts or members of different ethnic and cultural groups may not use words like “depression” or “anxiety,” Rather you may here statements such as: “I am in poor spirits,” or “I do not feel like myself,” “or my nerves are acting up.”

Common indicators of emotional distress include:

  • Resident verbalizing feelings of depression, sadness, anxiety, or fear
  • Feelings of hopelessness, helplessness, or worthlessness
  • Decreased activity engagement and social isolation/withdrawal
  • Increased tearfulness
  • Increased anger, irritability, feeling easily frustrated
  • Noncompliance with treatment recommendations, such as physical and occupational therapy
  • Noncompliance with ADL care, such as showers and grooming efforts
  • Change in appetite and weight loss/gain
  • Sleep disturbance (insomnia or sleeping too much)
  • Increased attention seeking behaviors
  • Preoccupation with death and dying or statements that life is not worth living

What is Psychotherapy?

A primary role of the psychologist in a LTC or rehabilitation facility is providing individual psychotherapy to residents with emotional distress. The medical necessity for psychotherapy treatment is determined by a comprehensive initial assessment. Psychotherapy is often referred to as “talk therapy” because the resident and therapist will engage in dialogue about the resident’s worries, fears, and stressors. Psychotherapy most often occurs in weekly sessions, but the frequency depends on the unique needs of each resident. Some residents only need to meet with the psychologist for a few sessions to work on a specific goal, e.g. less severe grief symptoms, while other residents work with the therapist in longer-term treatment to address more chronic and severe symptoms.

In psychotherapy treatment sessions, the resident and therapist will collaboratively work to identify ways to either fix specific problems or learn strategies to better cope with stressors so as to improve emotional and physical well-being. It can be difficult to accept the things one cannot change and shift focus to the things that can be changed. Together, the therapist and resident will identify and focus on what the resident can control to most successfully improve self-efficacy beliefs, self-esteem, mood management, and quality of life.

The psychologist also provides a safe place to discuss sensitive topics and feelings the resident may not feel comfortable discussing with others. The psychologist validates the resident’s experience, while at the same time identifying and developing the resident’s strengths and helping focus energy on effective coping strategies to support emotional healing.

Types of Psychotherapy:

There are many different psychotherapy treatment modalities and interventions. Psychologists in LTC and rehabilitation settings often use an integrative approach and tailor interventions to each individual patient’s needs and identified therapy goals. Common treatment modalities include cognitive behavioral therapy, interpersonal therapy, acceptance and commitment therapy, supportive therapy, coping skills building, mindfulness and relaxation training, and life review/reminiscence, to name a few.

In Addition to Individual Psychotherapy, What Services Can the Psychologist Provide?

Comprehensive psychology services include:

  • Psychiatric Diagnostic Assessments
  • Individual Psychotherapy
  • Group Therapy
  • Family/Couples Therapy
  • Cognitive/Neuropsychological Assessment
  • Nonpharmacological Behavioral Management
  • Patient and Family Education
  • Interdisciplinary Team Meetings and Care Planning
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