RD801 - Dementia Services Workgroup Report – December 7, 2021

Executive Summary:

Virginia’s state mental health hospitals have been experiencing increasingly high bed census rates over the past several years. Efforts to curb high census rates – and improve safety for both patients and staff – have led to targeted efforts to divert individuals from unnecessary hospitalization in state facilities as well as quickly discharge those who are clinically ready to be discharged to appropriate community services. One large population with above-average lengths of stay is the population of individuals with dementia and other forms of cognitive impairment. Often, these patients have no underlying serious mental illness and yet may exhibit behavioral and psychological symptoms that result in a temporary detention order (TDO) and transfer to a state hospital. As a first step, temporary detention and inpatient hospitalization could be avoided through proactive prevention in individual’s home and community environments, whether that be with a family member, in an assisted living facility (ALF), or nursing facility. Absent intervention, behavioral and psychological symptoms may escalate and make inpatient care unavoidable. However, state mental health facilities struggle to provide the type of treatment that these individuals require, which includes non-pharmacological interventions as a first line of treatment. This results in individuals being admitted to state psychiatric facilities with limited step-down or treatment options after they are stabilized. More appropriate care options would include memory care support in the community, ALF, a nursing facility or other residential environment. This report provides additional background on this issue, including recommended services for individuals with dementia, and makes recommendations for the creation or expansion of specific services in Virginia to better serve this growing population.