Urgent behavioral health phone calls from skilled nursing and long‐term care facilities during COVID‐19 lockdown: Developing topics

Posar, Steven Laurence; Reid, Anita; Heiser, Daniel

BACKGROUND: Beginning the third week in March 2020 Skilled Nursing and Long‐Term Care Facilities (SNF‐LTC) in Indiana instituted protocols aimed at preventing the transmission of COVID‐19. These included exclusion of all visitors, room isolation and other measures. These measures were anticipated to have a deleterious effect on the mental health of SNF‐LTC residents. An Indiana neuro‐behavioral health practice (Vanguard Eldercare Medical Group), providing on‐site care at greater than 200 SNF‐LTC’s, measured the change in incoming urgent/emergent patient care phone requests during April as a potential proxy for a negative change in SNF‐LTC resident neuro‐psychiatric status. METHOD: Urgent/emergent incoming behavioral health phone requests were compiled from January 1, 2020 until May 17, 2020 on a weekly basis. Incoming calls during regular business hours (BH) (M‐F 7:00 AM to 5:00 PM) and after‐hours (AH) were measured from the medical group’s telephone monitoring system and EMR. These were analyzed using one‐tailed t‐tests to determine if the onset of the COVID‐19 pandemic (declared 3/11/2020) increased the number of incoming calls after accounting for the number of patients. RESULT: In Figure 1, the number of BH calls appears to increase in the end of March, while AH calls appear to decline. Table 1 shows the mean number of BH calls per week prior to 3/9/2020 increases from 41.44 to 69.03 (p=0.0014). After hours calls decreased from 17.33 to 9.8 (p=0.00056) and the number of patients served increased from 7618.33 to 7767.90 (p=0.0073). To adjust for the increasing patient population, we calculated the mean number of calls per week per 1000 residents. BH calls per 1000 patients increased from 5.44 to 8.67 (p=0.0018) and AH calls per 1000 patients decreased from 2.28 to 1.26 (p=0.00052). CONCLUSION: It was anticipated that increased stressors would negatively impact these residents’ mental health. The significant increase in behavioral health phone requests suggests confirmation of this hypothesis. The disparity between business hours and after‐hours phone calls may be due to heightened SNF‐LTC staff awareness and/or change in the nature/severity of behavioral health decompensation.