Supporting VA’s geriatric mental health care needs

Staff attrition at medical facilities, providers taking extended leave, and an expanding Veteran population all impact access to care.

Bedford VA in Massachusetts, with a 300-bed Community Living Center, Dementia Unit, and Geriatric Psychiatry Unit complex needed geriatric psychiatrists in the spring of 2021.

New England VA’s Clinical Resource Hub (CRH) stepped in to ensure geriatric psychiatric care continued without disruption or delay. The service has expanded to other sites in Massachusetts, New Hampshire, Maine, and Connecticut—with  plans for more to come.

Edith Emerson, working in the Memory Care Unit at the Togus Maine VA, meets regularly with the CRH remote geriatric psychiatric team. She notes that while having an in-house gero-psychiatrist was ideal, it is not currently realistic.

“In the absence of an on-site gero-psychiatrist, the ability to consult weekly with a virtual specialist who has access to the patient’s chart in real-time and can ask clarifying questions has improved patient care and allowed for closer monitoring of medication changes,” Emerson said. “Having access to a specialist who not only understands psychiatric medicine but the pharmacological goals of the elderly we care for has made a tremendous difference in our ability to keep our Veterans stabilized and safe in our memory care unit.”

CRH is a program deployed in 2018 to fill gaps at VA facilities when they occur, mobilizing telehealth technology through VA health care networks to connect Veterans with distant primary care, mental health and specialty care teams.

Dr. Burgos-Chapman, Dr. Marc Nespoli (geriatric psychiatrist), Dr. Gregory Ouellet (geriatrician), and Mary Molitor (registered nurse) form a small but mighty CRH team that supports local VISN 1 facilities in providing this essential, integrated care. They are hands-on, joining in staff meetings and building meaningful relationships with patients and the nurses and physicians they support.

Able to provide coverage where Veterans lack access

“Nationwide, there’s a shortage of geriatric services, in particular geriatric psychiatry. With our consultation service, what we’ve been helping to do is provide coverage to sites within the New England region where Veterans lack access to either geriatric psychiatry or geriatric medicine,” said Dr. Isis Burgos-Chapman, a CRH geriatric psychiatrist providing community living center and outpatient consultation services. “Our intent is to make it as easy as possible for both the providers who are placing the consult and for the Veterans who are receiving care. For many, it might be cumbersome to drive to a VA site or they might not be able to drive for a number of different reasons.

“Incredibly helpful and easier for Veterans and their caregivers.”

“Being able to do these evaluations into the Veteran’s home, the feedback we’ve gotten is that it’s so incredibly helpful, efficient, and makes it easier for Veterans and their caregivers,” she added.

Telehealth services, e-consults, inpatient care, and outpatient care support are just the beginning of what the CRH team can provide. Dr. Burgos-Chapman recognizes that even with these services, geographical challenges and language barriers must be addressed in delivering the soonest and best care to Veterans. And she looks forward to making that happen.

For more information on Clinical Resource Hubs, visit the CRH website.