Care model pilot for behaviorally complex long-term care residents sought; proponents cite ER and hospital savings

The North Dakota Long-Term Care Association asked the Human Services Policy and Appropriations Committee to fund a $3 million, two-year pilot to deliver behavioral-health training, on-site non-billable supports and clinical wraparound services to nursing homes and basic-care facilities treating residents with severe behavioral health needs.

Nikki Wagner, president of the association, introduced the proposal and said facilities face growing difficulty caring for residents who present severe agitation, aggression or self-harm risk. Wagner said staffing policies, regulatory risks (for example, restraints, psychotropic oversight and resident-safety citations) and limited access to inpatient psychiatric beds leave nursing homes unable to stabilize a subset of high-need residents.

Dr. Christy Kovacs, chief clinical officer of Behavioral Health Solutions, outlined a model deployed in other states. The proposed approach combines:

- Targeted staff training (de-escalation, trauma-informed practices, psychiatric and dementia care). - Creation of individualized behavior-support and crisis plans and training caregivers on those plans. - Deployment of paraprofessional supports and one-on-one psychosocial activities (behavioral health technicians, dementia-certified activity professionals) to reduce staff burden and provide therapeutic engagement. - Clinical wraparound billed where possible (Medicare Part B) including psychiatric assessment, medication management, psychotherapy, cognitive assessment and peer support; monthly gradual-dose-reduction reviews for psychotropic medications.

Dr. Kovacs said other states use different rate structures; Nevada—s behavioral-complex program offers supplemental daily payments that range roughly between $111 and $326 per resident day depending on intensity, she said. Behavioral Health Solutions presented Nevada results showing fewer ER visits for participants (a 72 percent reduction in ER visits for people on the Nevada program compared with controls cited by the vendor) and fewer out-of-state placements; the vendor also reported reductions in antipsychotic use where nonpharmacologic interventions were employed.

Wagner and Dr. Kovacs proposed a targeted pilot of about 50 residents for North Dakota, at an estimated $100 per resident per day under the requested $3 million biennial funding. They described a 90-day ramp-up to credential staff, onboard facilities and begin training and said the pilot would emphasize data collection to evaluate cost-savings and clinical outcomes before any statewide expansion.

Committee members asked about applicability to dementia patients, antipsychotic use and measurable cost savings. Dr. Kovacs said the model covers a broad diagnostic range (neurocognitive disorders such as Alzheimer—s with associated behaviors, primary psychiatric disorders, substance-use related behavioral psychiatric presentations) and that the clinical aim is to reduce severity and frequency of behaviors through staff training and individualized plans; she said some patients will still require medication but that measured reductions in psychotropic use may follow successful nonpharmacologic interventions.

Ending: Committee members expressed interest and asked for more data and implementation details; no appropriation or committee vote was recorded in the transcript excerpt.