Home Care Clinicians Offered Models for Management of Depression

Prevalent condition is deemphasized by current Medicare requirements

At a conservative estimate, 13.5% of homebound elderly patients suffer from depression. This figure is considered conservative, because depression is often underdiagnosed and untreated, particularly among the elderly, according to an article published in Home Health Care Management & Practice.

Further, despite such evidence as the results of a recent meta-analysis, which found that depression is the highest risk factor for functional decline among community dwelling older adults, the Medicare Home Health Benefit does little to address this issue, asserts author William D. Cabin, PhD, of Richard Stockton College, Pomona, NJ.

Cabin recounts the “historic failure” of the Medicare Home Health Benefit to require screening, assessment, and treatment of depression and the “limited promise” of the new Outcome Assessment and Information Set instrument, OASIS-C (mandated January 2010 by the federal Centers for Medicare and Medicaid Services), which, although it does ask home care agencies if they screened for depression, does not require screening, follow-up, or use of a standardized screening instrument.

Medicare has not focused on depression among the homebound elderly, or indeed on any mental health condition to date, notes Cabin. “Instead, the Medicare Home Health Benefit has focused on short-term, intermittent physical health needs that require skilled nursing or physical therapy and can be treated and discharged,” he writes.

“The historic physical health emphasis of Medicare Home Health exists despite significant evidence of high prevalence and physical health consequences of depression among the elderly, particularly the homebound
elderly.”

In the article, Cabin explores available evidence-based practice options for home health agencies to expand their services to home care patients with depression, because “the lack of strong requirements and financial
and quality of care scoring incentives will leave the depression screening, monitoring, and treatment initiative largely to the voluntary action of agencies,” he says.

IMPACT: AN EVIDENCE-BASED MODEL OF DEPRESSION MANAGEMENT

One example of a depression management program developed through collaboration between primary care physicians and other providers is Improving Mood-Promoting Access to Collaborative Treatment (IMPACT), deemed by the author as having the greatest potential for home care providers to improve depression outcomes and overall patient quality of life, even with Medicare’s limited emphasis on depression.

As of mid-2007, IMPACT — which focuses specifically on primary care patients aged 60 years or older with major depression — had been the subject of five evaluation studies, was implemented at over 100 sites in the U.S., and was also being used in Canada, Australia, and the Netherlands.

In a 2005 randomized controlled trial of IMPACT intervention among 1801 depressed patients (mean age, 71 years; impairment in at least one activity of daily living, 30%) at 18 primary care clinics in five states, 44.6% of participants in the intervention group had substantial improvement in depressive symptoms over one year,
compared with 19.3% among the usual care group. The study, published in the Journal of the American Geriatrics Society, also found that among both groups, participants whose depression improved were significantly more likely to experience improvement in physical functioning.

IMPACT and IMPACT-modified depression management models meet the OASISC requirements, and would also facilitate plan of care follow-up, Cabin points out. These and other potential benefits “are improvements in patient care and patient and caregiver quality of life, which is the underlying mission of home care.”

Source: “Lifting the Home Care Veil from Depression: OASIS-C and Evidence-Based Practice,” Home Health Care Management &
Practice; April 2010; 22(3):171-177. Cabin WD; Richard Stockton College, Pomona, New Jersey.“Treatment of Depression  Improves Physical Functioning in Older Adults,” Journal of the American Geriatrics Society; March 2005; 53(3):367-373. Callahan

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