[year] Senior Mental Health Care Guidance: What You Should Know When Facing Insufficient Care Coverage


It can be a difficult decision to put a loved one in a nursing home. Some will resent not having the same level of independence as before, and families may worry about their loved one’s future. Also, there are plenty of stories of senior citizens who have been admitted into nursing homes, and shortly thereafter, their mental health begins to decline. Many factors contribute to the decline of mental health, but one major factor may be the lack of Medicare and Medicaid coverage for behavioral health-related concerns.

Medicare is split into two parts: Medicare part A, which covers long-term care, and Medicare part B, which covers outpatient visits to their physician. Medicare part A is free to anyone over 65, and Medicare part B is paid for by premiums.

What Medicare and Medicaid Cover for Mental Health

There is a huge limit on what Medicare covers as far as behavioral health claims are concerned. Any psychotherapy visit might have as much as a fifty percent co-payment. Also, coverage for prescription drugs is poor, and there is usually either very little or no coverage for home health care. Medicare also only covers sudden flare-ups and does not cover long-term care for a patient who is suffering from an extended psychiatric illness. Because of these limitations, seniors often have to pay large out-of-pocket expenses to get help for their mental health concerns.

Medicaid is even more complicated than Medicare. On the one hand, it helps people who do not make a lot of money. On the other hand, Medicaid coverage can be complicated because eligibility rules vary from state to state. Given that Medicaid is a program covered jointly by both federal and each state (with states shouldering approximately 50% of the costs), what ends up happening is that each state is given incredible power to cover costs at its discretion.

What this means is that each state can individually determine who is eligible for their services, and what they will or will not cover. Medicaid rates tend to cover considerably less than private insurance companies.

Confused Yet? You Aren’t Alone

Because of the confusing nature of Medicare and Medicaid, it is more than possible that many seniors and their families may not know what they are entitled to. Often they assume that they cannot afford medication or to see a doctor if they have concerns about their mental illness. As a result, the patient might ignore a mild flare-up of a mental illness. This, too, could be a contributing factor in the decline of mental health in seniors who have been admitted into a nursing home.

Apart from these issues, another concern might be a doctor’s reluctance to prescribe any additional medication to a loved one, particularly if the patient is already taking a number of them, or if coverage on their health plan is very limited. Medications are not the only answer, however. There is quite a lot that can be done to keep an elderly person’s mind sharp, even after being admitted to a nursing home.

What Options Do You Have?

Family members can become proactive in their loved one’s mental health care despite the limitations Medicare and Medicaid impose. Simply being there for someone who has recently been admitted can help keep him or her calm and secure in their new environment.

Another thing that might help is to keep them occupied and engaged. Sometimes simply talking with your loved one, playing games, listening to music, taking long walks together and anything that keeps them engaged is beneficial to their physical and mental well-being.

Those in charge of the care of seniors in a nursing home should additionally make sure that they are constantly coming up with solutions to keep them from being in pain. Some seniors with mental health disorders may act out if they are in pain if they do not know how else to express it. Encouraging them to exercise or prescribing pain medication can lessen the need for doctors to prescribe psychotropic medication. Being sensitive to each individual’s needs can do wonders for their health. From time to time, unfortunately, psychotropic drugs will need to be prescribed.

Doctors, nurses, and loved ones must work with the individual to assess what needs to be done to help them adjust to their new life in a nursing home. Continuing to visit, helping them stay engaged, and ensuring that they are comfortable are all techniques to keep their mental health as strong as it can be.

What To Read Next?

✅ Ideas for seniors in financial trouble

✅ Home improvement & remodeling for the retirement home

✅ Help for seniors with disabilities and special needs

✅ How can you be at peace with others?

✅ What to do when feeling bored and lonely?

✅ How to stay mentally and physically healthy for older adults?

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