Diverting Older Adults with Mental Illnesses From Unnecessary Skilled Nursing Facility Placement: Successful Care Transitions on Hospital Behavioral Health Units

Start time
10:00 AM (Pacific)
End time
11:00 AM (Pacific)

Presented by ASA’s Mental Health and Aging Network (MHAN)

ASA Members: Register now for FREE

Not a Member? Join ASA or Register for this event for $49

Includes complimentary CEUs

This web seminar is based on the 2017 Aging in America Conference (AIA) workshop “Preventing Unnecessary Placement of Mentally Ill Older Adults in Skilled Nursing Facilities.”

Behavioral health is emerging as one of the primary target areas for healthcare reform. Hospital systems and community-based organizations engaged in transitional care initiatives are challenged with how to effectively coordinate care, provide quality services, and engage the client and their caregiver in a person-centered way. The Bridge Model’s person-centered, social work–led approach to transitional care, which traditionally was designed for older adults, has shown promising results when adapted for implementation at a local Chicago hospital’s Behavioral Health Unit.

Individuals who suffer from a mental illness are disproportionally sent to skilled nursing facilities post-discharge from a hospital, and tend to stay longer. One goal of this program was to deflect patients from unnecessary skilled nursing facility placements and provide them the support they need in the community. In this presentation, you will learn about program adaptations that were made to better suit this population, including the program’s successes and challenges.

Participants in this web seminar will be able to:

  • Understand the national policy context regarding behavioral health;
  • Understand an evidence-based model of transitional care working with older adults with behavioral health needs;
  • Demonstrate the importance of person-centered transitional care programs; and,
  • Identify metrics to demonstrate successful intervention implementation.


Renae Alvarez, MPH, is a policy analyst for the Center of Long-Term Care Reform at Health & Medicine Policy Research Group.





Amy Crawford, MSW, is the manager of Transitional Care at Aging Care Connections, a nonprofit, community-based service provider that serves as the point of entry for aging services within five townships of Cook County, Ill.




Jessica Grabowski, AM, LCSW, is the director of Social Services at Aging Care Connections.





Shabbir Zarif, MD, is assistant professor of Clinical Psychiatry at Loyola University Medical Center, has practiced and taught community based psychiatry for more than 20 years in the Chicagoland area, and worked with adult and geriatric patients in hospitals, clinics and homes.