This week I am talking to Sherie Friedrich, Chief Psychology Officer at MediTelecare a company delivering Telehealth behavioral services to skilled nursing and assisted living facilities.
An often overlooked component of post-discharge patient care is behavioral health, although 20% of people over the age of 55 have some form of mental health condition and this impacts readmission rates doubling for those with mental health issues. Historically we have failed to recognize the importance of adding psychological interventions rather than pharmacological interventions
We are social human beings and need community and social interactions but as we age society in general struggles to include older generations and this group has been underserved. As Sherie notes during her training society had mostly written off this group
“There is no life after 60″
Nothing, of course, could be further from the truth and amongst the many silver linings of the pandemic has been the spotlight focus on this area and the opportunity to deliver a higher more compassionate level of care to this population. During the pandemic, we even saw people “Dying from loneliness” something that should trouble everyone as we all face our own mortality and frailty of aging.
We discuss the challenges of resources and the struggle to attract more people into the profession for caring for the elderly from a physical standpoint as well as their mental health with solutions that need to address the recruitment and retention of people who have historically felt very undervalued in these roles. We discuss other countries and societies and what we can learn from them and the potential for technology to amplify our resources and expand the reach, especially to the under-served communities whose inequity was further amplified by the pandemic
Listen in to hear the key things we need to bring to bear to our elderly population that can capitalize on the opportunity to bring more individualized psychotherapy, cognitive care planning, and specialized care to our elder community in a more consistent and accessible format
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Raw Transcript
Nick van Terheyden
Hello and today I’m delighted to be joined by Sharif Friedrich and she is the chief psychology officer at medi telecare. sharee. Thanks for joining me today.
Sherie Friedrich
Thank you so much lovely to be here.
Nick van Terheyden
So, before we get into the details of the topic at hand and behavioral services, tell us a little bit about your background and how you got to this point in your career.
Sherie Friedrich
Well, I have always had an interest as a clinical psychologist in access and problems with access to behavioral health care. So actually started my career working with children and families, kids in foster care systems who were having trouble accessing health care, I’m in New York City. And from there I’ve kind of made my way I guess through the lifespan and now I am specialized at working with older adults who are in nursing settings and experiencing their own struggles with access to care.
Nick van Terheyden
Fantastic. So tell us a little bit about medi telecare, and what it is that you’re doing and the problem you’re trying to solve.
Sherie Friedrich
Well many telecare is a behavioral health organization that is focused on servicing the psychiatric and psychological needs of older adults aging in various systems like nursing homes and assisted living set settings. And really, we came out of movement to use technology to improve problems with access to care in those settings where typically there’s limitations and having behavioral health services for the residents, we service. Now patients who are also living in the community, as we realize that elders are really being excluded from a lot of the tech companies that are doing behavioral health. So we’re now seeing patients anywhere from you know, those who are living at home to those who need higher levels of care and are in various facility types. We have psychological and psychiatric services for those patients. And we use a care coordinated model which brings a facilitator into the facilities to really be able to engage the patient and the staff, but also delivered the provider right to the patient’s bedside.
Nick van Terheyden
So as I cast my mind back to clinical practice and my interactions, my sense of this is that historically, we didn’t really consider this as part of the set of services in that, you know, assisted living aged care. I don’t recall the being much of any kind of psychological support, is this a new addition? Or have we sort of started to recognize that failure?
Sherie Friedrich
I think that’s a really good point. I think it’s an evolution, I think that the behavioral health component of care historically has been a high focus on medication to manage various behaviors that people experience, whether it’s a patient with dementia, or somebody who’s profoundly depressed because they’ve lost their spouse and just given up their home. And thankfully, I think over the last decade, we have really recognized that there is more to emotional well being than treating people with medication. And while that has an important role to play, there are so many other first line approaches when somebody is struggling, and so that evolution has been folded into it non pharmacological interventions, a place for psychotherapy for older adults. You know, it used to be a joke when I was in graduate school, that sort of, there’s no life after you’re 60, because the early psychologist, sort of, you know, all of the developmental theorists, it was sort of after 16, nothing kind of happens in your life. And we know that that’s actually really not true. And as people age, they have these psychological challenges and existential crises that they’re facing that have a place and can really benefit from psychological intervention. So I think that that’s where we’re moving. And hopefully, this is something that becomes more accessible to more people. I think there are still only select groups of patients and facilities that that have full access to those services.
Nick van Terheyden
So it sounds like we’re starting or or we’ve over the course of the past, we’ve created more focus You know, we’ve moved away from here take this pill that solves the problem, which, you know, in many instances didn’t, let’s be clear, you know, our comprehension of what pharmacological interventions would help for these instances, I think are still at this point very limited was struggling with, you know, medications to actually treat many of the Mental Health behavioral health conditions. But in the past couple of years, we’ve seen what I would call an amplification, or at least a spotlight focused on many of these areas of challenges. Would you say that’s been true for this area with COVID? Or was this just an ongoing challenge? You know, that continued on it has COVID helped? Or has it made it worse? Where do you see that?
Sherie Friedrich
I think COVID has opened up an opportunity for addressing and understanding meaning making and people’s lives and the things and experiences that older adults go through. And as we started to see, our patients and our family members be more isolated from society, I think it really did shine a light on the psychological struggles that people were experiencing related to I remember early in the pandemic, reading an article about people dying from loneliness. And that, you know, there was really no explanation for some of these patients that were passing in facilities, other than loneliness and isolation and the profound effect that that has on people. So I think COVID gave us more of a language and ability to talk about and face these things. And I think it also showed the world what was happening in nursing homes, which are a place that many people avoid even family members, because they are, they’re painful places where you know, people are sometimes at the end of their life, or are isolated or struggling with dementia. And because that’s so profoundly sad, we’ve weighed looking at it, and COVID forced us to look at it. And so I think we’re now talking about these things in more nuanced ways than than we had then.
Nick van Terheyden
So I put that in the good news column. Let’s be frank. And you know, that’s a challenge. I say this every time when I talk about good news from COVID, because it was such a devastating impact on our world. But, you know, another silver lining was the spotlight, you know, the focus on this, and, you know, the recognition that there’s this whole activity that takes place in this after care, these assisted living facilities. That, you know, as you rightly point out, people avoid, I think, you know, I wouldn’t be wrong in saying that, nobody wants to end up there, they want to end up in their own home. That’s not always possible. We’ve got challenges in achieving that. And clearly, there’s a a failure or an opportunity, as you describe it to deliver better services there. How do we do that? Given the, you know, my understanding is we’ve got limited resources in this space?
Sherie Friedrich
Well, I think that that that’s the magic question is how do we do that? I mean, I think that there, it’s a systemic issue, it’s a societal issue it, you know, recognizing that we, we may all come to a point in time that we may need a higher level of care, and what would we want that to look like for ourselves and our families, and it involves a movement in the healthcare system. It involves policies and legislation, and funding. There are so many things that are involved in improving our patients experiences that are, you know, specific to providers, but also beyond what providers alone can do. So it requires a movement, and I think in appreciation of what the problems are, and a commitment to to really attacking those problems to see better outcomes. So I don’t I don’t think it I think it’s, it’s the long game.
Nick van Terheyden
So other good examples of this, I mean, other places that we can look at and say, Wow, that’s somewhere that they’re doing a good job of this kind of approach?
Sherie Friedrich
I think so. I think that certainly there are There are countries that have much more appreciation for aging communities and the care that people receive as the as they kind of advance through the care system. I look at, I have family in both Germany in the Ukraine, and, you know, my aunts and uncles would be in, you know, these little kind of tiny village homes that the cemetery was across the street, and they could walk for coffee next door, and they could visit children at the daycare next door, and it was more, there’s more community wrapped around their aging experience. And so it wasn’t one of loneliness and isolation. It was actually one of, you know, feeling valued as being an elder and feeling a part of the community system. And certainly, we’re lacking that here.
Nick van Terheyden
You know, it’s interesting, you bring that up. And, you know, I often think about Japan where, you know, there’s much more perception of respect of elders, you know, almost reverence to the point of, you know, they’re an integral part of the community an expectation. We don’t seem to do that, here in the West. And I would say, it’s not just a US problem, certainly, based on my international experiences, how are we going to sort of you talk about the long game, but let’s talk about some of the shorter term potentials. You know, we have what we have, you can’t just throw this out, that’s a realistic understanding of the world. How do we start to approach this so that we can turn this around in a way that, you know, as you rightly put it, what would we like this to look like?
Sherie Friedrich
Well, I think that we are, the good news is that I think technology is helping to support one of this. So just a small example. And another possible silver lining, coming off of hopefully, the pandemic is that technology has made services more accessible to aging adults. And I think that that’s a really important point where we are being able to bring quality care quality services to older adults through use of technology. And the other good news is that we find that older adults are highly adaptable. And so it’s really a myth, that time you know, that they won’t be able to engage with technology, it’s actually not true. And what we’ve found at our practice, that I know we’re not alone in seeing this is that older adults are adaptable, and will really meet the task and can benefit from different forms of engagement. I think that another important point is looking at healthcare workers that are minimally paid, and feel marginalized in that regard that are leaving the healthcare workforce in droves and having some immediate impact to be able to offer better pay better benefits, better work life balance, for those really essential health care workers, the people who are feeding our elders who are changing them who are socializing with them. Those people feel really marginalized and left out and they have such an important role. So I think that that’s something I would hope what we’re learning from this great resignation, as it’s been named, is that we really have to value these employers because they really bring a lot to the table. And if they’re gone, who’s going to do that work?
Nick van Terheyden
So for those of you just joining, I’m Dr. Nick the incrementalist today I’m talking to Sheree Friedrich, she is the chief psychology officer at medi telecare. We were just talking about, you know, the value of all of these people, you know, and you’re talking about those supporting infrastructure that Do you know, all of this incredibly valuable work? And, you know, it reminded me of, you know, all of the folks that we suddenly realized were essential to us, like, people in the supermarkets that were stocking shelves that I would I my own personal experience would suggest that I probably didn’t even notice I think we failed to take and pay attention, you know, folks that contribute. But I want to go back to something else that you talked about and you know, just amplify this that the idea that adults can’t change you know, we’re not able to is completely an utterly unfounded. And the data point that I have is around technology. They are the what certainly have been one of the fastest growing groups to adopt portable or, you know, technology that essentially surrounded us. And, you know, individuals sort of looked at and said, they’re not able to access the iPhone or the iPad, or, you know, these tablet devices. And it was small changes that made a difference to that, you know, using your finger can be difficult for some of them, actually, providing a little pen with those little soft rubber tips made a huge difference for my own mother, who was elderly, and it was more about, you know, just a functional thing. But she was a dab hand. And, you know, as you rightly point out, we’ve got a positive around this. So this is bringing technology, I guess, you know, some kind of telehealth that expands that, what what are the services that we need to bring to bear and the technology that’s going to start to make this difference?
Sherie Friedrich
What from a behavioral health standpoint, I think the services are really intensive individualized psychotherapy, of course, and having access to that on a very consistent basis, just like somebody like you, or if we went into an outpatient psychotherapist, we would, you know, we’d probably want to meet weekly or twice a week. And we would want consistency of provider and routine, that is just as important to a 70 year old woman in a nursing facility. So making sure that we have the providers, making sure that we have the technology to support that. We know technology breaks down the geographic barriers, so it’s much easier to bring the providers to the patient. I think things like cognitive care planning, which was really heavily emphasized and supported through the American Alzheimer’s Association as recognition that our older patients who develop cognitive problems are going to need more support, and more in depth specialized care planning, luckily, that has that has been advocated for and is now something supported by CMS. So we can give patients that really good care. And these additional services, things like group therapy, and nursing facilities where patients can really share and learn from one another can be very therapeutic and healing. And then really improving the ways that we measure outcomes and look at the work that we’re doing. Again, just like in any other healthcare setting, not just sort of subpar care, or good enough care, but really striving for excellence. For the patients that we’re servicing, those are the things that I really am pushing for at my organization, but would like to see on a more widespread basis. When we talk about behavioral health care for older adults.
Nick van Terheyden
I think, you know, some great concepts and ideas of, you know, small things that we can do. I underlying to all of this is just a, for me, one of the big challenges, and that’s resources. So technology can expand, but do we have the resources available, or the the professional capabilities and the individuals coming into this area to support this?
Sherie Friedrich
Well, that’s a struggle. So it’s something technology helps us to overcome. But I do worry about the future in terms of new people coming into the field to deliver these services, we know that there is a significant shortage of behavioral health specialists, and that is continuing to grow. And so have that that is so important. And it’s it’s a part of the conversation and part of the issue of quality education at affordable prices for people who want to go into this field and don’t want to come out with you know, half a million dollars in student loans. So this is just it’s another systemic issue that’s really important to address. So we have resources, but we need more resources, and that that’s very evident in what what we’re seeing just across the landscape, not just for this patient population. And then of course working with adults it is a specialized area of focus. So that just really narrows your population of you know, providers who can will and want to provide these types of services. So we definitely need more people who are interested in geriatrics, more people who are interested in, in geriatric behavioral health, that that is definitely a shortage in the field.
Nick van Terheyden
So we’re struggling with individuals coming in, we’ve got, you know, a failure to sort of, I guess attract, you know, it sounds like some of this is a financial issue. Clearly, we need some, you know, focus and attention on that. The other area that always strikes me around this, particularly, as soon as you mentioned technology as a supporting act, and whatever is that it raises the challenge of health equity. For those individuals that have historically been underserved, we shone another spotlight on it, and people go, how do we address that? I mean, the just the seems to be this failure in delivering an equitable, you know, we’ve got the solutions, we just they’re not evenly distributed.
Sherie Friedrich
That’s absolutely true. I think that one pathway, one opportunity is really looking at rural health care needs, because we know that in, in our rural communities, it is challenging for people to access these kinds of services, services and equity is, is largely woven into that problem with access. I think also making technology available to wider ranges of people who may not be able to afford technology or may not, you know, be able to easily access a telehealth visit. But that’s something that we really should be addressing. Because I think that it starts there, if somebody has the technology in that infrastructure, it becomes a lot easier to access care. I mean, certainly, we were aware of that through the pandemic, where I think probably 90% of my interactions with my primary care physician were through my smartphone. But for people that don’t have access to a smartphone, they don’t have the internet. You know, it’s really problematic. And many of the organizations that cater towards that patient population, like many mental health centers, are just under siege, they’re over, they’re understaffed, they have too many patients, sometimes to care for the lock, the weights are very long. And so it makes it very hard for those patients to be seen at all.
Nick van Terheyden
So where we’ve challenged our society with what is essentially subpar care for our elder population across many dimensions, you know, we’re challenged with a shortage of professionals, we’ve got some technology that can help address it, but it, you know, create some equitable challenges for people that are failing to access that care. Given all of that, and the fact that, you know, this is not just somebody else’s problem, this is all of our problem, because ultimately, we all age. What are you excited about? In? In the future? Where do you see this all going?
Sherie Friedrich
Well, what I’m really excited about is the idea that we are going to help people age in a more healthy and wellness centered manner. And so that work is being started. It’s happening. And while there’s room for improvement, I think getting started is the hardest part, and that there’s work to do, but the commitment is there and the recognition of the need is there. And like with many things, that’s where good work really begins.
Nick van Terheyden
Fantastic. Well, unfortunately, as we have, every week, we’ve run out of time, I think, you know, tremendous opportunity, as you rightly described. You know, we’ve underserved this population, there are models in other countries and other places where they do this and do it effectively. I think, you know, the, the threads that I draw out from this are the small changes the incremental steps that we can, you know, take to get there. That includes social interactions and the essential component of community but as you pointed out the opportunity of technology to amplify capabilities and attracting more people into this area that I think would be engendered. I mean, I imagine it being a very sad his fine area if you felt supported in terms of delivering this so, good news, bad news, but ultimately good news in terms of you know, the opportunity to deliver more and better care to our elderly population. Cherie. Thanks for joining me today.
Sherie Friedrich
Thank you so much for having me.
