As the population of older adults continues to grow, so too does the complexity of their health care needs—particularly when it comes to mental health. According to the Federal Interagency Forum on Aging-Related Statistic, Americans are living longer, thereby creating increasing demands on long term care facilities, with those individuals 85+ years being the highest consumers of care facilities.
A particular concern with aging is dementia or other cognitive changes. The incidence of dementia increases with age, with an estimated 5 percent prevalence of dementia among individuals between the age of 71 and 79, and over 37 percent for those 90 and over living in the community. However, in long term care settings, studies suggest that almost two-thirds of nursing home residents exhibit cognitive impairment, and as many as 70 percent of assisted living residents have been diagnosed with dementia.
People who are experiencing cognitive changes may also experience depression, anxiety, irritability/short temper, occasional aggression, and a lack of interest in previously pleasurable activities, and are thus appropriate for treatment by mental health professionals.
But it is not only neurocognitive/memory impairment that is addressed by mental health professionals. Between 25 percent and 50 percent of assisted living facility residents have been diagnosed with some psychiatric condition. In the skilled nursing home population, as many as 25 percent meet diagnostic criteria for Major Depression Disorder and as many as 82 percent report some type of depressive symptoms. Anxiety disorders are also prevalent, with close to 6 percent of nursing home residents being diagnosed with anxiety disorders.
When mental health services are intentionally integrated into facility treatment programs and aligned with medical care providers, the result can be transformative. Residents thrive, staff feel more supported and attended to, and facilities are much better positioned to meet regulatory requirements and family expectations for whole-person care. Residents who receive mental health support report improved mood, better sleep, stronger social connections, and have greater participation in facility activities. These improvements translate to a more vibrant, engaged, and fulfilled resident population and community.
Mental health providers play an increasingly vital role in the overall quality of care within long term care facilities, addressing not just the mental health of residents but also supporting staff, families, and facility systems. Their contributions span multiple domains including psychotherapy, behavioral interventions, staff training, and program development, helping to build a more collaborative and holistic care model.
Psychotherapy and Counseling
Older adults in long term care settings frequently experience mental health challenges such as depression, anxiety, grief, and adjustment disorders. Mental health professionals provide individual therapy tailored to the cognitive and emotional capacities of residents. These interventions help residents cope with the psychological toll of chronic illness, loss of independence, social isolation, and transitions in living situations. Evidence-based modalities such as Cognitive Behavioral Therapy (CBT), reminiscence therapy, and supportive counseling are adapted to fit the unique needs of older adults. These services not only improve the quality of life but can also reduce the need for psychotropic medications.
Behavioral Interventions
Behavioral disturbances such as aggression, agitation, wandering, or resistance to care are common in residents with dementia and other neurocognitive disorders. Mental health professionals are trained in identifying the underlying causes of these behaviors—often unmet needs, discomfort, or communication barriers—and in developing nonpharmacological intervention plans. These behavioral care plans are typically customized and multidisciplinary, involving nursing, direct care staff, and often families. Through ongoing monitoring and staff coaching, psychologists help reduce distressing behaviors, improve staff-resident interactions, and decrease reliance on antipsychotic medications by utilizing non-pharmacological alternatives like behavioral redirection, environmental modifications, reminiscence therapy, or caregiver/family coaching. Facilities that are able to proactively address mental health needs have seen reduced emergency room transfers or hospitalizations due to better behavior and mood management strategies already in place.
Support During Physical Rehabilitation
Rehabilitation following injury, surgery, or illness can be physically demanding and emotionally taxing, especially for older adults managing multiple comorbidities. Psychologists provide emotional support to residents undergoing physical or occupational therapy, addressing fear, discouragement, and noncompliance. By enhancing a resident’s mental resilience and sense of agency, psychologists can boost engagement in rehab, improve functional outcomes, and foster a more hopeful recovery process. Especially with rehabilitation residents, mental health providers will collaborate with primary care physicians, nurse practitioners, physician assistants, and physical rehabilitation staff to form an integrated health team.
This type of holistic approach ensures that psychological symptoms are not separated from physical health concerns. For example, a resident who is not eating and who presents with exaggerated somatic complaints that prevents them from engaging with needed rehabilitation therapy, should be referred for a mental health evaluation and treatment rather than solely treating the symptoms with primary care medical interventions. This type of collaborative care model, where primary care and mental health work side-by-side, has been shown to reduce symptom burden, enhance treatment adherence, and improve overall health outcomes. Indeed, this model of whole-person care is the goal of all patient care.
Staff Training and Support
The psychological well-being of staff is a key factor in maintaining a compassionate and competent care environment. Unfortunately, direct staff often face the heavy emotional toll of managing challenging behaviors without adequate training or support. By integrating mental health professionals into the care team, crucial backup is provided for staff and caregivers. These professionals can offer staff consultation, professional training, or in-services to explore topics such as de-escalation techniques for managing agitation or trauma-informed care and can offer improved education and understanding of mental health conditions, diagnoses, and basic care.
In addition, mental health providers can engage staff and provide emotional support, particularly during mental health crises. Training sessions led by clinicians can build staff confidence and competence in caring for residents with mental health needs, thereby fostering a more compassionate and resilient workforce. Importantly, this type of staff support will also help reduce burnout and can improve the retention of much-needed employees. In some facilities, psychologists offer formal support groups or confidential debriefing sessions.
Case Intervention and Complex Care Planning
Psychologists frequently participate in interdisciplinary case reviews where behavioral, emotional, or ethical challenges arise. They offer expertise in assessing capacity, evaluating risk (such as suicidality), and helping guide patient-centered care planning. Their involvement can be especially important in situations involving refusal of care, family conflict, or concerns about resident safety, and this specialized insight will contribute to comprehensive person-centered solutions.
Health Decline and End of Life Decisions
Psychologists help residents and families navigate the psychological complexities of chronic illness, functional decline, and terminal diagnoses. They provide grief counseling, existential support, and guidance around advanced directives and palliative care or hospice care decision-making. This support often extends to family members and staff, helping everyone involved manage anticipatory grief and emotional distress. Psychologists can also facilitate discussions about goals of care and ethical decision-making during end-of-life transitions.
Program Development and Advocacy for Collaborative Care
Beyond direct clinical services, psychologists contribute to the development of systemic programs that promote mental health and behavioral health. This can be things such as implementing depression screening protocols, behavior tracking systems, or wellness initiatives. They are also strong advocates for a collaborative care model, emphasizing the integration of psychological services with medical, nursing, social work, and rehabilitative care. By working closely with physicians and other healthcare providers, psychologists help ensure that mental health is treated as an essential component of overall wellness in the long term care setting.
In summary, as long term living evolves to meet the needs of an aging and more medically complex population, whole-person care must include mental and emotional wellness. When mental health professionals collaborate effectively with medical providers, facilities can offer safer, more compassionate care, reduce costly disruptions, and enhance resident and staff satisfaction.
Facility owners and administrators should assess their current approach to mental health and ensure strategic partnership with mental health providers to fully integrate wellness and holistic care. To find the right mental health provider, administrators must seek clinicians or clinical groups that offer experience working in assisted living or long term care environments. This will include licensure, credentialing, and billing capabilities for Medicare, Medicaid, and other insurance companies. Clinicians must also have a keen understanding of HIPAA, elder rights, and regulatory compliance requirements. And just as importantly, clinicians must be willing to participate in interdisciplinary collaboration and education and fully integrate into the treatment community of long term care.
Michael Penland, Ph.D., is a LifeSource clinical psychologist with extensive experience in long term care settings with a focus on the mental health care of older adults. He is also a contributing author in the new book, LifeSource: A Caregiver’s Guide for Managing Mental Wellness for the Older Adult.