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Long term and post-acute care (LT/PAC) providers screen residents for depression and other mental health illnesses on admission and periodically. The Minimum Data Set (MDS) in skilled nursing centers includes sections pertaining to cognition, mood, behavior, functional status, and more.

In addition to the MDS, centers conduct other assessments or evaluations over time performed by members of the interdisciplinary team, including the physician or nurse practitioner.

“These assessments are often based on standards or evidence pertaining to the focus of the assessment,” says Holly Harmon, senior director of clinical services at the American Health Care Association.

“Every member of the team and, most importantly, the patient/resident and/or family are key to engage in this process in an effort to identify a clear baseline, capture subtle changes over time, and intervene in a manner that is most effective and in alignment with the person’s goals or wishes,” Harmon says.

While a number of screening tools for depression are available, few are accessible in the public domain, says Barbara Peterson, PhD, clinical assistant professor at the University of Minnesota. These include:

• The Geriatric Depression Scale: One of the most widely accepted screening questionnaires. Self-administered. 30 items. A cut-off score of 11 or above on the full GDS indicates a probable depressive disorder.
• Short form of GDS: A shortened version of the GDS, about 15 items. It takes about 10 minutes to complete. The cut-off score set at 5.
• The Patient Health Questionnaire 9 (PHQ-9): Used for screening for depression in primary care as well as a means of measuring severity of symptoms. PHQ-9 scores of 5, 10, 15, and 20 represent mild, moderate, moderately severe, and severe depression, respectively.“These screening tools can be used in any setting; however, it depends on the client’s cognitive status and function,” says Peterson. “Consider: Is the client able to respond reliably?”