Ari D. Kalechstein, President and CEO EMH

The past two and a half years have been extremely challenging for SNF healthcare teams, including those of us who provide mental health services.  We adapted to the pandemic using telehealth, paid careful attention to new CMS payment requirements, created new jobs to optimize remote mental health services, and generally sought to evolve during this most difficult time.  But the worst is not behind us.  We see significant challenges in the short- and medium term to continue to provide mental health care for patients in a SNF setting and for the general population.

Quality of care of patients begins with quality of life for clinicians and SNF management teams – it’s a basic premise to ensure a good future for us all. Here are four things I’m seeing as we enter 2023 which will affect our ability to support mental health care in SNF’s:


  • The pandemic is just one of many issues that has adversely affected the mental health of Americans. While the pandemic brought to the forefront just how much the American psyche was negatively affected, there are other landmark events that have changed the way we look at mental illness in the recent years – from the increase in homelessness, to the aftereffects of 9/11, to the current political polarization and difficulty for dialogue across party lines. The effects of these events are longstanding and serve as a signal of a greater undercurrent of mental health care issues that require attention.


  • There’s an increasing need for mental health services for older Americans. America is “going gray,” which means that there is an increasing need for more services for older adults. Health care providers will require additional resources to fulfill that need, and that includes insurers providing coverage for the treatment of older Americans.  It’s essential Medicare and Medicaid provide adequate reimbursement so clinicians can provide the services that people need.


  • More work, less clinicians, less reimbursement. Based on our experience and what we’ve read, we see two primary issues regarding to the implementation of mental health services. First, it’s difficult to recruit and hire mental health specialists. Second, the reimbursement from insurers has not kept pace with general changes in the economy. If one tracks reimbursement for mental health care over the past 10 years and adjust that to inflation, reimbursement has decreased.  From our perspective, and to sustain a healthy mental health sector, it is necessary to advocate for an increase in reimbursement aligned with current economic conditions.


  • Work-life balance is of critical importance for clinicians. Our aim as a company to create a business model that allows clinicians to feel good about the work that they do, know they are valued, and enjoy a good work-life balance. Clinicians today are concerned about remuneration and the autonomy to manage their schedules in conjunction with available support and guidance in their patient work.  Others are experiencing compassion fatigue. We need to ensure clinicians can manage that stress, have the flexibility to live their lives, and facilitate processes so they feel good about the great work they are doing at the end of each day.

While there is a clear need for change, there are bright signs on the horizon. We are openly discussing concerns about mental health. People can use telemedicine to obtain treatment and using digital tools to boost mental health. CMS has acknowledged remote care is integral to providing interventions for those in need. Workplaces are also beginning to foster and support a culture of mental health with resources and access to mental health services. And importantly, states are increasingly directing funding to mental health care support – such as California’s $518.5 million in grants to help provide services and housing options to those with severe mental illness or substance abuse problems.

For those reasons and many more, I am hopeful for our industry and for the continued growth and better mental health care in the U.S. And like the adage says “If you want to go fast, go alone. If you want to go far, go together.” For us, together is the only option.