PALTC23 Conference Recordings SA16 Make Challenging Patients Easier: Integrate Behavioral and Medical Care

Make Challenging Patients Easier: Integrate Behavioral and Medical Care

Long-term care patients who express an unmet need in the form of “agitation”, “aggression” or simply “acting out” can be particularly challenging. These behaviors may be the result of medical issues, cognitive decline, neurologic damage, mental health challenges or any combination of these issues. Providers often hear “The patient needs medication or to go to the hospital”. This does not get to the root cause. Studies show a strong correlation between multiple chronic medical conditions and mental illness. Siloed approaches to care have led to increased cost, poor outcomes and cascading polypharmacy. We present an integrated, team-based approach to managing complex medical and behavioral patients led by the primary medical provider with the assistance of a behavioral health team. We'll present a framework for integration of care and examples of successful practices managing complex patients with schizophrenia, dementia with behaviors, and personality disorders.

Learning Objectives:

At the completion of this session, learners will be able to:

  • Establish how a patient’s mental and physical health influence each other.
  • Provide a framework to assess and identify a complex patient’s physical and behavioral health needs to reduce ‘unmanageable’ behavioral issues.
  • Explore best practices for management of behavioral disorders in complex medical care to improve outcomes (and make the situation easier to manage).

Jay Tillman, MD

Jay Tillman, MD, is currently the Optum Psychiatric Medical Director in Rhode Island and Connecticut. He has over twenty years of experience providing psychiatric care in a variety of settings including LTC and AL facilities, as well as a community-based general outpatient psychiatric practice. Currently, he is also the psychiatrist for a leading group home system based in Hartford, Connecticut.

Matthew Resinger, PMHNP, FNP

Matthew Resinger, PMHNP, FNP, is board certified as a psychiatric mental health nurse practitioner and family nurse practitioner. He is currently employed at Optum, as a senior clinical services manager within the senior community care division. He has spent 20 years working to improve the behavioral health care delivery in long term care facilities in Rhode Island and Connecticut. He has served as a volunteer guardian for the DHS guardianship program of Rhode Island division of elderly affairs.

Karl Dauphinais, MD, MSS, FACP, CMD

Karl Dauphinais, MD, MSS, FACP, CMD, has practiced in Long Term Acute Care, Short Term Rehab, Primary Care, Primary Care Sports Medicine and Long Term Care. Currently he is the CT and RI Medical Director for the Senior Community segment of Optum Home and Community. He is a community clinical instructor for the University of Connecticut School of Medicine and maintains a practice as a skilled nursing facility medical director and attending at a SNF in central CT.

Nancy Reed, MSW, LICSW

Nancy Reed, MSW, LICSW, is a member of the Behavioral Health Team that assesses and supports Optum members in Rhode Island long term care settings. She has extensive experience in geriatric care with specialty in dementia assessment, psychiatric case management and Utilization Review. She has dedicated her career to training/ teaching both staff and families, promoting non pharmacological strategies for behavior management and improved understanding of disease trajectory.

  • 1.5 CME
  • 1.5 CMD Clinical
  • 1.5 MOC

Release Date: 03/29/2023   |   Expiration: 03/01/2026

Credit Statements:

Accreditation: Post-Acute and Long-Term Care Medical Association is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. 

CME Designation: Post-Acute and Long-Term Care Medical Association designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

CMD Credit Hours: This CME activity has been pre-approved by the American Board of Post-Acute and Long-Term Care Medicine (ABPLM) for up to 1.5 clinical hours toward certification or recertification as a Certified Medical Director (CMD) in post-acute and long-term care medicine. Each physician should claim only those hours of credit actually spent on the activity.

The CMD Program is administered by the ABPLM. Each physician should claim only those credit hours that he/she actually spent in the activity. For further information, contact ABPLM at 410-992-3117 or at cmd@paltmed.org.

ABIM Maintenance of Certification (MOC): Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.5 Medical Knowledge MOC points and patient safety credit in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program.

Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

Financial Disclosure Statement:

The Association requires the disclosure of all speaker/faculty/planner’s relevant financial relationships; presence of off-label use of a device or medication; and discussion of any experimental, new or evolving topic prior to each accredited education activity.

If the learner perceives any bias toward a commercial product or service, advocation of unscientific approaches to diagnosis or therapy, or recommendation, treatment, or manners of practicing healthcare that are determined to have risks or dangers that outweigh the benefits or are known to be ineffective in the treatment of patients please report this to the Association's staff.

The following speaker(s) disclosed relevant financial relationship(s): 

  • Julie Gammack, MD, CMD (Planner & Speaker): Stockholder: Amarin
  • Kenya Rivas Velasquez, MD, CMD, FAAFP (Planner & Speaker): OptumRx: Stockholder
  • All other planners, speakers, and AMDA staff have no relationships with ineligible companies.

All relevant financial relationships have been identified and mitigated.

Components visible upon registration.