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GREATER HARTFORD HEALTH • Spring 2018 www.HartfordBusiness.com • March 26, 2018 • Hartford Business Journal 23 behavioral-health services at about 100 nursing homes and assisted-living facilities in Connecticut, and who is medical director in the behavioral health unit at Hebrew Senior Care — hasn't seen good historic data on Connecticut's geriatric psychiatry bed trends, but said he has first- hand experience of the growing demand. "I just know that there are many times when we're full and we can't take people and they sit in emergency rooms," Cooper said of Hebrew Senior Care's 22 behavioral health beds. "e other bit of so data I can tell you is that we're oen getting patients from very far away, like Stamford or Groton, which usually means that we're the closest place to them that has a bed," he added. e Treatment Advocacy Center did a national study of state-owned adult psychiatry beds two years ago, finding that Connecticut had 615 in 2016, down from 741 in 2010. at equates to just over one-third of the beds medical experts recommend per capita, yet Connecticut's per-capita bed count was still considered the sixth most sufficient in the country. Meanwhile, DMHAS data shows that state hospital beds for people 65-plus have been relatively constant since fiscal 2013, about 4.5 percent of total beds in the system. Hospitals, however, charged the Medicare program nearly $310 million for mental disorder inpatient stays in fiscal year 2015, up 32 percent from 2011. Psychiatrist shortage Cooper said he is happy hospitals are investing in new facilities and beds for older patients with mental illness. But hospitals need psychiatrists to staff new facilities, and there's a shortage — one that Cooper worries will create a serious imbalance as Connecticut's and the nation's population grays and additional geriatric psychiatrists retire. "It's a crisis already, it's going to be a catastrophic crisis in another 10 years," Cooper said. Bristol Hospital CEO Kurt Barwis concurs on the provider shortage, but said there's another major challenge, too. His new psychiatry unit wouldn't exist if the hospital didn't subsidize it. "e economics simply do not work," Barwis said. "[Psychiatrists] get paid exactly as a primary care provider, but if you think about their office visits, they are probably more than 30 minutes each." Primary care providers, which have also faced shortages, particularly in more rural areas, are typically among the lowest- paid doctors. "It's true here that it's not about the money," Barwis added. Until reimbursements for geriatric psychiatry services improve, the situation is unlikely to get better, Cooper said. "Am I optimistic that it's going to change? No, I'm not, especially with what seem to be the governmental priorities these days — it's not human services," he said. Geriatric Mental Healthcare Spending Source: DMHAS $0 $50,000 $100,000 $150,000 $200,000 $250,000 $300,000 $350,000 Medicare charge (in thousands) 2011 2012 2013 2014 2015 Fiscal Year The chart shows the amount of money Connecticut hospitals charged to Medicare, which generally insures people 65 and older, for providing mental-health services. Kurt Barwis, CEO, Bristol Hospital Dr. Martin Cooper, a geriatric psychiatrist and medical director at Connecticut Mental Health Systems in Farmington, says there are too few geriatric psychiatrists getting into the field. Strong handshake could indicate a healthy heart \\ By Mark Lieber, CNN A strong handshake could be an indication of a healthy heart, a new study suggests. Greater handgrip strength was associated with less cardiac hypertrophy and remodeling, which are indicators of long-term cardiovascular disease. e study's results could help identify those at higher risk for cardiovascular disease. "Remodeling/hypertrophy, which may be easier understood as a form of reshaping of the heart muscle, is a type of disease that can lead to a weaker heart and that mostly occurs in older individuals," said Dr. Sebastian Beyer, an internal medicine physician in Boston and lead author of the study. "e results of our study indicate that better muscular strength, as measured by handgrip strength, may be associated with fewer changes (reshaping) of the heart. Less reshaping of the heart is associated with fewer cardiovascular complications," Beyer added. e research, published recently in the journal PLoS ONE, compared handgrip strength with cardiac structure and function among 4,654 adults in the United Kingdom. Participants were men and women, aged 40 to 69, who were recruited between 2006 and 2010 in 22 centers across the country. e researchers measured handgrip strength using a machine called a hydraulic hand dynamometer. ey then analyzed the structure and function of participants' hearts using cardiovascular magnetic resonance or CMR, a rapidly developing technology that provides high-resolution images of the heart. e researchers looked at six indicators of cardiac function, such as the overall mass of the heart, as well as a number of measurements assessing le ventricular function, including stroke volume, ejection fraction, end-diastolic volume and end-systolic volume. e le ventricle is the portion of the heart that is primarily responsible for pumping blood throughout the body. Stroke volume refers to the volume of blood pumped per heartbeat, and end-diastolic volume is a measurement of the filling capacity of the le ventricle, according to Beyer. e research team found that each one standard deviation increase in handgrip strength was associated with an increase in stroke volume, an increase in end-diastolic volume and a decrease in le ventricular mass. H H

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