Mental Health

States vary greatly in nursing home admissions for people with mental illnesses

State variation in services for people with mental illnesses and how they are admitted to nursing homes may result in longer-than-average stays for those individuals, a new study finds. Vincent Mor, Ph.D., of Brown University, and colleagues analyzed 2005 data from the Centers for Medicare & Medicaid Services. They found that States varied widely in nursing home admission rates for people suffering from mental illness. For example, nursing homes in Wyoming, Nevada, Arkansas, and South Dakota had the lowest rates for admitting individuals with schizophrenia and bipolar disorder, while Connecticut, Ohio, and Massachusetts had the highest rates. What's more, in 2004 nearly 46 percent of people with mental illnesses admitted to nursing homes in the United States remained in the facility 90 days after admission compared with 24 percent of people who did not have a mental illness.

The authors suggest that the way Medicaid pays nursing homes may be one reason for State variations in admissions for people with mental illnesses. For instance, Medicaid pays nursing homes higher rates for people with mental illnesses who have minimal physical problems. Thus, these higher rates may give nursing homes an incentive to admit these patients. Further, some States may bypass the Federal policy requiring State mental health authorities to assess people for mental illnesses before admission to a nursing home. They do this by allowing people with mental illnesses to be admitted from a hospital for a 30-day nursing home stay under an attending physician's orders. Finally, variation could also be a result of some States being able to offer home and community-based services or State psychiatric hospitals in lieu of nursing home care.

The authors assert that people with mental illnesses must navigate disparate care systems for medical care, mental health care, and aging services. They suggest the lack of a safety net for these patients may explain why so many of them become long-term nursing home residents. This study was funded in part by the Agency for Healthcare Research and Quality (T32 HS00011).

See "Mental illness in nursing homes: Variations across States," by David C. Grabowski, Ph.D., Kelly A. Aschbrenner, Ph.D., Zhanlian Feng, Ph.D., and Dr. Mor in the May/June 2009 Health Affairs 28(3), pp. 689-700.

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