Serious mental illness and nursing home quality of care.

OBJECTIVE To estimate the effect of a nursing home's share of residents with a serious mental illness (SMI) on the quality of care. DATA SOURCES Secondary nursing home level data over the period 2000 through 2008 obtained from the Minimum Data Set, OSCAR, and Medicare claims. STUDY DESIGN We employ an instrumental variables approach to address the potential endogeneity of the share of SMI residents in nursing homes in a model including nursing home and year fixed effects. PRINCIPAL FINDINGS An increase in the share of SMI nursing home residents positively affected the hospitalization rate among non-SMI residents and negatively affected staffing skill mix and level. We did not observe a statistically significant effect on inspection-based health deficiencies or the hospitalization rate for SMI residents. CONCLUSIONS Across the majority of indicators, a greater SMI share resulted in lower nursing home quality. Given the increased prevalence of nursing home residents with SMI, policy makers and providers will need to adjust practices in the context of this new patient population. Reforms may include more stringent preadmission screening, new regulations, reimbursement changes, and increased reporting and oversight.

[1]  J. Bowblis.  Staffing ratios and quality: an analysis of minimum direct care staffing requirements for nursing homes. , 2011, Health services research.

[2]  V. Mor,et al.  The Effect of State Policies on Nursing Home Resident Outcomes , 2011, Journal of the American Geriatrics Society.

[3]  V. Mor,et al.  Medicaid bed-hold policy and Medicare skilled nursing facility rehospitalizations. , 2010, Health services research.

[4]  K. Aschbrenner,et al.  Review: Quality of Mental Health Care for Nursing Home Residents: A Literature Review , 2010, Medical care research and review : MCRR.

[5]  V. Mor,et al.  Trends in mental health admissions to nursing homes, 1999-2005. , 2009, Psychiatric services.

[6]  V. Mor,et al.  Mental illness in nursing homes: variations across States. , 2009, Health affairs.

[7]  S. Åström,et al.  Factors associated with the prevalence of violent behaviour among residents living in nursing homes. , 2009, Journal of clinical nursing.

[8]  D. Grabowski,et al.  Nursing Home Quality as a Common Good , 2008, The Review of Economics and Statistics.

[9]  L. Shugarman,et al.  Nursing Home Selection: How Do Consumers Choose?: Volume I: Findings from Focus Groups of Consumers and Information Intermediaries , 2007 .

[10]  V. Mor,et al.  The effect of state medicaid case-mix payment on nursing home resident acuity. , 2006, Health services research.

[11]  K. E. Kilpatrick,et al.  Medicare Prospective Payment and Quality of Care for Long-Stay Nursing Facility Residents , 2006, Medical care.

[12]  M. Housman,et al.  Use of PASRR programs to assess serious mental illness and service access in nursing homes. , 2006, Psychiatric services.

[13]  S. Bartels.  Evidence-based geriatric psychiatry. , 2005, Psychiatric Clinics of North America.

[14]  R. Drake,et al.  Evidence-based geriatric psychiatry: an overview. , 2005, The Psychiatric clinics of North America.

[15]  H. Kales,et al.  Disruptive Behaviors in Veterans Affairs Nursing Home Residents: How Different Are Residents with Serious Mental Illness? , 2004, Journal of the American Geriatrics Society.

[16]  Susan C. Miller,et al.  Driven to tiers: socioeconomic and racial disparities in the quality of nursing home care. , 2004, The Milbank quarterly.

[17]  J. Zwanziger,et al.  Use of Resident-Origin Data to Define Nursing Home Market Boundaries , 2002, Inquiry : a journal of medical care organization, provision and financing.

[18]  Michael P. Accordino,et al.  Deinstitutionalization of Persons with Severe Mental Illness: Context and Consequences , 2001 .

[19]  C. Bishop,et al.  Where are the missing elders? The decline in nursing home use, 1985 and 1995. , 1999, Health affairs.

[20]  N. Ikegami,et al.  Low-care cases in long-term care settings: variation among nations. , 1997, Age and ageing.

[21]  C. Cowles.  Nursing home statistical yearbook , 1995 .

[22]  B. Fries.  Comparing case-mix systems for nursing home payment , 1990, Health care financing review.

[23]  Mal Schechter,et al.  Improving the Quality of Care in Nursing Homes , 1987 .

[24]  J. Kruzich.  The chronically mentally ill in nursing homes: issues in policy and practice. , 1986, Health & social work.

[25]  R. Bootzin,et al.  Nursing homes: the new total institution in mental-health policy. , 1984, International journal of partial hospitalization.

[26]  R. Scruton.  Mental illness. , 1981, Journal of medical ethics.

[27]  P. J. Carling.  Nursing homes and chronic mental patients: a second opinion. , 1981, Schizophrenia bulletin.

[28]  R. Kane,et al.  The mentally ill in nursing homes. New back wards in the community. , 1977, Archives of general psychiatry.