Mental illness in nursing homes: Variations across states

Health Affairs

Volumn 28, Issue 3, 2009, Pages 689-700

  Grabowski, David C ^a   Aschbrenner, Kelly A ^d   Feng, Zhanlian ^b   Mor, Vincent ^c  

^a HARVARD MEDICAL SCHOOL   (United States)

^b BROWN UNIVERSITY   (United States)

^c BROWN UNIVERSITY   (United States)

^d NONE

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; HEALTH CARE POLICY; HEALTH CARE UTILIZATION; HOSPITAL ADMISSION; HUMAN; MENTAL DISEASE; MENTAL HEALTH; MENTAL HEALTH CARE; NURSING HOME;

ADOLESCENT; ADULT; AGE FACTORS; AGED; AGED, 80 AND OVER; COMMUNITY MENTAL HEALTH SERVICES; CROSS-SECTIONAL STUDIES; HEALTH SERVICES ACCESSIBILITY; HUMANS; LONG-TERM CARE; MENTAL DISORDERS; MIDDLE AGED; NURSING HOMES; PATIENT ADMISSION; UNITED STATES; UTILIZATION REVIEW; YOUNG ADULT;

EID: 66749127375     PISSN: 02782715     EISSN: 15445208     Source Type: Journal    
DOI: 10.1377/hlthaff.28.3.689     Document Type: Article

References (24)

1. C.A. Fullerton et al., "Trends in Mental Health Admissions to Nursing Homes: 1999-2005," Psychiatric Services (forthcoming).
2. B.S. Black, P.V. Rabins, and P.S. German, "Predictors of Nursing Home Placement among Elderly Public Housing Residents," Gerontologist 39, no. 5 (1999): 559-568. (Pubitemid 30117058)
3. K. Linkins et al., "Screening for Mental Illness in Nursing Facility Applicants: Understanding Federal Requirements," Pub. no. (SMA) 01-3543 (Rockville, Md.: Center for Mental Health Services, Substance Abuse and Mental Health Sendees Administration, 2001).
4. U.S. Department of Health and Human Services, Office of Inspector General, "Younger Nursing Facility Residents with Mental Illness: Preadmission Screening and Resident Review (PASRR) Implementation and Oversight" (Rockville, Md.: DHHS OIG, 2001).
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6. J.N. Morris et al., "Designing the National Resident Assessment Instrument for Nursing Homes," Gerontologist 30, no. 3 (1990): 293-307
7. Fullerton et al., "Trends in Mental Health Admissions."
8. The state estimates used in this study are available from the University of Texas Medical Branch Web site, http://psy.utmb.edu/estimation/USAest06-htm/- USindex/Wlxmhm2asq-3.htm (accessed 18 March 2009). For a description of the general methodology used to derive these estimates, see C.E. Holzer, D.J. Jackson, and D. Tweed, "Horizontal Synthetic Estimation: A Strategy for Estimating Small Area Health Related Characteristics," Evaluation and Program Planning 4, no. 1 (1981): 29-34. (Pubitemid 12216270)
9. In this context, "synthetic estimation" refers to the application of statistical models using national data on the risk factors for mental illness to derive state-level estimates of mental illness based on the presence of these risk factors within a state. Importantly, the Holzer definition of serious mental illness roughly parallels the definition used by SAMHSA. Specifically, the Holzer definition (termed MHM2) includes a minimum impairment score; a minimum number of disability days; and then a range of chronic conditions including bipolar I and II, mania, major depression with hierarchy, dysthymia hierarchy, generalized anxiety, hypomania, major depressive episode, panic disorder, post-traumatic stress disorder, agoraphobia with or without panic, social phobia, and specific phobia. Importantly, although schizophrenia is not specifically accounted for by this measure, a person with schizophrenia would typically be included under one of the other criteria. Also, we opted to use Holzer's estimates of serious mental illness, because his more narrow definition of severe and persistent mental illness (MHM1) excluded both generalized anxiety and major depressive episode, and his broader definitions (MHM3 and MHM4) included people with current (rather than only chronic) conditions.
10. DHHS OIG, "Younger Nursing Facility Residents with Mental Illness."
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16. P.D. Harvey, Schizophrenia in Late Life: Aging Effects on Symptoms and Course of Illness (Washington: American Psychological Association, 2004).
17. Linkins et al., "Screening for Mental Illness in Nursing Facility Applicants."
18. M. Kitchener et al., "Home and Community-Based Services: Introduction to Olmstead Lawsuits and Olmstead Plans" (San Francisco: University of California, San Francisco, National Center for Personal Assistance Services, 2008).
19. M. Kitchener et al., "Home and Community-Based Services: Introduction to Olmstead Lawsuits and Olmstead Plans2008).Ibid.
20. C.C. Colenda, S.J. Bartels, and G.L. Gottlieb, "The United States System of Care," in Principles and Practices of Geriatric Psychiatry, ed. J.R.M. Copeland, J.T. Abou-Saleh, and D.G. Blazer (New York: Wiley, 2002), 689-696.
21. B.G. Knight and B. Kaskie, "Models for Mental Health Service Delivery to Older Adults," in Emerging Issues in Mental Health and Aging, ed. M. Gatz (Washington: APA, 1995), 231-255.
22. SAMHSA, "Community Integration for Older Adults with Mental Illnesses: Overcoming Barriers and Seizing Opportunities," Pub. no. (SMA) 05-4018 (Rockville, Md.: SAMHSA, 2004).
23. V. Mor et al., "Inter-Rater Reliability of Nursing Home Quality Indicators in the US," BMC Heaitli Services Research 3, no. 1 (2003): 20.
24. Harvey, Schizophrenia in Late Life.