Associations between psychiatric inpatient bed Sand the prevalence of serious mental illness in veterans affairs nursing homes

N.W. Bowersox, B.J. Szymanski and J.F. McCarthy

American Journal of Public Health, 2013, vol. 103, issue 7, 1325-1331

Abstract: Objectives. We assessed whether reductions in inpatient psychiatric beds resulted in transinstitutionalization to nursing home care of patients with serious mental illness (SMI) within the Veterans Health Administration (VHA). Methods. We assessed trends in national and site-level inpatient psychiatric beds and nursing home patient demographics, service use, and functioning from the VHA National Patient Care Database, VHA Service Support Center Bed Control, and VHA Minimum Data Set. We estimated nursing home admission appropriateness using propensity score analyses based on Michigan Medicaid Nursing Facility Level of Care Determinations ratings. Results. From 1999 to 2007, the number of VHA inpatient psychiatric beds declined (43 894-40 928), the average inpatient length of stay decreased (33.1-19.0 days), and the prevalence of SMI in nursing homes rose (29.4%-43.8%). At site level, psychiatric inpatient bed availability was unrelated to SMI prevalence in nursing home admissions. However, nursing home residents with SMI were more likely to be inappropriately admitted than were residents without SMI (4.0% vs 3.2%). Conclusions. These results suggest the need for increased attention to the long-term care needs of individuals with SMI. Additional steps need to be taken to ensure that patients with SMI are offered appropriate alternatives to nursing home care and receive adequate screening before admission to nursing home treatment. Copyright © 2012 by the American Public Health Association®.

Keywords: aged; article; cohort analysis; female; government; human; length of stay; male; mental disease; middle aged; nursing home; patient transport; prevalence; propensity score; psychiatric department; standard; statistics; United States; utilization review; very elderly, Aged; Aged, 80 and over; Cohort Studies; Female; Humans; Length of Stay; Male; Mental Disorders; Michigan; Middle Aged; Nursing Homes; Patient Transfer; Prevalence; Propensity Score; Psychiatric Department, Hospital; United States; United States Department of Veterans Affairs (search for similar items in EconPapers)
Date: 2013
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Persistent link: https://EconPapers.repec.org/RePEc:aph:ajpbhl:10.2105/ajph.2012.300783_1

DOI: 10.2105/AJPH.2012.300783

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