Provision of Mental Health Services in U.S. Nursing Homes, 1995–2004

Abstract

Objective To track the trend of the ability of U.S. nursing homes to provide on-site mental health services after the Omnibus Budget Reconciliation Act (OBRA) mandated mental illness detection and treatment for nursing home patients, and to determine cross-sectional correlates of service availability and models of services. Methods Retrospective analyses of the 1995-2004 National Nursing Home Surveys (NNHS) periodically conducted by the Centers for Disease Control and Prevention. Longitudinal trend of mental health service provision was analyzed for all and subgroups of facilities. Multivariate regression determined facility and geographic correlates in 2004. Results Representing the nation’s approximately 17,000 nursing homes, the NNHS suggested that roughly 80% of facilities provided on-site mental health services each year and over time. In 2004, roughly a quarter of all facilities provided each model of services – regular (25%), on call (28%), or both regular and on call (24%) services – with the remaining 23% facilities providing no on-site mental health services. Multivariate analyses found that largest facilities (≥200 beds) were more able to serve the mentally ill (odds ratio=3.80, p=.024) than small facilities (<100 beds); facilities with mass coverage by Medicare/Medicaid programs, in the northeast region, or in metropolitan areas were more likely than their counterparts to provide on-site services. Similar correlates were found for alternative service models available. Conclusions The overall availability of nursing home-based mental health services did not improve over time during the post-OBRA era. Service availability is more problematic for certain facilities such as small or rural ones. Financial, regulatory, and system-level efforts are needed to address this issue.

Providing Behavioral Health Services in Nursing Homes Is Difficult: Findings From a National Survey

“…This is troubling as the proportion of the NH population with BH conditions is large and increasing, driven largely by NH admission of residents diagnosed with depression. 1,10 In most states, Medicaid covers only basic BH services. Since Medicaid reimbursement rates are generally low, there is little incentive for NHs to enhance these services to long-term care residents (who are largely funded by Medicaid).…”

“…By 2004, only 25% of US NHs provided BH services on a regular basis, 24% provided BH services on an as-needed basis, 28% provided BH services both on a regular and an as-needed basis, and 22% provided no such services. 10 Two recent surveys of BH services were conducted in NHs in Florida 11 and Hawaii. 12 Administrators in Florida NHs reported being highly satisfied with BH service availability/quality.…”

Psychiatric Services: Experience, Perceptions, and Needs of Nursing Facility Multidisciplinary Leaders

“…[1][2][3] Despite this and legislation, in the form of the Omnibus Budget Reconciliation Act of 1987 (OBRA'87), that attempted to increase access to care, only 78% of nursing facilities provide on-site mental health services, and only 25% provide it on a regular basis. 4 There are many barriers to providing psychiatric services to nursing homes: time, financial costs, inadequate or lack of reimbursement for certain services, lack of interest and knowledge by provider and requester, and a poor match between facility and provider. 5 Alternatively, access to nursing facility beds has been a problem for hospital patients, resulting in large numbers of ''waitlisted'' patients, many of for whom the primary barrier to placement is psychiatric and behavioral problems.…”

“…Mental disorders are common in older adults and are even more prevalent in nursing home residents, in whom they are estimated to range from 60% to more than 90% 1–3 . Despite this and legislation, in the form of the Omnibus Budget Reconciliation Act of 1987 (OBRA'87), that attempted to increase access to care, only 78% of nursing facilities provide on‐site mental health services, and only 25% provide it on a regular basis 4 . There are many barriers to providing psychiatric services to nursing homes: time, financial costs, inadequate or lack of reimbursement for certain services, lack of interest and knowledge by provider and requester, and a poor match between facility and provider 5 .…”

Patients with mental–physical multimorbidity: do not let them fall by the wayside

“…Unfortunately, the availability and quality of mental health services in nursing homes is perceived as a bottleneck in many countries (Bartels, 2004; Grabowski et al , 2010; Li, 2010; Snowdon, 2010). Even if a specialized multidisciplinary team is available for residents of a geronto-psychiatric nursing home unit, this team has to collaborate with medical and mental healthcare specialists in order to provide optimal care to these residents.…”