Psychiatric Consultation in the Nursing Home

Reichman, William E.; Coyne, Andrew C.; Borson, Soo; Negrón, Arnaldo E.; Rovner, Barry W.; Pelchat, Rodney; Sakauye, Kenneth; Katz, Paul R.; Cantillon, Marc; Hamer, Robert M.

doi:10.1097/00019442-199811000-00007

Cited by 16 publications

(17 citation statements)

References 19 publications

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“…In general, the functioning of U.S. nursing homes and their care and staff structures are organized around the management of chronic medical conditions and functional disabilities of elders rather than care specifically for persons with psychiatric disabilities (25). Members of nursing home staff usually do not receive appropriate training that emphasizes mental health issues (11).…”

Section: Discussionmentioning

confidence: 99%

Origination of Medical Advance Directives Among Nursing Home Residents With and Without Serious Mental Illness

Cai¹,

Cram²,

Li³

2011

Psychiatric Services

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Objective Nursing home residents with serious mental illness need a high level of general medical and end-of-life services. This study tested whether persons with serious mental illness are as likely as other nursing home residents to make informed choices about treatments through medical advance care plans. Methods Secondary analyses were conducted with data from a 2004 national survey of nursing home residents with serious mental illness (N=1,769) and without (N=11,738). Bivariate and multivariate analyses determined differences in documented advance care plans, including living wills; “do not resuscitate” and “do not hospitalize” orders; and orders concerning restriction of feeding tube, medication, or other treatments. Results The overall rates of having any of the four advance care plans were 57% and 68% for residents with and without serious mental illness, respectively (p<.001). Residents with serious mental illness also showed lower rates for individual advance care plans. In a multivariate analysis that adjusted for resident and facility characteristics (N=1,174 nursing homes) as well as survey procedures, serious mental illness was associated with a 24% reduced odds of having any advance directives (adjusted odds ratio=.76, 95% confidence interval=.66–.87, p<.001). Similar results were found for individual documented plans. Conclusions Among U.S. nursing home residents, those with serious mental illness were less likely than others to have written medical advance directives. Future research is needed to help understand both resident factors (such as inappropriate behaviors, impaired communication skills, and disrupted family support) and provider factors (including training, experience, and attitude) that underlie this finding.

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Section: Discussionmentioning

confidence: 99%

Origination of Medical Advance Directives Among Nursing Home Residents With and Without Serious Mental Illness

Cai¹,

Cram²,

Li³

2011

Psychiatric Services

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“…Nevertheless, the overall inadequate coverage for mental healthcare in nursing homes by the Medicare and Medicaid programs, which together account for the majority of nursing home payments, discourages specialty mental health providers to serve the mentally ill. For example, a survey of approximately 900 nursing directors in 6 states found that the availability of psychiatric consultations to nursing homes was deemed to be inadequate by a half of nursing directors, and that non-pharmacologic management and behavioral interventions, which tended to be uncovered or ill-reimbursed, were largely overlooked by consulting specialists (8). As a further note, the gross shortfall of geriatric psychiatrists and other professionals (28) tend to worsen the substantial unmet needs for specialist care by mentally-ill residents, especially those residing in small or rural facilities, and facilities in certain regions (8).…”

Section: Discussionmentioning

confidence: 99%

“…As a further note, the gross shortfall of geriatric psychiatrists and other professionals (28) tend to worsen the substantial unmet needs for specialist care by mentally-ill residents, especially those residing in small or rural facilities, and facilities in certain regions (8). …”

Section: Discussionmentioning

confidence: 99%

“…They concluded that the routine presence of mental health specialists combined with a multidisciplinary team is a preferred model of delivering mental health care in nursing homes. Nevertheless, it is often the case that nursing homes cannot arrange formal contracts with consultant psychiatrists to ensure their routine availability (8). Therefore, additional efforts are needed to remove the financial, institutional, and system-level barriers to obtaining routine specialist care for mentally-ill nursing home residents.…”

Section: Discussionmentioning

confidence: 99%

“…Studies have suggested that on-site mental health services provided to nursing home residents resulted in improved clinical outcomes and reduced acute resource utilizations (11,12). However, the function of the nursing home and its care and staff structures have been historically focused on the management of chronic medical conditions and functional disabilities, rather than psychiatric and behavioral abnormalities (8). As a result, expansion of nursing home service lines in response to the requirement of OBRA 1987 may take place slowly or barely take place, and is expected to depend on intrinsic facility characteristics.…”

Section: Introductionmentioning

confidence: 99%

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

Li¹

2010

Psychiatric Services

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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.

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