Serious mental illness and nursing home quality of care

Abstract

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.

Keywords: Mental illness; instrumental variables; nursing home; quality.

Figure 1

Distribution in the Share of Nursing Home Residents with Severe Mental Illness by Year

Figure 2

Local Linear Regression of the Difference in the Share with Severe Mental Illness over the 2000–2008 Period in a Given Facility on the Difference in the Distance of the Nearest Mental Hospital Relative to the Distance of the Nearest General Hospital (DD)