Are Patients with Serious Mental lllness More Likely to be Admitted to Nursing Homes with More Deficiencies in Care?

A study to determine whether patients with serious mental illness (SMI) are admitted to nursing homes with acceptable quality of care as often as other patients found that patients with SMI were more likely to be admitted to nursing homes with more total and health care-related deficiency citations.

Patients with SMI require high levels of both psychiatric and nursing care, but often face disparities in quality of nursing home care. The authors analyzed over 1.3 million new Medicaid and/or Medicare nursing home admissions from 2007, looking at data on state-issued deficiency citations and examining the association of schizophrenia or bipolar disorder with admissions to institutions with more deficiencies.

Both patients with schizophrenia and bipolar disorder were associated with admission to nursing homes with more overall and health care-related deficiencies. The relationship between SMI patients and admission to facilities with inadequate quality of care persisted even after controlling for choice of facilities within a county, patient characteristics and facility covariates, although the number of deficiencies varied with patients’ age.

The authors suggest that the demand for nursing home care has allowed administrators to avoid admitting SMI patients because of concerns about patients’ behavior or staff competence. The authors recommend further research to ascertain why disparities in nursing home care quality are associated with SMI.