Mental illness trumps dementia in nursing home admissions

Cleveland-A study has found more nursing home admissions suffer with mental illness than dementia, underscoring the need for nursing homes to have resources to adequately treat residents with mental illness.

The study, “Trends in Mental Health Admissions to Nursing Homes, 1999-2005,” studied first-time admissions to nursing homes with mental illness, dementia, or both, during the six-year period. According to an article in Psychiatric Services, “Current trends show that the proportion of nursing home admissions with mental illness, in particular, depression, has overtaken the proportion with dementia. These changes may be related to increased recognition of depression, availability of alternatives to nursing home residents with dementia, and increased specialization among nursing homes in the care of post-acute rehabilitation residents.”

The Minimum Data Set was used to estimate the number and percent admitted to nursing homes who had mental illness (defined as schizophrenia, bipolar disorder, depression, or an anxiety disorder), dementia, or both from 1999 to 2005. Data from 2005 were used to compare demographic characteristics and comorbid conditions of the three groups and treatments received. The number of individuals admitted with mental illness increased from 168,721 in 1999 to 187,478 in 2005. According to the study, the 2005 number is more than 50% higher than the number admitted with dementia only (118,290 in 2005). The increase was driven by growth in admissions of persons with depression-from 128,566 to 154,262 in 2005.

CMS wants homogenized Medicaid waivers

Assisted living organizations are waving warning flags about a proposed rule from the Centers for Medicare & Medicaid Services (CMS) that would collapse three types of Medicaid Home and Community-Based Services (HCBS) waivers into one-allowing individual state Medicaid waivers to cover such services for the aged/disabled, the developmentally disabled/mentally retarded, and the mentally ill. A second proposed change would define HCBS in a way that could potentially exclude assisted living facilities.

“Having these three distinct services competing for Medicaid dollars is helpful to no one,” says Meribeth Bersani, ALFA Senior Vice President of Public Policy. “And more narrowly defining the settings may be all right for younger disabled, but for seniors, the assisted living facility is their home.”

Alluding to the proposed “lumping together” of services, David Kyllo, executive director of NCAL, noted, “The frail elderly poor don’t tend to have a great deal of political clout.” He added, “If you believe in choice and person-centered care, then assisted living facilities-regardless of their size-have to be considered a choice. Besides, people in assisted living, average age almost 87, have already gone the home-based services route and they need an assisted living-level of services.”

NCAL Senior Policy Director Karl Polzer said, “Our concern is that the proposed changes are driven by the politics of the younger disabled groups. The government pays only for services, and now it’s getting picky about that.”

CMS maintains that Medicaid financial support should focus on individual health needs, not diagnoses or conditions, and in the most personalized residential settings possible, as determined by states, without federal regulatory barriers. CMS is inviting comments to be submitted via mail or e-mail by August 21. Providers should contact their state associations for the CMS addresses.

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Long-Term Living 2009 August;58(8):10