Despite the high prevalence and evidence of underrecognition and undertreatment of
mental disorders in residents of nursing homes, pathways for access to mental health
services for these vulnerable elderly persons, who today number over 1.5 million,
remain poorly understood. We know little more today about the types, availability,
or adequacy of mental health services provided in long-term care settings than we
did before the implementation of the Omnibus Budget Reconciliation Act of 1987 (OBRA
'87) over 10 years ago. We do know that skilled nursing facilities vary widely in
the quality of general nursing care provided to residents and the vigor with which
they have embraced the national mandate for improvement in mental health care. We
also know that their orientation to care remains predominantly medical, supportive,
and supervisory; when formal psychiatric services are provided, they follow mainly
a consultative, rather than a longitudinal, integrated biopsychosocial model of care.
Inadequate detection and treatment of mental disorders remain key issues unresolved
by the OBRA provisions, and too many facilities still lack reliable access to qualified
specialty providers capable of meeting the needs for expert mental health services.
At the same time, punitive regulatory practices highlight potential cases of fraud
and abuse
1
instead of fostering comprehensive, patient-centered quality improvement.To read this article in full you will need to make a payment
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References
Department of Health and Human Services Office of the Inspector General: Mental Health Services in Nursing Facilities. OEI-02-00860, May 1996
- The Impact of OBRA '87 on Psychiatric Services in Nursing Homes: Joint Testimony of the American Psychiatric Association and the American Association for Geriatric Psychiatry.Am J Geriatr Psychiatry. 1999; 7: 12-17
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- Nursing home nurses' attitudes, empathy, and ideological orientation.Int J Aging Hum Development. 1986; 22: 235-246
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- Psychiatric consultation in the nursing home: a survey of six states.Am J Geriatr Psychiatry. 1998; 6: 320-327
Borson S, Reichman WE, Coyne AC, et al: Effectiveness of nursing home staff as managers of disruptive behavior: perceptions of nursing directors. Am J Geriatr Psychiatry (in press)
- Cross-discipline disparities in perceptions of mental disorders in a long-term care facility.J Am Geriatr Soc. 1996; 44: 792-797
- New directions for state long-term care systems, IV: limiting state Medicaid spending on nursing home care. AARP Public Policy Institute, Washington, DC1997 (Report #9702)
Article info
Footnotes
This editorial and the Long-Term Care Survey were produced, in part, with the support of an unrestricted educational grant from Eli Lilly & Company.
Dr. Moak is Chair, AAGP Clinical Practice Committee, 1996–1999; and AAGP Board Member, 1999–2002.
Dr. Borson is Immediate Past President, AAGP, 2000–2001.
Identification
Copyright
© 2000 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.
