Serious Mental Illness and Nursing Home Quality of Care
Article first published online: 26 DEC 2012
© Health Research and Educational Trust
Health Services Research
Volume 48, Issue 4, pages 1279–1298, August 2013
How to Cite
Rahman, M., Grabowski, D. C., Intrator, O., Cai, S. and Mor, V. (2013), Serious Mental Illness and Nursing Home Quality of Care. Health Services Research, 48: 1279–1298. doi: 10.1111/1475-6773.12023
- Issue published online: 4 JUL 2013
- Article first published online: 26 DEC 2012
- National Institute on Aging. Grant Numbers: P01AG027296, R01 AG034179
- Mental illness;
- nursing home;
- instrumental variables
To estimate the effect of a nursing home's share of residents with a serious mental illness (SMI) on the quality of care.
Secondary nursing home level data over the period 2000 through 2008 obtained from the Minimum Data Set, OSCAR, and Medicare claims.
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.
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.
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.