Get access

Serious Mental Illness and Nursing Home Quality of Care

Authors

  • Momotazur Rahman,

    Corresponding author
    • Center for Gerontology and Healthcare Research, Brown University, Providence, RI
    Search for more papers by this author
  • David C. Grabowski,

    1. Department of Health Care Policy, Harvard Medical School, Boston, MA
    Search for more papers by this author
  • Orna Intrator,

    1. Center for Gerontology and Healthcare Research, Brown University, Providence, RI
    2. Providence Veterans Administration Medical Center, Health Services Research Program, Providence, RI
    Search for more papers by this author
  • Shubing Cai,

    1. Center for Gerontology and Healthcare Research, Brown University, Providence, RI
    2. Providence Veterans Administration Medical Center, Health Services Research Program, Providence, RI
    Search for more papers by this author
  • Vincent Mor

    1. Center for Gerontology and Healthcare Research, Brown University, Providence, RI
    2. Providence Veterans Administration Medical Center, Health Services Research Program, Providence, RI
    Search for more papers by this author

Address correspondence to Momotazur Rahman, Ph.D., Center for Gerontology and Healthcare Research, Brown University, Box G-S121(6), Providence, RI 02912; e-mail: Momotazur_Rahman@brown.edu.

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.

Get access to the full text of this article

Ancillary