Behavioral Health Disorder Diagnosis Decreases Access to High-Quality Facilities

Abstract

Post-acute patients diagnosed with a behavioral health disorder are more likely to enter low-quality nursing home facilities and less likely to enter high-quality facilities than those without the diagnosis, according to study results in the American Journal of Geriatric Psychiatry. “[Our findings] demonstrate that access to high-quality nursing home care is more limited for patients with behavioral health disorders than previously demonstrated,” Helena Temkin-Greener, PhD, study researcher with the University of Rochester School of Medicine and Dentistry in New York, told Caring. Dr. Temkin-Greener said that previous reports suggested nursing homes are reluctant to accept patients with behavioral health disorders. However, only one prior empirical study showed that patients with severe mental illness were more likely to be admitted to nursing homes that have a higher number of deficiency citations, which is one measure of poorer quality. “We wanted to expand on this empirical study by including patients with other behavioral health disorders, including depression which is highly prevalent,” she said, “and also by using newer measures of nursing home quality [i.e., Five-Star metrics] published by the Centers for Medicare & Medicaid Services.” For the study, the researchers used the national Minimum Data Set as well as information on the patients’ sociodemographics and their functional, cognitive, diagnostic, and therapeutic status. The analysis included 3,920,860 new post-acute Medicare nursing home admissions (age 65 years and older) from December 2011 to November 2014 [Am J Geriatr Psychiatry Feb. 28, 2018; doi:10.1016/j.jagp.2018.02.005]. The final sample size was reduced to 2,896,164 participants (78%) from 15,096 facilities due to incomplete records for all necessary covariates. Dr. Temkin-Greener and her colleagues defined the key independent variables as behavioral health diagnoses — including schizophrenia or psychosis, bipolar disorder, depression or anxiety, personality disorder, and substance abuse — based on the admission assessment. The researchers measured quality for overall and staffing domains using the CMS Five-Star Quality Rating System. Overall, 43% of admissions had a behavioral health diagnosis. Patients with schizophrenia/psychosis, bipolar or personality disorder, or substance abuse were younger and more likely to be dually eligible for Medicaid and Medicare compared with patients without a behavioral health disorder diagnosis. In a bivariate analysis, they found the patients with a behavioral health diagnosis had an increased likelihood of entering 1-Star facilities and a decreased likelihood of admittance into 5-Star facilities, as measured by both the overall quality and staffing domains. The researchers noted the distribution of 5-Star facility access during any given year was more favorable for patients without a behavioral health diagnosis than for patients with most behavioral health diagnoses. The one exception was patients with depression/anxiety, who had similar access to quality homes compared with those without any behavioral health diagnosis. “Patients with behavioral health disorders other than serious mental illness were less likely to be admitted to high quality nursing homes and more likely to be admitted to lowest quality homes,” Dr. Temkin-Greener said. Patients with behavioral health disorders and their families should be made aware that nursing home quality metrics are publicly available and should be consulted when discussing discharge plans to a nursing home. Brian Ellis is a freelance writer and editor based in NJ.