Reducing psychiatric hospitalization among mentally ill veterans living in board-and-care homes.

Abstract

The effectiveness of a community-based case management program at the Veterans Affairs West Los Angeles Healthcare Center in reducing hospital readmission of mentally ill veterans living in privately operated board-and-care homes was evaluated. A retrospective cohort design was used. The sample consisted of 321 patients identified by hospital records as living in one of 24 board-and-care homes in the Los Angeles area that were approved by the community residential care program. A total of 214 subjects who received monthly home visits from case managers (program group) were compared with 107 subjects who did not receive monthly home visits (comparison group). The median number of psychiatric bed-days used was calculated for the two years before and after follow-up. The number of days from the start of follow-up to the first psychiatric hospitalization was also calculated. Among subjects in the program group, the median number of psychiatric bed-days used decreased significantly, from 59 days to 50 days. No significant change in the median number was observed for comparison subjects. Comparison subjects were rehospitalized 1.7 times more often than program subjects. Overall, program subjects under age 62 (younger subjects) were rehospitalized 2.5 times more often than older subjects. In the program group, those who had received home visits for more than two years were hospitalized three times more often than those who had received visits for less than two years, and younger subjects were rehospitalized 1.8 times more often than older subjects. The findings suggest that home visits conducted by case managers in a community residential care program helped reduce psychiatric hospitalization among veteran patients living in privately operated board-and-care homes.