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Trends in Mental Health Admissions to Nursing Homes, 1999–2005

Dr. Fullerton, Dr. McGuire, and Dr. Grabowski are affiliated with the Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave., Boston, MA 02115 (e-mail: fullerton{at}hcp.med.harvard.edu). Dr. Fullerton is also with the Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts. Dr. Feng is with the Center for Gerontology and Health Care Research and Dr. Mor is with the Department of Community Health, both at Brown University, Providence, Rhode Island.

OBJECTIVE: The study examined 1999–2005 data on first-time nursing home admissions of individuals with mental illness, dementia, or both to identify trends and characteristics. METHODS: The Minimum Data Set was used to estimate the number and percentage of persons newly admitted to nursing homes who had mental illness (schizophrenia, bipolar disorder, depression, or an anxiety disorder), dementia, or both from 1999 to 2005. Data from 2005 were used to compare demographic characteristics and comorbid conditions of the three groups and treatments received. RESULTS: The number of individuals admitted with mental illness increased from 168,721 in 1999 to 187,478 in 2005. The 2005 number is more than 50% higher than the number admitted with dementia only (118,290 in 2005). The increase was driven by growth in admissions of persons with depression—from 128,566 to 154,262 in 2005. Persons admitted with depression had higher rates of comorbid conditions than those admitted with dementia or with neither dementia nor mental illness. They also had high rates of antidepressant treatment and high rates of receipt of training in skills required to return to the community. CONCLUSIONS: Current trends show that the proportion of nursing home admissions with mental illness, in particular depression, has overtaken the proportion with dementia. These changes may be related to increased recognition of depression, availability of alternatives to nursing homes for persons with dementia, and increased specialization among nursing homes in the care of postacute, rehabilitation residents. In light of these trends, it is critical to ensure that nursing homes have resources to adequately treat residents with mental illness to facilitate community reintegration.

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