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Health Services Research & Development

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2006 HSR&D National Meeting Abstract


3092 — Nursing Home Placement Among VA Patients with and without Serious Mental Illness

Author List:
McCarthy JF (VA Serious Mental Illness Treatment Research and Evaluation Center)
Kales HC (VA Serious Mental Illness Treatment Research and Evaluation Center)
Welsh D (VA Serious Mental Illness Treatment Research and Evaluation Center)
Blow FC (VA Serious Mental Illness Treatment Research and Evaluation Center)

Objectives:
The organization and delivery of long-term care services to meet the needs of individuals with serious mental illnesses (SMI) present major health policy challenges. Improved mental health treatments have extended longevity in this population, resulting in substantial projected increase in the need for nursing home services. Few studies have examined the risks of nursing home placement among individuals with SMI as compared to patients without SMI.

Methods:
Using data from the VA’s National Psychosis Registry, we identified all VA patients who received a diagnosis of schizophrenia or bipolar disorder in fiscal year 1999 (FY1999) and who completed the VA’s Large Health Survey of Veteran Enrollees (LHSVE; N = 24819). We also examined data from a random sample of VA patients in FY1999 who did not receive SMI diagnoses and who completed the LHSVE (N = 18866). Among patients who were not nursing residents on 1/1/2000, we used a multivariate survival analysis to model time to first VA or VA-funded nursing home admission over the next 4.75 years. Model covariates included indicators of psychiatric diagnosis in FY1999, age, gender, and self-reported race/ethnicity, general health status, limitations affecting social activities, pain, and physical and emotional health status. In addition, the model included Charlson Comorbidity Index scores, categorized as 0, 1, or >=2. Patients were right censored at the end of the observation period (9/30/04) or at date of death.

Results:
Of the 43,685 subjects, 3328 patients (7.6%) had a nursing home admission during the study period. 5254 patients (12.0%) died during the study period without receiving VA nursing home care. 10.0% of patients with schizophrenia and 8.3% of patients with bipolar disorder received nursing home care, as compared to 5.6% of non-SMI patients. In multivariate analyses, both patients with schizophrenia and those with bipolar disorder were at increased risk of nursing home admission (OR=2.30 and OR=1.95, respectively), as compared to non-SMI patients.

Implications:
Among active VA patients, individuals with serious mental illness are at increased risk for nursing home placement.

Impacts:
As VA nursing homes increasingly provide services for individuals with SMI, research and policy initiatives are needed to ensure quality of care.


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