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2011 HSR&D National Meeting Abstract

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2011 National Meeting

3009 — VHA Inpatient Psychiatric Bed Capacity and Prevalence of Serious Mental Illness in Long-Term Care Facilities, 1999-2007

Bowersox NW (Ann Arbor SMITREC), Szymanski BR (Ann Arbor SMITREC), Barry KL (Ann Arbor SMITREC), Valenstein M (Ann Arbor SMITREC), McCarthy JF (Ann Arbor SMITREC)

Objectives:
For decades there have been concerns that reductions in inpatient psychiatric bed capacity may result in inappropriate transfers of individuals with serious mental illness (SMI) from inpatient psychiatric care to long-term care facilities. The pre-admission screening mandated in the OBRA-87 legislation was intended to prevent such “transinstitutionalization.” In this study, we assess trends in Veterans Health Administration (VHA) inpatient psychiatric bed capacity and in the prevalence of SMI (i.e., schizophrenia, bipolar disorder and other psychotic disorders) among VHA patients in VHA Community Living Centers (CLCs) and VA-contracted Community Nursing Homes (CNHs).

Methods:
Using data from the Bed Control Cube at the VHA Support Service Center (VSSC), we assessed VHA inpatient psychiatric bed capacity nationally and at parent station facilities for each fiscal year, 1999-2007. Prevalence of SMI in VHA CLCs and in CNHs was assessed using diagnosis data from the National Patient Care Database.

Results:
Between FY1999 and FY2007, the number of inpatient psychiatric bed counts decreased consistently, from 6,570 in FY99 to 4,745 in FY07. In this same period, the prevalence of SMI in VA CLCs significantly increased (chi square (1) = 48.35, p < .0001), from 21% in FY99 to 25% in FY07, and among recipients of VA-contracted CNH care SMI prevalence significantly increased from 37% in FY99 to 43% in FY07 (chi square (1) = 15.68, p < .0001).

Implications:
This study documents overall declines in inpatient psychiatric bed availability, and concurrent increases in the prevalence of SMI among both CLC and CNH care recipients. Ongoing analyses examine measures of the appropriateness of CLC admissions, by SMI status.

Impacts:
Decreases in VHA psychiatric inpatient bed capacity may create pressure to admit patients with SMI to other institutional care settings. Enhancing care transitions and post-discharge services is a priority in meeting the needs of Veterans with SMI.


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