Determinants of the use of specialist mental health services by nursing home residents.
OBJECTIVE
This study examines the effects of resident and facility characteristics on the probability of nursing home residents receiving treatment by mental health professionals.


METHODS
The study uses data from the Institutional Population Component of the 1987 National Medical Expenditure Survey, a secondary data source containing data on 3,350 nursing home residents living in 810 nursing homes as of January 1, 1987.


METHODS
Andersen's health services use model (1968) is used to estimate a multivariate logistic equation for the effects of independent variables on the probability that a resident has received services from mental health professionals. Important variables include resident race, sex, and age; presence of several behaviors and reported mental illnesses; and facility ownership, facility size, and facility certification.


METHODS
Data on 188 residents were excluded from the sample because information was missing on several important variables. For some additional variables residents who had missing information were coded as negative responses. This left 3,162 observations for analysis in the logistic regressions.


RESULTS
Older residents and residents with more ADL limitations are much less likely than other residents to have received treatment from a mental health professional. Residents with reported depression, schizophrenia, or psychoses, and residents who are agitated or hallucinating are more likely to have received treatment. Residents in government nursing homes, homes run by chains, and homes with low levels of certification are less likely to have received treatment.


CONCLUSIONS
Few residents receive treatment from mental health professionals despite need. Older, physically disabled residents need special attention. Care in certain types of facilities requires further study. New regulations mandating treatment for mentally ill residents will demand increased attention from nursing home administrators and mental health professionals.
Shea
D G
DG
Pennsylvania State University, University Park 16802.
Streit
A
A
Smyer
M A
MA
D000203:Activities of Daily Living; D000368:Aged; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D008962:Models, Theoretical; D015999:Multivariate Analysis; D009735:Nursing Homes / Q000706:statistics & numerical data*; D016017:Odds Ratio; D012866:Skilled Nursing Facilities / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D014481:United States