Associations between psychiatric inpatient bed supply and the prevalence of serious mental illness in Veterans Affairs nursing homes.
OBJECTIVE
We assessed whether reductions in inpatient psychiatric beds resulted in transinstitutionalization to nursing home care of patients with serious mental illness (SMI) within the Veterans Health Administration (VHA).


METHODS
We assessed trends in national and site-level inpatient psychiatric beds and nursing home patient demographics, service use, and functioning from the VHA National Patient Care Database, VHA Service Support Center Bed Control, and VHA Minimum Data Set. We estimated nursing home admission appropriateness using propensity score analyses based on Michigan Medicaid Nursing Facility Level of Care Determinations ratings.


RESULTS
From 1999 to 2007, the number of VHA inpatient psychiatric beds declined (43,894-40,928), the average inpatient length of stay decreased (33.1-19.0 days), and the prevalence of SMI in nursing homes rose (29.4%-43.8%). At site level, psychiatric inpatient bed availability was unrelated to SMI prevalence in nursing home admissions. However, nursing home residents with SMI were more likely to be inappropriately admitted than were residents without SMI (4.0% vs 3.2%).


CONCLUSIONS
These results suggest the need for increased attention to the long-term care needs of individuals with SMI. Additional steps need to be taken to ensure that patients with SMI are offered appropriate alternatives to nursing home care and receive adequate screening before admission to nursing home treatment.
Veterans Health Administration, Serious Mental Illness Treatment Resource and Evaluation Center, Center for Clinical Management, Ann Arbor, MI 48109-2800, USA. nickbowe@umich.edu
Nicholas W
NW
Bowersox
Benjamin J
BJ
Szymanski
John F
JF
McCarthy
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000628:therapy; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D009735:Nursing Homes / Q000592:standards / Q000706:statistics & numerical data*; D010360:Patient Transfer / Q000706:statistics & numerical data; D015995:Prevalence; D057216:Propensity Score; D011567:Psychiatric Department, Hospital / Q000706:statistics & numerical data* / Q000600:supply & distribution / Q000639:trends; D014481:United States; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data*