title: Serious mental illness and nursing home quality of care.
abstract: OBJECTIVE
  To estimate the effect of a nursing home's share of residents with a serious mental illness (SMI) on the quality of care.
  
  
  METHODS
  Secondary nursing home level data over the period 2000 through 2008 obtained from the Minimum Data Set, OSCAR, and Medicare claims.
  
  
  METHODS
  We employ an instrumental variables approach to address the potential endogeneity of the share of SMI residents in nursing homes in a model including nursing home and year fixed effects.
  
  
  RESULTS
  An increase in the share of SMI nursing home residents positively affected the hospitalization rate among non-SMI residents and negatively affected staffing skill mix and level. We did not observe a statistically significant effect on inspection-based health deficiencies or the hospitalization rate for SMI residents.
  
  
  CONCLUSIONS
  Across the majority of indicators, a greater SMI share resulted in lower nursing home quality. Given the increased prevalence of nursing home residents with SMI, policy makers and providers will need to adjust practices in the context of this new patient population. Reforms may include more stringent preadmission screening, new regulations, reimbursement changes, and increased reporting and oversight.
authors.affiliation: Center for Gerontology and Healthcare Research, Brown University, Providence, RI 02912, USA. Momotazur_Rahman@brown.edu
authors.forename: Momotazur
authors.initials: M
authors.lastname: Rahman
authors.forename: David C
authors.initials: DC
authors.lastname: Grabowski
authors.forename: Orna
authors.initials: O
authors.lastname: Intrator
authors.forename: Shubing
authors.initials: S
authors.lastname: Cai
authors.forename: Vincent
authors.initials: V
authors.lastname: Mor
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006769:Hospitals, General / Q000706:statistics & numerical data; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data; D006801:Humans; D016018:Least-Squares Analysis; D016014:Linear Models; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D001523:Mental Disorders / Q000628:therapy*; D009735:Nursing Homes / Q000592:standards* / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D014481:United States; D000078329:Workforce
keywords: Mental illness; instrumental variables; nursing home; quality