A new report offers insights into the identification and support of older individuals with serious mental illnesses who require appropriate long-term care solutions.
The paper was published in the AMA Journal of Ethics. It was written by Ari Ne’eman, a PhD candidate in health policy at Harvard University.
The study underscores the necessity of improved care options for individuals with serious mental illnesses (SMIs), such as bipolar disorder, psychosis, and schizophrenia. In the past two decades more people with SMIs have entered nursing homes. In fact, one in five residents had a psychotic disorder in 2019.
The authors say that people with SMI will probably experience long-term institutionalization if they go into a nursing home. They say hospitals and doctors should avoid discharging them into long-term care communities, as a nursing home community is “generally inappropriate” for people with SMIs. Nursing homes are ill equipped to provide mental health services, Ne’eman wrote.
Because people with SMI have a high risk for long stays in nursing homes, the authors said that Congress should repeal the present Preadmission Screening and Resident Review (PASRR) process for post-acute admissions. Under PASRR, hospital discharge planners have to screen for SMI and intellectual disability.
“Rather than weaken PASRR through additional exemptions, federal regulators should look for opportunities to strengthen the program, including through auditing state practices,” Ne’eman wrote.
“Both individual clinicians and hospital systems have an ethical obligation to work to divert persons with SMI from nursing home placement, including via discharges for post-acute care,” the authors said. “At the same time, hospital systems and policy makers should work collaboratively to build more effective infrastructure for supporting persons with SMI in community-based settings.”
Last year, California announced a plan that would let family, friends, first responders, and clinicians petition a judge to order mental healthcare as part of a two-year care plan. It’s called the Care Court plan, and it’s part of the state Care Act.
