Image of M. Barton Laws, Ph.D., Image credit: Peter Goldberg
M. Barton Laws, Ph.D., Image credit: Peter Goldberg

The percentage of people diagnosed with serious mental illness, many of whom represent the under-65 population, has continued to increase in skilled nursing facilities, a new analysis of public data has found. SNF directors of nursing say this influx of untraditional residents has posed care challenges.

A younger population of adults with mental health challenges such as schizophrenia and bipolar disorder began to utilize the services of SNFs after the mental health deinstitutionalization movement of the 1960s and 1970s. Previously, these residents would have received care in psychiatric hospitals. The new study aimed to find whether this trend has continued in SNFs, and whether there is a relationship between the proportion of people with behavioral health disorders and younger age.

According to the most recent data available from Brown University’s part-federally funded, the proportion of nursing home residents diagnosed with schizophrenia or bipolar disorder increased from 6.5% in 2000 to 12% in 2017, reported the authors of a research letter published in the December issue of JAMDA.

At the same time, the percentage of residents aged 65 years or younger increased from 11% in 2000 to 16% in 2017, with the average overall resident age subsequently falling from 81 years to 79 years, wrote M. Barton Laws, Ph.D., of the Brown University School of Public Health. Even when a reported rise in inappropriate diagnoses of schizophrenia in nursing home residents was taken into account, the analysis showed that the increase in younger residents who require mental health services is real, Laws and colleagues noted.

What does this mean for residents and their care overall? Interviews with facility directors of nursing across 10 states found that these trends contributed to “dramatic changes” that impact patient care, the researchers reported. Relatively younger people with behavioral health needs have different requirements for activities, independence and nutrition than traditional residents, who tend to be much older and many of whom have dementia, they explained.

Together, these disparate needs pose “logistical and care challenges,” Laws and colleagues found. In addition, although many of the younger population with serious mental health diagnoses did not require skilled nursing care, they also had no appropriate discharge setting — often leaving them with no other option but to become long-stay residents, the nursing directors reported.

Interventions to improve the care of this newer population of nursing home residents is critically needed, the authors concluded. 

“Most importantly, the development and evaluation of alternatives to long-term residence in [nursing homes] for people with behavioral health needs who could be better served in less restrictive, and less expensive, community settings must become high priority,” they wrote.