Under-65 nursing home population grows in some states, putting new emphasis on mental health care

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Scripps Geronotology Center's Matt Nelson and co-author found younger residents need different kinds of help.
Scripps Geronotology Center's Matt Nelson and co-author found younger residents need different kinds of help.

Though nursing facilities have traditionally been designed to treat the elderly, younger residents are using facilities more often — bringing with them fewer physical demands and more behavioral health diagnoses.

"We've typically had this image of a nursing home of being (for) older adults, and now they are middle older adults," said Ian Matt Nelson, a research scholar at Miami University's Scripps Gerontology Center.

Nelson recently co-authored a report on this new generation of nursing home residents for the state of Ohio, where 20% of Medicaid long-stay residents were under 65 in 2015. That puts it 11th in the nation.

Across the country, the under-65 proportion of residents climbed steadily from 16.5% of residents in 2011 to 17.4% in 2015. The rate jumped most for those between 55 and 64, up from 9.8 % to 11.1% in 2015.

Co-author John Bowblis told McKnight's that unpublished data from the study shows Utah leads the nation in the prevalence of young long-term care Medicaid patients, followed by Illinois, Nevada, Missouri and Arizona.

A close look at Ohio reveals how shifting demographics can impact needed services and skill sets.

Almost half of the young Ohio residents had a diagnosis of severe mental illness — including bipolar disorder or schizophrenia — and nearly a quarter had paralysis. Those numbers compared to one-quarter and one-tenth, respectively, among seniors.

Meanwhile, younger residents are less likely to need help with activities of daily living that nursing home workers are typically trained to handle. In 2015, 28% of Ohio's under-65 population had one or fewer ADLs.

Katherine Judge, a professor of psychology at Cleveland State University, told Crain's Cleveland that younger adults will present a challenge for nursing homes.

"I think the implications are what are we doing on the community side and on the nursing home side to address the needs?" Judge asked. "It's not clear for example what community services would best meet the needs of these individuals, or at this point how nursing homes might be able to offer different services to address their needs."