Mental Health Services in Nursing Homes: Regulatory Oversight, Payment Policy, and Quality Improvement in Mental Health Care in Nursing Homes

Abstract

During the past 15 years, federal regulations, survey and inspection programs, and payment policies have presented conflicting incentives and disincentives for the provision of mental health services in nursing homes in the United States. Policies and regulatory measures have reflected the concern that many patients in nursing homes are not receiving the mental health care they need, and, more prominently, the concern that some of the services that are provided seem to be inappropriate or medically unnecessary. Despite evidence that payment policy and regulatory oversight can be used effectively to promote quality improvement, the need for improved access and quality of mental health services in long-term care remains substantial. Recent reports issued by the Surgeon General and by the Institute of Medicine identify a need for refinements in the assessment process, the use of outcomes-based quality measures, and payment policies designed to improve access and quality. These elements must be coordinated to promote humane treatment in nursing homes, including access to medically necessary psychiatric care.

Antipsychotic Use in Nursing Homes Varies by Psychiatric Consultant

“…4–6 Further, financial constraints limit the extent to which psychiatric and psychological consultants can provide behavior-based, non-pharmacologic, interventions. 5,7,8 Taken together, financial and manpower constraints result in a persistent challenge for clinical and healthcare policy leaders. 5 …”

Mental Health Care Deficiency Citations in Nursing Homes and Caregiver Staffing

“…The 1999 Surgeon General's Report on Mental Health described one cause of the substantial challenges associated with this care: ''Although every community has an Administration on Aging to assist with services for older adults generally, there is no administrative body responsible for integrating the daunting array of services needed specifically for individuals with severe mental illnesses'' (Department of Health and Human Services [DHSS], 1999: 7). Streim et al (2002Streim et al ( : 1418, describing recent literature on mental health care in nursing homes, noted that in the wake of findings of several highlevel governmental reports, calls have been made for ''refinements in the assessment process, the use of outcomes-based quality measures, and payment policies designed to improve access and quality.'' Associations between nurse staffing and quality in acute settings are well documented.…”

Mental Health Outcomes and Physical Restraint Use in Nursing Homes {Private}

“…Possibly providing an explanation for these deficiencies in mental health care, Streim et al (2002Streim et al ( , p. 1416) describe mental health care in nursing homes as ''an example of contradiction across policy domains: regulatory policy requires mental health assessment and treatment, whereas payment policy undermines this goal by allowing states to under fund nursing homes. ''…”