Elderly nursing home residents are increasingly living alongside young and middle-age people with mental illness, with sometimes tragic results, according to a 50-state investigation by the Associated Press. It appears that in many cases this potentially dangerous trend is a violation of federal law.
Figures that the AP obtained from the Centers for Medicare and Medicaid Services through the Freedom of Information Act show that nearly 125,000 non-elderly adults with serious mental illness were living in U.S. nursing homes in 2008. This is a 41 percent increase from 2002, when nursing homes housed about 89,000 mentally ill people ages 22 to 64. Younger mentally ill people now make up more than 9 percent of the nation's nearly 1.4 million nursing home residents, up from 6 percent in 2002, the AP found.
The AP concludes that nursing homes have become state "dumping grounds" for the mentally ill. This seems to be happening for a combination of reasons: state mental institutions are closing, there is a shortage of hospital psychiatric beds, and nursing homes have more room because today's elderly are healthier than the previous generation and because more and more states are encouraging potential nursing home residents to continue living in the community. Also, it can be advantageous for states to place mentally ill people in nursing homes because of quirks in how the federal government pays for mental health services.
Although no government agency tracks violence by mentally ill residents against elderly residents, the AP article cites a number of recent cases, including the one of a 77-year-old Alzheimer's patient who died when his roommate, a mentally ill man 30 years his junior, allegedly smashed him in the face with a clock radio.
"Sadly, we're seeing the tragic results of the failure of federal and state governments to provide appropriate treatment and housing for those with mental illnesses and to provide a safe environment for the frail elderly," Janet Wells, director of public policy for the National Citizens' Coalition for Nursing Home Reform, told the AP.
The Omnibus Budget Reconciliation Act (OBRA) of 1987 (P.L. 100-203) mandates that patients suffering from mental illness other than dementia cannot be admitted to Medicaid-certified nursing homes unless it is shown that they need the high level of care a nursing home can provide. 1396r(b)(3)(F) State agencies screen entering patients using a questionnaire called the Pre-Admission Screening and Annual Resident Review (PASARR). The federal nursing home law also guarantees nursing home residents the right to be free from physical abuse.
To read the Associated Press article, click here.