The American Geriatrics Society and American Association for Geriatric Psychiatry Recommendations for Policies in Support of Quality Mental Health Care in U.S. Nursing Homes

Approximately 1.5 million older adults reside in nursing homes, and 65% to 91% of residents have a significant mental disorder. Moreover, the majority (89%) of older adults with severe mental illness who receive institution-based care are in nursing homes, and only 11% are in hospitals. Depression and behavioral and psychiatric symptoms associated with dementia are the most common psychiatric problems in nursing homes. Approximately 30% to 40% of persons with dementia have significant behavioral and psychiatric symptoms, and approximately 22% of nursing home residents have symptoms of depression. In addition to the psychological suffering caused by these disorders, psychiatric disorders in nursing homes are associated with high rates of functional impairment and disability. Behavioral symptoms and depression are associated with worse health outcomes, physical injury, increased rates of hospitalization, and greater emergency service use and lower rates of retention of nursing home staff. However, despite the high prevalence and effects of psychiatric and behavioral symptoms in nursing homes, nursing home staff are generally ill equipped to serve residents with chronic mental illness. The consensus statement of the expert panel assembled by the American Geriatrics Society and the American Association for Geriatric Psychiatry, also published in this issue, focuses on these important mental health concerns for the United States’ 1.5 million nursing home residents. Assessment and treatment for nursing home residents take place within the framework of local, state, and federal health systems and their regulations and policies, which can support or hinder quality mental health care. As the expert panel developed the consensus statement, it became clear to many panel members that a commentary on health policies to support quality mental health care in nursing homes was needed. A subgroup of the panel took on the responsibility of drafting policy statements and comments into a document for review by the full panel. Many statements herein reflect discussions that took place during the development of the panel’s consensus statement. Government, academic institutions, public advocacy groups, and providers must work together to give U.S. nursing home residents the quality mental health care they need and deserve. The unintended consequence of some government regulations is to discourage quality mental health care. Even policies that address improved mental health care often fail to ensure that supportive financing is made available for the effort. Although some nursing homes make every effort to provide quality mental health care, too many still view mental health concerns as tangential to quality. Providers have too often focused on how to reduce regulation rather than improve it. Unless government and providers work together to craft policy that supports quality mental health care, the assessment and treatment practices that the panel advocates are unlikely to be implemented.