Are Post-Acute Patients with Behavioral Health Disorders Admitted to Lower-Quality Nursing Homes?

We measured the proportion of new post-acute nursing home admissions with behavioral health diagnoses and examined whether patients with these disorders (schizophrenia/psychosis, bipolar, depression/anxiety, personality disorder, and substance abuse) faced disparities in access to high quality facilities.

The analytical sample included 3,729,282 admissions to 15,600 facilities nationwide for 2012-2014.

Quality was measured for overall and staffing domains reported by the Centers for Medicare and Medicaid Services in the Five-Star Quality Rating System. Multinomial logistic regression models were used. The base model included the diagnostic groups of interest and state dummies. Patient sociodemographics, functional and cognitive status, and comorbid conditions were sequentially added to the base model to determine the independent effect of having a behavioral health diagnosis at admission.

Patients with these conditions experienced disparities accessing to high-quality homes compared to patients without. For example, patients with depression/anxiety had lower access to five-star homes, for the staffing quality domain (Model 3 ORs = 0.88, 0.93, 0.92 in years 1 through 3, respectively) compared to patients with no behavioral health diagnosis. Access disparities were faced not only by patients with serious mental illness, as previously demonstrated, but also patients with substance abuse and with depression/anxiety who account for one-third of all new admissions.

Our findings demonstrate persistence of disparities in access to high quality facilities over time and for patients with a broad range of behavioral health conditions. Further research is needed to understand the impact of these disparities on outcomes of patients with behavioral disorders.