The substitution of nursing home for inpatient psychiatric care

Although the era of deinstitutionalization of the aged from state mental facilities and of the rapid growth of the nursing home industry appears to have ended, the question remains of the extent to which nursing home care is substituted for psychiatric care. To study this question, the numbers per capita of Medicaid program recipients of inpatient psychiatric care for each state in the period 1979-82 was regressed on numbers per capita of Medicaid nursing home recipients, numbers of nursing home beds per capita, and the percentage aged. As expected, psychiatric care is negatively related to bed supply, positively to nursing home recipients and to percentage aged; and the relationship to nursing home recipients is stronger in states with undersupplies of beds. These findings are interpreted to show that nursing home care is substituted for inpatient psychiatric care, depending on bed supply, the generosity of the Medicaid program, and the level of demand for care.