Policies needed to address mental illness issues in assisted living
MELBOURNE: Little to no research exists when it comes to the barriers, clinical outcomes and policy effects of discharging assisted living residents who have mental illness, according to the authors of a new study. They called for additional research to identify effective discharge supports and to understand post-discharge outcomes for such residents.
One expert said the study underlines the need for staff training on mental illness as well as policies and procedures related to suicidal thoughts in assisted living.
For the research, investigators from Boston University and the University of North Carolina at Chapel Hill analyzed 16 studies to learn about the barriers, facilitators, effects of federal and state policies, and clinical outcomes related to the discharge of residents with mental illness from assisted living communities and nursing homes. Their findings were published in the August issue of JAMDA – The Journal of the Post-Acute and Long-Term Care Medical Association.
AL studies 15+ years old
Their analysis found that most studies focused on skilled nursing facilities, with very limited research into what happens in assisted living communities. In fact, the research that exists about assisted living is more than 15 years old.
The authors cited a 2022 special article that appeared in JAMDA and was written by Sheryl Zimmerman, PhD, director of the Center for Excellence in Assisted at the University of North Carolina at Chapel Hill, CEAL@UNC, and colleagues.
Zimmerman said that more than one-fourth of assisted living residents (26%) have depression, and rates of mental illness have been increasing.
“In research that is more than 15 years old, the [new] JAMDA study found depression to be a risk factor for discharge to nursing homes,” Zimmerman said. “For this very reason, recommendations for medical and mental care in assisted living — such as staff training on mental illness and policies and procedures related to suicidal thoughts — are especially relevant given the extent of need.”
More research needed
The authors of the new study called for more research into the topic to identify trends in discharge trajectories, evaluate policy effects, identify effective discharge supports and understand post-discharge outcomes for residents in assisted living communities and SNFs.
According to the study findings, rates of mental illness in assisted living communities and other long-term care and post-acute settings are disproportionately higher compared with rates in the general population. The researchers estimated that the prevalence of people with serious mental illness — schizophrenia and bipolar disorder, for example — being admitted to those settings doubled from 6.5% in 2000 to 12.4% in 2020.
Successful community discharge, they said, requires coordination across multiple systems, including medical, behavioral health, housing and social services. Although community reintegration is the goal following short periods of care, the individuals face numerous barriers, including insufficient care coordination, inadequate caregiver support, insufficient medical self-management skills, limited affordable and accessible housing, and restrictive Medicaid eligibility policies, according to the researchers.
Those barriers, they said, increase the individuals’ risk of rehospitalization or readmission. For those reasons, 51% of people in post-acute care who have serious mental illness are not discharged, and they become senior living and care residents, compared with just 35% of older adults without mental illness, according to the study.
Despite the substantial existing evidence on discharge barriers and facilitators for individuals receiving long-term or post-acute care who have functional and cognitive impairments, very little is known about the mental, functional and physical health outcomes of individuals with mental illness after discharge from a post-acute or long-term care setting. This gap is particularly concerning, the researchers said, given that older adults with mental illness have more comorbidities and higher rates of premature mortality, as well as face increased barriers to health services compared with older adults without mental illness.
The authors concluded that targeted funding is needed to support research in this area, particularly in assisted living communities, which are underrepresented in the literature. New research, they added, could inform the development of effective discharge processes, guide evidence-based policy reform, and promote successful post-discharge community reintroductions for residents with mental illness.