Community Mental Health Journal

, Volume 49, Issue 4, pp 389–395 | Cite as

State Regulations for Nursing Home Residents with Serious Mental Illness

Original Paper


To identify state regulations for nursing home residents with Serious Mental Illness (SMI). We reviewed state regulations for policies relating to nursing home residents with SMI, and conducted interviews with expert stakeholders. A framework for analyzing state regulations was generated by identifying four discrete categories: States with specific mental illness regulations, Alzheimer’s or dementia regulations, minor mention of mental illness, and no mention of mental illness. A large majority of the states have little or no mention of mental illness in their nursing home regulations, suggesting limited attention to all forms of mental illness by most state regulatory bodies.


SMI Long term care State regulations 



This research was funded by a research grant from The State of Florida Agency for Health Care Administration. The authors would like to acknowledge Cassi Meyerhoffer, Robert Michael Goggin, Kimberly McGann, and Jennifer Greene for their assistance with data collection, and Jeralynn Cossman and Barbara Dombrowski for helpful comments.

Conflicts of interest



  1. American Geriatrics Society, American Association for Geriatric Psychiatry. (2003). Consensus statement on improving the quality of mental health care in US nursing homes: Management of depression and behavioral symptoms associated with dementia. Journal of the American Geriatrics Society, 51, 1287–1298.CrossRefGoogle Scholar
  2. Appelbaum, P. (2003). The ‘quiet’ crisis in mental health services. Health Affairs, 22, 110–116.PubMedCrossRefGoogle Scholar
  3. Bagchi, A. D., Verdier, J. M., & Simon, S. E. (2009). How many nursing home residents live with mental illness? Psychiatric Services, 60(7), 958–964.PubMedCrossRefGoogle Scholar
  4. Bartels, S. J., Muesser, K. T., & Miles, K. M. (1997). A comparative study of elderly patients with schizophrenia and bipolar disorder in nursing homes and the community. Schizophrenia Research, 27(2–3), 181–190.PubMedCrossRefGoogle Scholar
  5. Bartels, S. J., Miles, K. M., Dums, A. R., & Levine, K. J. (2003). Are nursing homes appropriate for older adults with severe mental illness? Conflicting consumer and clinician views and implications for the Olmstead decision. Journal of the American Geriatrics Society, 51(11), 1571–1579.PubMedCrossRefGoogle Scholar
  6. Becker, M., & Mehra, S. (2005). Serious mental illness in Florida nursing homes: A study of resident, facility, cost, and quality of care characteristics. Technical report presented to the Florida Agency for Health Care Administration, May 2005.Google Scholar
  7. Buck, J. A. (2003). Medicaid, health care financing trends, and the future of state-based public mental health services. Psychiatric Services, 54(7), 659–662.Google Scholar
  8. Burgio, L. D., Stevens, A., Burgio, K. L., Roth, D. L., Paul, P., & Gerstle, J. (2002). Teaching and maintaining behavior management skills in the nursing home. The Gerontologist, 42, 487–496.PubMedCrossRefGoogle Scholar
  9. Camp, C. J., Cohen-Mansfield, J., & Capezuti, E. A. (2002). Use of non-pharmacologic interventions among nursing home residents with dementia. Psychiatric Services, 53, 1397–1401.PubMedCrossRefGoogle Scholar
  10. Colenda, C. C., Streim, J., Greene, J. A., Meyers, N., Beckwith, E., & Rabins, P. (1999). The impact of OBRA’87 on psychiatric services in nursing homes: Joint testimony of the American Psychiatric Association and the American Association for Geriatric Psychiatry. American Journal of Geriatric Psychiatry, 7(1), 12–17.PubMedGoogle Scholar
  11. Fullerton, C. A., McGuire, T. G., Feng, Z., Mor, V., & Grabowski, D. C. (2009). Trends in mental health admissions to nursing homes, 1999–2005. Psychiatric Services, 60(7), 965–971.PubMedCrossRefGoogle Scholar
  12. Grabowski, D. C., Aschbrenner, K. A., Feng, Z., & Mor, V. (2009). Mental illness in nursing homes: Variation across states. Health Affairs, 28(3), 689–700.PubMedCrossRefGoogle Scholar
  13. Grabowski, D. C., Aschbrenner, K. A., Rome, V. F., & Bartels, S. J. (2010). Quality of mental health care for nursing home residents: A literature review. Medical Care Research and Review, 67(6), 627–656.PubMedCrossRefGoogle Scholar
  14. Harvey, P. D., Howanitz, E., Parrella, M., Davidson, M., Mohs, R. C., et al. (1998). Symptoms, cognitive functioning, and adaptive skills in geriatric patients with lifelong schizophrenia: A comparison across treatment sites. American Journal of Psychiatry, 155, 1080–1086.PubMedGoogle Scholar
  15. Hyer, K., & Johnson, C. (2005). Serious Mental Illness in Florida nursing homes: A study of the quality of care of Florida nursing homes serving high and low proportions of older SMI residents. Submitted to Florida Agency for Health Care Administration, Dec 2005.Google Scholar
  16. Kaiser Commission on Medicaid and the Uninsured. (January, 2006). Paying for nursing home care: Asset transfer and qualifying for Medicaid. Accessed on November 1, 2010.
  17. Katz, S., Adams, C., Beigel, A., et al. (1986). Improving the quality of care in nursing homes. Report of the Committee on Nursing Home Regulation. Washington DC: Institute of Medicine, National Academy Press.Google Scholar
  18. Linkins, K. W., Lucca Lucca, A. N., Housman, M., & Smith, S. A. (2006). Use of PASRR programs to assess serious mental illness and access in nursing homes. Psychiatric Services, 57, 325–332.PubMedCrossRefGoogle Scholar
  19. Linkins, K., Robinson, G., Karp, J., Cooper, S., Liu, J., & Bush, S. (2001). Screening for mental illness in nursing facility applicants: Understanding federal requirements. SAMHSA Publication No. (SMA) 01-3543. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, July 2001.
  20. Magaziner, J., German, P., Zimmerman, S. I., Hebel, J. R., Burton, L., Gruber-Baldini, A. L., et al. (2000). The prevalence of dementia in a statewide sample of new nursing home admissions aged 65 and older. The Gerontologist, 40(6), 663–672.PubMedCrossRefGoogle Scholar
  21. Molinari, V., Chiriboga, D., Branch, L., Cho, S., Turner, K., Guo, J., et al. (2010). Provision of psychopharmacological services in nursing homes. Journals of Gerontology: Psychological Sciences and Social Sciences, 65(1), 57–60.CrossRefGoogle Scholar
  22. Olmstead decision. (1999). Accessed on June 3, 2011.
  23. Omnibus Budget Reconciliation Act of 1987. Pub. L. No. 100-203, 101 Stat. 1330.Google Scholar
  24. Parmelee, P. A., Katz, I. R., & Lawton, M. P. (1993). Anxiety and its association with depression among institutionalized elderly. American Journal of Geriatric Psychiatry, 1, 46–58.CrossRefGoogle Scholar
  25. Phillips, C., & Spry, K. (2000). Characteristics and care of U.S. nursing home residents with a history of chronic mental illness. Canadian Journal of Aging, 19, 1–17.CrossRefGoogle Scholar
  26. Shea, D. G., Russo, P. A., & Smyer, M. A. (2000). Use of mental health services by persons with a mental illness in nursing facilities: initial impacts of OBRA87. Journal of Aging and Health, 12, 560–578.PubMedCrossRefGoogle Scholar
  27. Snowden, M., & Roy-Byrne, P. (1998). Mental illness and nursing home reform: OBRA-87 ten year later. Psychiatric Services, 49, 229–233.PubMedGoogle Scholar
  28. Surgeon General of the United States. (1999). Mental Health: A report of the surgeon general. Washington DC: US Public Health Service. Accessed on November 4, 2010.
  29. Teresi, J., Abrams, R., Holmes, D., Ramirez, M., & Elmicke, J. (2001). Prevalence of depression and depression recognition in nursing homes. Social Psychiatry and Psychiatric Epidemiology, 36, 613–620.PubMedCrossRefGoogle Scholar
  30. Zhang, N. J., Gammonley, D., Paek, S. C., & Frahm, K. (2008). Facility service environments, staffing, and psychosocial care in nursing homes. Health Care Financing Review, 30(2), 5–17.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Department of SociologyThe State University of New York at BuffaloBuffaloUSA
  2. 2.School of Aging Studies, College of Behavioral and Community SciencesUniversity of South FloridaTampaUSA
  3. 3.Department of Child & Family StudiesUniversity of South FloridaTampaUSA

Personalised recommendations