Understanding working-age adults with mental illness living in nursing homes

项目摘要/摘要 1990年美国残疾人法案(ADA)，1999年奥姆斯特德最高法院裁决，以及ADA 2008年修订法案旨在保护患有严重精神疾病的人免受歧视 将制度化视为最后的手段，只有在以社区为基础的综合服务 这不是一个可行的选择。尽管有这些联邦命令，养老院可能已经取代了州立精神病院 医院是默认的护理来源。养老院现在为更多患有精神疾病的成年人提供服务 医疗设施加在一起。据认为，有10%-25%的养老院居民患有SMI。居民 患有SMI的人通常比普通居民年轻，需要疗养院可能无法提供的服务 来提供。对于目前这种潜在的劳动年龄成年人的仓储程度，人们缺乏了解 与SMI合作。我们建议使用2011-2016年联邦授权的纵向最小数据集3.0中的数据 认证和调查提供商增强了报告文件，以进行纵向观察 居住在养老院的22岁至岁成人的观察研究我们的 具体目标是：1)估计这些工作年龄养老院居民中SMI的总体流行率 和描述精神障碍的住院时间；2)检查这些患者的精神治疗收据 居民；以及3)使用潜变量模型在患有SMI的人中识别不同的功能亚组 并描述这些子组、居民和设施特征以及处置状态之间的关系。 这项提案涉及国家精神卫生研究所的战略目标2：绘制精神疾病图表 确定何时、何地和如何干预的轨迹和4.1：提高效率和效力 通过研究对现有的心理健康服务进行评估。这项探索性研究将为改进 通过说明当前的护理需求，向特别脆弱的人群提供精神卫生服务 有精神疾病的劳动适龄成年人。

PROJECT SUMMARY/ABSTRACT The 1990 Americans with Disabilities Act (ADA), 1999 Olmstead Supreme Court Decision, and ADA Amendments Act of 2008 are supposed to protect people with serious mental illness (SMI) against discrimination by considering institutionalization as the last resort to be used only if integrated community-based services are not a viable alternative. Despite these federal mandates, nursing homes may have replaced state psychiatric hospitals as the default source of care. Nursing homes now serve more adults with mental illnesses than all other healthcare facilities combined. Between 10-25% of nursing home residents are thought to have SMI. Residents with SMI are often younger than the typical resident and require services that nursing homes might not be able to provide. Knowledge is lacking about the current extent of this potential warehousing of working-age adults with SMI. We propose using data from the 2011-2016 federally mandated, longitudinal Minimum Data Set 3.0 and Certification and Survey Provider Enhanced Reporting files to conduct an observational longitudinal observational study of adults between the ages of 22 and 64 years with SMI residing in nursing homes. Our specific aims are to: 1) estimate the overall prevalence of SMI among these working-age nursing home residents and to describe the length of stay by psychiatric disorder; 2) examine receipt of psychiatric treatment for these residents; and 3) use latent variable models to identify distinct subgroups of functioning among those with SMI and describe relationships between these subgroups, resident and facility characteristics, and disposition status. This proposal addresses the National Institute of Mental Health’s Strategic Objectives 2: to chart mental illness trajectories to determine when, where, and how to intervene and 4.1: to improve the efficiency and effectiveness of existing mental health services through research. This exploratory research will inform efforts to improve the delivery of mental health services to a particularly vulnerable population by illuminating the current care needs of working-age adults with mental illness.