The prevalence of serious mental illness (SMI) among people who live in assisted-living communities is rising faster than in the community at large, suggests a study in the American Journal of Geriatric Psychiatry.
“This increased prevalence of SMI in [assisted living] has implications for the provision of mental health services in this setting, a topic that is largely underexplored other than in broad strokes,” wrote Cassandra L. Hua, Ph.D., of the Brown University School of Public Health and colleagues.
The researchers analyzed data from the Medicare Master Beneficiary Summary File, a ZIP code history file, OASIS home health assessment data, Medicare Part B claims, a national list of state licensed assisted-living communities, and a Residential History File. They separated the population into three groups: those who lived in the community at large, in a nursing home, or in assisted living on December 31 of each year from 2007 to 2017.
Over the 10-year period studied, the prevalence of SMI in assisted living increased by 54%, compared with an increase of 39% in the community at large. However, the prevalence of SMI rose the fastest in nursing homes, increasing 77%.
The prevalence of SMI in assisted living varied widely between states, ranging from 3.2% in Wyoming to 33.1% in New York.
“Given that Medicaid coverage of [assisted living] varies by state, funding for [assisted-living] services may remain suboptimal in many locations,” Hau and colleagues wrote. “Future research can empirically investigate the relationship between state Medicaid policy and changes in the prevalence of SMI in [assisted living].”
People with SMI had a higher prevalence of medical conditions such as obesity, COPD, and diabetes, and they were more likely to have at least six chronic conditions compared with people without SMI.
“The prevalence of health concerns may be a concern because … [assisted-living] communities are not required to provide round the clock nursing services, although 54% have an RN or LPN on staff,” the researchers wrote. “More research is needed into the mental health and medical care needs for this population.”
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