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In Washington, D.C., last month, APA and the American Association for Geriatric Psychiatry urged a committee of the Institute of Medicine to improve the quality and accessibility of psychiatric care for patients in the nation's nursing facilities.
"The unfortunate fact is that treatment of mental disorders in the nursing facility population still does not receive the emphasis and attention that the prevalence of such disorders warrants," testified Peter Rabins, M.D., a geriatric psychiatrist at Johns Hopkins University School of Medicine, on behalf of APA and the AAGP at the hearing. The two groups also submitted a joint written statement to the Institute of Medicine Committee on Improving Quality of Long-Term Care. The Institute of Medicine is an arm of the National Academy of Sciences.
Prevalence studies have shown that two of every three nursing home residents have diagnosable mental disorders and one in four has clinically significant symptoms of depression.
At the same time, some progress has been made since Congress passed nursing home reforms in the Omnibus Budget Reconciliation Act (OBRA) of 1987.
For example, the inappropriate use of psychotropic medications has declined, multidisciplinary treatment guidelines have been developed, data collection has improved, and nursing home residents with primary or secondary psychiatric diagnoses are increasingly identified, according to Rabins.
Nonetheless, barriers remain to ensuring access to medically necessary psychiatric services such as fragmented Medicare/Medicaid payment sources and inconsistent application of coverage policies and determinations of medically necessary care, according to the joint statement.
"Stigma against persons with mental illness should be eradicated, such as the prejudicial term 'chemical restraint' in the federal regulatory vocabulary," Rabins stressed.
He urged the committee to recommend that federal policy focus on developing specific and measurable outcomes for patient care that recognize the quality of the resident's living environment and his or her ability to obtain high-quality medically necessary psychiatric services in a timely and efficient manner.
To achieve this, Rabins recommended the following actions:
Rabins concluded in his testimony, "Mr. Chairman, given the prevalence of mental disorders, sound medical policy should place an emphasis on appropriate care. To achieve this, APA and AAGP strongly recommend the continued development and refinement of psychiatric and mental health quality outcome measures for nursing facilities and other long-term-care settings such as home health care, unregulated board and care homes, continuing care communities, Medicare-certified subacute hospital-based nursing facilities, [and] long-term-care hospitals."
Christopher Colenda, M.D., chair of APA's Council on Aging, later told Psychiatric News that "APA and AAGP members need to participate in policymaking discussions because of our expertise in psychiatric and geriatric care."
He encouraged district branch members who are interested in geriatric psychiatry to join local committees on aging and discussions on improving the quality of long-term care in state Medicaid programs. Medicaid is the biggest payer of long-term nursing care, Colenda noted.