Skip to main content
SpringerLink
Log in

Mental health service use and cost of care for older adults in assisted living facilities: Implications for public policy

  • Brief Report
  • Published:
The Journal of Behavioral Health Services & Research Aims and scope Submit manuscript

Abstract

With changing demographics prompting greater demand for assisted living facility (ALF) care, indigent older adults with mental health needs face underfunded residential care options and mental health systems currently unprepared to meet their service requirements. In particular, overreliance on inpatient mental health services for older individuals with mental illness and inadequate reimbursement of ALF facilities potentially increase costs and threaten availability of ALF care. This article analyzes Florida's administrative data and presents findings on mental health service use and cost of care for poor older persons. Using Florida as an example, the authors recommend policy changes to ensure the quality and availability of residential care for low-income adults with mental health needs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

References

  1. Gatz M, Kasl-Godley JE, Karel MJ. Aging and mental disorders. In: Birren JE, Schaie WK, Abeles RP, et al, eds.Handbook of the Psychology of Aging. 4th ed. San Diego, CA: Academic Press; 1996:365–382.

    Google Scholar 

  2. Burns BJ, Taube CA. Mental health services in general medical care and nursing homes. In: Fogel BG, Furino A, Gottlieb GL, eds.Mental Health Policy for Older Americans. Washington, DC: American Psychiatric Press; 1990:63–84.

    Google Scholar 

  3. Jeste DV, Alexopoulos GS, Bartels SJ, et al. Consensus statement on the upcoming crisis in geriatric mental health.Archives of General Psychiatry. 1999;56:848–853.

    Google Scholar 

  4. Atay JE, Witkin MJ, Manderscheid RW.Utilization of Mental Health Organizations by Elderly Persons, Mental Health Statistical Note 214. Rockville, MD: Center for Mental Health Services; 1995. DHHS publication (SMA) 95-3032.

    Google Scholar 

  5. Semke J, Fisher WH, Goldman HH, et al. The evolving role of the state hospital in the care and treatment of older adults: state trends 1984 to 1993.Psychiatric Services. 1996;47:1082–1087.

    Google Scholar 

  6. Gutheil I. The physical environment and quality of life in residential facilities for frail elderly.Adult Residential Care Journal. 1991;5:131–145.

    Google Scholar 

  7. Kane R. Personal autonomy for residents in long-term care: concepts and measurements. In: Birren J, Lubben J, Rowe J, Deutchman D, eds.The Concept and Measurement of Quality of Life in the Frail Elderly. San Diego, CA: Academic Press; 1991:316–334.

    Google Scholar 

  8. Florida Department of Health and Rehabilitative Services.Review of Class Members Recently Discharged from G. Pierce Wood Memorial Hospital: Johnson v. Kurtz. Tallahassee, FL: State of Florida, Office of the Monitor; 1996.

    Google Scholar 

  9. Gatz M, Smyer MA. The Mental Health System and Older Adults in the 1990s.American Psychologist. 1992;47:741–751.

    Google Scholar 

  10. Smyer MA, Shea DG, Streit A. The provision and use of mental health services in nursing homes: results from the National Medical Expenditure Survey.American Journal of Public Health. 1994;84:284–287.

    Google Scholar 

  11. Katz IR, Simpson GM, Curlik SM, et al. Pharmacologic treatment of major depression for elderly patients in residential care setting.Journal of Clinical Psychology. 1989;51(7S):41–47.

    Google Scholar 

  12. American Association of Retired Persons (AARP) Public Policy Institute. Across the states: profiles of long-term care systems. Eds. RW Bectel and NG Tucker. Washington, DC: AARP; 1998.

    Google Scholar 

  13. Hodlewsky RT. Facts and trends: the assisted living sourcebook. Washington, DC: National Center for Assisted Living; 1998.

    Google Scholar 

  14. Hatfield AB, Worrall R.Issues in Mental Illness and Aging. Greenbelt, MD: The Nation's Voice on Mental Illness; 1997.

    Google Scholar 

  15. Bartsch DA, Shern DL, Coen AS, et al. Service needs, receipt, and outcomes for types of clients with serious and persistent mental illness.The Journal of Mental Health Administration. 1995;22:430–440.

    Google Scholar 

  16. Mollica RL.State Assisted Living Policy. Portland, ME: National Academy for State Health Policy; 1998.

    Google Scholar 

  17. Fla Stat § 440.402(2).

  18. Murtaugh CM, Sparer MS, Feldman PH, et al.State Strategies for Allocating Resources to Home and Community-Based Care. New York: Center for Home Care Policy and Research, Visiting Nurse Service of New York; 1999.

    Google Scholar 

  19. Nymen JA. Assisted living: will it reduce long-term care costs?Journal of Aging and Social Policy. 1994;6:33–42.

    Google Scholar 

  20. Oakley ML.Controlling Nursing Home Bed Supply Must Be a Part of the Plan To Promote Aging in Place. Tampa, FL: Florida Policy Exchange Center on Aging; 2000. Aging Research & Policy Report, 9.

    Google Scholar 

  21. Mitchell JM, Kemp BJ. Quality of life in assisted living homes: a multidimensional analysis.Journal of Gerontology. 2000;55B:117–127.

    Google Scholar 

  22. Kane RA, Kane RL, Hixon Ilston L, Nyman JA, Finch MD. Adult foster care for the elderly in Oregon: a mainstream alternative to nursing homes?American Journal of Public Health. 1991;81(9):1113–1120.

    Google Scholar 

  23. Regnier V, Hamilton J, Yatabe S.Assisted Living for the Aged and Frail. New York: Columbia University Press; 1995.

    Google Scholar 

  24. Mollica RL.State Assisted Living Policy 2000. Portland, ME: National Academy for State Health Policy; 2000.

    Google Scholar 

  25. Office of Program Policy Analysis and Government Accountability.Review of Assisted Living Facilities Serving Residents with Severe Mental Illnesses. Tallahassee, FL: The Florida Legislature; 1997. Report 96-57.

    Google Scholar 

  26. Brooks ML.A Comparative Analysis of the Characteristics of Adult Congregate Living Facilities in Florida That Do and Do Not Accept Optional State Supplementation Residents. Tampa, FL: Department of Gerontology, University of South Florida; 1994. Master's thesis.

    Google Scholar 

  27. Oakley ML.Options for Increasing Financial Support to Low-Income Individuals in Florida's Assisted Living Facilities. Tampa, FL: Florida Policy Exchange Center on Aging; 2000.

    Google Scholar 

  28. Florida Facility Industry. Tampa, FL: Florida Policy Exchange Center on Aging; 1996.

  29. Becker M, Stiles P, Schonfeld L.A Study of Mental Health Service Needs, Receipt, and Outcomes for OSS Clients Residing in Florida Assisted Living Facilities. Tampa, FL: University of South Florida, Louis de la Parte Florida Mental Health Institute; 1997.

    Google Scholar 

  30. Bachrach L.The Homeless Mentally Ill. The Chronic Mental Patient/II. Washington, DC: American Psychiatric Press; 1987:65–92.

    Google Scholar 

  31. May ME, Kaminska E, Kasten J, et al.Managing Institutional Long-Term Care for the Elderly. Gaithersburg, MD: Aspen Publishers, Inc; 1991.

    Google Scholar 

  32. Mechanic D, Rochefort D. A policy of inclusion for the mentally ill.Health Affairs. 1992;11:128–149.

    Google Scholar 

  33. Mollica RL, Wilson KB, Ryther BS, et al.Guide to Assisted Living and State Policy. Washington, DC: National Academy for State Health Policy; 1995.

    Google Scholar 

  34. Okin RL, Borus JF, Baer L, et al. Long-term outcome of state hospital patients discharged into structured community residential setting.Psychiatric Services, 1995;46:73–78.

    Google Scholar 

  35. Speer DC, Stiles PG. A crying shame.Responses to an Aging Florida. Fall 1998:23–25.

  36. Nyman JA, Svetlik MA. Does the average cost of home care vary with case mix?Public Health Reports. 1989;104(4):335–341.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Community Mental Health, Louis de la Parte Florida Mental Health Institute, University of South Florida, 13301 Bruce B. Downs Boulevard, 33612, Tampa, FL

    Marion Becker RN, PhD (Associate Professor)

  2. Department of Mental Health Law and Policy, Louis de la Parte Florida Mental Health Institute, University of South Florida, USA

    Paul Stiles JD, PhD (Associate Professor)

  3. Department of Aging and Mental Health, Louis de la Parte Florida Mental Health Institute, University of South Florida, USA

    Lawrence Schonfeld PhD (Professor)

Authors
  1. Marion Becker RN, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Paul Stiles JD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lawrence Schonfeld PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marion Becker RN, PhD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Becker, M., Stiles, P. & Schonfeld, L. Mental health service use and cost of care for older adults in assisted living facilities: Implications for public policy. The Journal of Behavioral Health Services & Research 29, 91–98 (2002). https://doi.org/10.1007/BF02287836

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02287836

Keywords

Search

Navigation