Deficiency Citations for Mental Health Care in Nursing Homes

  • Nicholas G. Castle


The Centers for Medicare and Medicaid Services (CMS) certifies approximately 17,000 nursing homes per year. When a facility does not meet a standard, a deficiency citation is issued. Using 1998 citations, we examined the structure and process characteristics of nursing homes that were associated with mental health deficiencies. Our findings showed that (a) some nursing homes have a high number of deficiencies in the area of mental health care; (b) these deficiencies do not appear to be associated with specific processes used in nursing homes; and (c) some structural factors such as staffing, private-pay occupancy, and Medicare occupancy appear to have an important influence on the number of mental health care deficiencies.

deficiency citations Medicaid Medicare nursing homes 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Achterberg, W.P., van Campen, C., Pot, A.M., Kerkstra, A., & Ribbe, M.W. (1999). Effects of the resident assessment instrument on the care process and health outcomes in nursing homes: A review of the literature. Scandinavian Journal of Rehabilitation Medicine, 31, 131–137.PubMedGoogle Scholar
  2. Borson, S., Liptzin, B., Nininger, J., & Rabins, P. (1987). Psychiatry and the nursing home. American Journal of Psychiatry, 144, 1412–1418.PubMedGoogle Scholar
  3. Braun, B.I. (1991). The effect of nursing home quality on patient outcome. Clinical Investigations, 39, 329–338.Google Scholar
  4. Burns, B.J., & Taube, C.A. (1990). Mental health services in general medical care and in nursing homes. In B. Fogel, A. Furino, & G. Gottlieb (Eds.), Mental health policy for older Americans: Protecting minds at risk (pp. 63–84). Washington, DC: American Psychiatric Press.Google Scholar
  5. Burns, B.J., Wagner, H.R., Taube, J.E., Magaziner, J., Permutt, T., & Landerman, L.R. (1993). Mental health service use by the elderly in nursing homes. American Journal of Public Health, 83(3), 330–337.Google Scholar
  6. Castle, N.G. (2000). Deficiency citations for physical restraint use in nursing homes. Journal of Gerontology: Social Sciences, 55B(1), S33-S40.Google Scholar
  7. Castle, N.G., & Fogel, B. (1998). Characteristics of nursing homes that are restraint free. The Gerontologist, 38(2), 181–188.PubMedGoogle Scholar
  8. Coleman, B. (1991). The Nursing Home Reform Act of 1987: Provisions, policy, prospects. Boston, MA: University of Massachusetts at Boston Gerontology Institute.Google Scholar
  9. Davis, M.A. (1991). On nursing home quality: A review and analysis. Medical Care Review, 48(2), 129–166.PubMedGoogle Scholar
  10. Day, P., & Klein, R. (1987). The regulation of nursing homes: A comparative perspective. The Milbank Quarterly, 65(3), 303–347.PubMedGoogle Scholar
  11. Demaris, A. (1992). Logit modeling: Practical applications. Newbury Park, CA: Sage.Google Scholar
  12. Donabedian, A. (1988). The quality of care. Journal of the American Medical Association, 260, 1743–1748.PubMedGoogle Scholar
  13. Emerson Lombardo, N.B., Belleville-Taylor, P., Fogel, B., Levine, D.L., Morris, J.N., Morris, S., Murphy, K., Muse, D.N., Ooi, W.L., & Sherwood, S. (1994). Barriers to mental health services for nursing home residents. Public Policy Institute, Report No. 9401. Washington, DC: American Association of Retired Persons.Google Scholar
  14. Emerson Lombardo, N.B., Fogel, B.S., Robinson, G.K., & Weiss, H.P. (1995). Achieving mental health of nursing home residents: Overcoming barriers to mental health care. Journal of Mental Health and Aging, 1(3), 165–203.Google Scholar
  15. Flood, A.B., & Scott, W.R. (1987). Hospital structure and performance. Baltimore, MD: Johns Hopkins University Press.Google Scholar
  16. Freiman, M.P., Arons, B.S., Goldman, H.H., & Burns, B.J. (1990). Nursing home reform and the mentally ill. Health Affairs, 9, 47–60.Google Scholar
  17. General Accounting Office. (1998). California nursing homes: Care problems persist despite federal and state oversight (GAO/HEHS–98–202). Washington, DC: Author.Google Scholar
  18. General Accounting Office. (1999a). Nursing homes: Additional steps needed to strengthen enforcement of federal quality standards (GAO/HEHS–99–46). Washington, DC: Author.Google Scholar
  19. General Accounting Office. (1999b). Nursing homes: Complaint investigation process often inadequate to protect residents (GAO/HEHS–99–80). Washington, DC: Author.Google Scholar
  20. General Accounting Office. (1999c). Nursing homes: Proposal to enhance oversight of poorly performing homes has merit (GAO/HEHS–99–157). Washington, DC: Author.Google Scholar
  21. Goldman, H.H., Felder, J., & Scanlon, W. (1986). Chronic mental patients in nursing homes: Reexamining data from the National Nursing Home Survey. Hospital and Community Psychiatry, 37, 269–272.PubMedGoogle Scholar
  22. Graber, D.R., & Sloane, P.D. (1995). Nursing home survey deficiencies for physical restraint use. Medical Care, 33, 1051–1063.PubMedGoogle Scholar
  23. Gustafson, D.H., Sainfort, F.C., Van Konigsveld, R., & Zimmerman, D.R. (1990). The quality assessment index (QAI) for measuring nursing home quality. Health Services Research, 25, 97–128.PubMedGoogle Scholar
  24. Institute of Medicine. (1986). Improving the quality of care in nursing homes. Washington, DC: National Academy Press.Google Scholar
  25. Intrator, O., Castle, N.G., & Mor, V. (1999). Facility characteristics associated with hospitalization of nursing home residents: Results of a national study. Medical Care, 37(3), 228–237.PubMedGoogle Scholar
  26. Kane, R.A., & Kane, R.L. (1988). Long-term care: Variations on a quality assurance theme. Inquiry, 25, 132–146.PubMedGoogle Scholar
  27. Kennedy, P. (1992). A guide to econometrics (3rd ed.). Cambridge, MA: MIT Press.Google Scholar
  28. Koenig, H., George, L., Meador, K. (1997). Use of antidepressants by nonpsychiatrists in the treatment of medically ill hospitalized depressed elderly patients. American Journal of Psychiatry, 154, 1369–1375.PubMedGoogle Scholar
  29. Lebowitz, B.D., Pearson, J.L., Schneider, L.S., Reynolds, C.F., Alexopoulos, G.S., Bruce, M.L., Conwell, Y., Katz, I.R., Meyers, B.S., Morrison, M.F., Mossey, J., Niederehe, G., & Parmelee, P. (1997). Diagnosis and treatment of depression in late life: Consensus statement update. Journal of the American Medical Association, 278(14), 1186–1190.PubMedGoogle Scholar
  30. Maddala, G.S. (1977). Econometrics. New York: McGraw-Hill.Google Scholar
  31. Migdail, K.J. (1992). Nursing home reform: Five years later. Journal of American Health Policy, 2(1), 41–46.PubMedGoogle Scholar
  32. Ray, W.A., Federspiel, C.F., & Schaffner, W. (1980). A study of antipsychotic drug use in nursing homes: Epidemiologic evidence suggesting misuse. American Journal of Public Health, 70, 485–491.PubMedGoogle Scholar
  33. SAS/STAT User's Guide [computer software] (Version 6, 4th ed., Vol. 2). (1990). Cary, NC: SAS Institute.Google Scholar
  34. Schnelle, J.F., Newman, D.R., White, M., Volner, T.R., Burnett, J., Cronqvist, A., & Ory, M. (1992). Reducing and managing restraints in long-term facilities. Journal of the American Geriatrics Society, 40(4), 381–385.PubMedGoogle Scholar
  35. Shadish, W.R., Luringion, A.J., & Lewis, D.A. (1990). After deinstitutionalization: The present and future of mental health long-term care policy. Journal of Social Issues, 45(3), 1–15.Google Scholar
  36. Shea, D., Streit, A., & Smyer, M. (1994). Determinants of the utilization of mental health services by nursing home residents. Health Services Research, 29(2), 169–185.PubMedGoogle Scholar
  37. Sheridan, J.E., White, J., & Fairchild, T.J. (1992). Ineffective staff, ineffective supervision, or ineffective administration? Why some nursing homes fail to provide adequate care. The Gerontologist, 32, 334–341.PubMedGoogle Scholar
  38. Shorr, R.I., Fought, R.L., & Ray, W.A. (1994). Changes in antipsychotic drug use in nursing homes during implementation of OBRA-87 regulations. Journal of the American Medical Association, 271, 358–362.PubMedGoogle Scholar
  39. Shortell, S.M., O'Brien, J.M., Carman, R.W., Foster, E.F., Hughes, F.X., Boerstler, H., & O'Connor, E.J. (1995). Assessing the impact of continuous quality improvement/total quality management: Concept versus implementation. Health Services Research, 30(2), 377–401.PubMedGoogle Scholar
  40. Smyer, M., Shea, D., & Streit, A. (1994). The provision and use of mental health services in nursing homes: Results from the national medical expenditure survey. American Journal of Public Health, 84(2), 284–287.PubMedGoogle Scholar
  41. Sorock, G., & Shimkin, E. (1999). Benzodiazepine sedatives and the risk of falling in a community dwelling elderly cohort. Archives of Internal Medicine, 148, 2441–2444.Google Scholar
  42. Spector, W., & Takada, H.A. (1991). Characteristics of nursing homes that affect resident outcomes. Journal of Aging and Health, 3, 427–454.PubMedGoogle Scholar
  43. Strahan, G.W. (1990). Mental illness in nursing homes: United States, 1985. Vital health statistics (Vol. 13, No. 105). Department of Health and Human Services Publication No. (PHS) 91–17668. Washington, DC: United States Government Printing Office.Google Scholar
  44. Strahan, G.W. (1991). Prevalence of selected mental disorders in nursing and related care homes. Mental health United States. Department of Health and Human Services Publication No. (ADM) 90–1708. Washington, DC: United States Government Printing Office.Google Scholar
  45. Strotsky, B., & Strotsky, E. (1985). Nursing homes: Improving a flawed community facility. Hospital and Community Psychiatry, 34, 238–242.Google Scholar

Copyright information

© Human Sciences Press, Inc. 2001

Authors and Affiliations

  • Nicholas G. Castle
    • 1
  1. 1.RANDPittsburgh

Personalised recommendations