More mentally ill being housed in nursing homes

JEFFERSON CITY, Mo. -- The number of people with mental illnesses living in Missouri nursing homes is growing at the third fastest clip in the country.

Federal data from the Centers for Medicare and Medicaid prepared for The Associated Press show that more than 4,400 people with mental illnesses stayed in Missouri nursing homes last year. Across the U.S., more mentally ill adults are being cared for in nursing homes, but few states have experienced the rapid growth of Missouri.

Missouri's nursing home population of mentally ill adults between the ages of 22 and 64 is the eighth highest in the country. It has increased by 76 percent since 2002 -- a growth rate behind only Nevada and Utah and that dwarfs the overall national increase of 41 percent.

Missouri's increase has prompted state officials responsible for regulating nursing homes to study whether it's appropriate to care for the mentally ill in nursing homes. A main concern is whether a nursing home is the least restrictive living arrangement for someone with a mental illness.

Not aware of problems

Kit Wagar, a spokesman for the Missouri Department of Health and Senior Services, said the agency isn't aware of any problems that have been caused by housing the elderly and the mentally ill in the same facilities. Wagar said most of the complaints have been from someone who is mentally ill and doesn't like living in a nursing home.

Jon Dolan, the executive director of the Missouri Health Care Association that represents nursing homes, said care in those facilities is less costly than in hospitals and that nursing homes can safely help an underserved mentally ill population.

"My providers are branching out, and I think it's great when I see providers that are welcoming these toughest cases," he said.

Dolan said Missouri nursing homes use common sense in caring for the mentally ill and the elderly, such as creating separate wings for geriatric residents and for residents with mental illnesses.

Wagar said it's up to individual providers to determine how to group and bunk their residents.

"The homes that are involved with these younger clients have done a decent job of integrating them into it," Wagar said.

Use of nursing homes

To be accepted into a Missouri nursing home, a prospective resident must pass through a series of screenings that include psychological testing and a determination on whether the person needs skilled nursing.

Dolan said about a dozen Missouri nursing homes are specialty facilities that have nearly as many mentally ill as elderly residents.

The increasing use of nursing homes to house those with mental illnesses comes as two Arlington, Va.-based groups have released reports critical of Missouri's existing mental health-care system.

The Treatment Advocacy Center found in a 2008 report that Missouri has what the group called a "serious" shortage in beds for mental health treatment based on data from 2005. That study found that Missouri has 21.5 beds per 100,000 people, which was 15th best ratio in the country. But the group found states should have at least 50 beds per 100,000 people.

Earlier this month, the National Alliance on Mental Illness gave Missouri a "C" for its care of the mentally ill. The group warned that mental health care has worsened and cited lack of treatment bed space as a main concern.

The Department of Mental Health operates 11 psychiatric facilities, which includes long-term care, acute psychiatric care and children's psychiatric hospitals. The facilities have 1,483 beds, and in February, the average population was 1,430.