Department of Psychiatry, Dartmouth Medical School, New Hampshire, USA.
J Aging Soc Policy. 2011 Jul-Sep;23(3):286-304. doi: 10.1080/08959420.2011.579511.
The appropriateness of nursing homes for individuals with serious mental illness remains a controversial issue in long-term care policy more than a decade since the landmark U.S. Supreme Court Olmstead decision in 1999 , which affirmed the rights of persons with disabilities to live in their communities. Using national nursing home Minimum Data Set assessments from 2005, the authors compared the demographic, clinical, and functional characteristics of persons with and without serious mental illness newly admitted to nursing homes. They found that newly admitted people with serious mental illness were younger and more likely to become long-stay residents than those admitted with other conditions, despite a higher proportion of residents with serious mental illness, including the elderly, classified as low-care status. The most substantial and clinically significant difference for rates of low-care status 90 days after initial admission are for persons younger than 65 with serious mental illness versus those younger than 65 without serious mental illness (33% vs. 8.5%, or 3.9 times greater). There is a notable difference in low-care status between persons aged 65 and older with serious mental illness and those aged 65 and older without serious mental illness (14% vs. 6.6%, or 2.1 times greater). These results suggest that a substantial number of adults with serious mental illness residing in nursing homes may have the functional capacity to live in less restrictive environments.
自 1999 年美国最高法院具有里程碑意义的 Olmstead 裁决以来，将患有严重精神疾病的个人安置在养老院的适宜性问题一直是长期护理政策中的一个有争议的问题。该裁决确认了残疾人在社区生活的权利。利用 2005 年全国养老院最低数据设置评估，作者比较了新入住养老院的患有严重精神疾病和没有严重精神疾病的人的人口统计学、临床和功能特征。他们发现，新入住的患有严重精神疾病的人比其他疾病的人更年轻，更有可能成为长期居住者，尽管患有严重精神疾病的居民比例较高，包括被归类为低护理状态的老年人。在最初入院后 90 天，低护理状态的比例存在最大且最具临床意义的差异，即患有严重精神疾病的 65 岁以下人群与没有严重精神疾病的 65 岁以下人群（33%比 8.5%，或 3.9 倍）。患有严重精神疾病的 65 岁及以上人群与没有严重精神疾病的 65 岁及以上人群之间的低护理状态存在显著差异（14%比 6.6%，或 2.1 倍）。这些结果表明，居住在养老院的患有严重精神疾病的成年人中有相当一部分可能具有在限制较少的环境中生活的功能能力。
