Barooah Adrita, Nadash Pamela
Department of Gerontology, John W. McCormack Graduate School of Policy and Global Studies, 14708University of Massachusetts Boston, Boston, MA, USA.
J Appl Gerontol. 2023 Feb;42(2):252-258. doi: 10.1177/07334648221131186. Epub 2022 Oct 3.
Rising rates of mental illness in nursing homes (NHs) led Congress to pass the 1987 Pre-Admission Screening and Resident Review (PASRR) mandate, aimed at limiting inappropriate institutionalization of people with mental illness (MI) and ensuring appropriate service of NH residents with MI. The law's flexibility results in significant cross-state variations. This study explores Massachusetts' experiences with PASRR implementation, using semi-structured interviews (=8) with key informants representing major stakeholders. Thematic Content Analysis was used for analysis.Four themes emerged as follows: 1) PASRR screens MI, insufficient in ensuring services, 2) NHs face challenges implementing PASRR, 3) inadequate community-based services increase pressure on NHs, and 4) reactions to PASRR revisions were mixed. Participants agreed that PASRR's first aim was met-avoiding inappropriate institutionalization-but not the second-ensuring appropriate services, and highlighted the limited community alternatives for serving people with MI. More research is needed to understand state variations in PASRR implementation.
养老院中心理疾病发病率的上升促使国会在1987年通过了入院前筛查和居民审查（PASRR）指令，旨在限制对患有精神疾病（MI）的人群进行不适当的机构收容，并确保为患有精神疾病的养老院居民提供适当的服务。该法律的灵活性导致了各州之间存在显著差异。本研究通过对代表主要利益相关者的关键信息提供者进行半结构化访谈（n = 8），探讨了马萨诸塞州在实施PASRR方面的经验。采用主题内容分析法进行分析。出现了以下四个主题：1）PASRR筛查精神疾病，但在确保服务方面不足；2）养老院在实施PASRR时面临挑战；3）基于社区的服务不足增加了养老院的压力；4）对PASRR修订的反应不一。参与者一致认为，PASRR的首要目标——避免不适当的机构收容——已经实现，但第二个目标——确保适当的服务——并未实现，并强调了为患有精神疾病的人群提供服务的社区替代方案有限。需要开展更多研究以了解PASRR实施过程中的州际差异。
