Mental Health Patients' Long-Term Care Institutionalization upon Hospital Discharge: Evidence from the 2007-2009 National Hospital Discharge Survey

Objective: Nursing home residents increasingly are being admitted from hospitals, with a significant share diagnosed with mental disorders. We examined factors associated with mental health patients' discharge status and how these vary by age.

Methodology: We compared working-age patients (age 18 to 64, n=100,241) and older patients (age 65 and older, n=79,158), using the pooled data from the 2007 through 2009 National Hospital Discharge Survey. A logistic regression analysis was used to examine the risk factors for institutionalization.

Findings: General mental disorders diagnosis increased the risks of institutionalization among the total sample population (age 18 and older) and in the older patients (OR=1.65, 95%CI[1.54,1.76]). Non-organic psychotic conditions increased the risks of institutional use in both groups. Patients with mental retardations were more likely to be institutionalized in both groups (OR=4.29, 95%CI[3.32,5.54], and OR=1.75, 95%CI[1.07,2.86]). Being Black was associated with higher risks in older group but not in working-age group. Medicare or Medicaid coverage was each associated with greater odds of institutionalization in both groups, and the effect was greater in the working-age group (OR=3.27, 95%CI[2.98,3.59] and OR=2.42, 95%CI[2.17,2.70]). Admission through the ER or from nursing facilities substantially increased the odds of institutional use. Patients discharged with lower-limb fractures or HIV/AIDS experienced greater the odds to be institutionalized in both age groups.

Implications: Patients with psychosis disorders or mental retardations experienced significantly greater odds of institutionalization after adjusting for other factors. Being Black increased the risks, especially among older patients. Research is needed to further explore the basis of this disparity.