Barriers to Discharge for Nursing Home Residents With Serious Mental Illness

Published in the JAMA Network Open. Here is a link to the article.

Regenstrief Institute authors: Kathleen T. Unroe, M.D., MHA, M.S.

This qualitative study explored why nursing home residents with serious mental illness, such as schizophrenia or bipolar disorder, often remain in long-term care despite being candidates for community living. Through interviews with 15 staff members from eight U.S. nursing homes, researchers identified barriers to discharge at multiple levels. Individual factors included behavioral challenges, medication noncompliance, and refusal to leave. Relational barriers involved limited family support and strained professional relationships. Structural challenges included insurance restrictions, limited community-based psychiatric and substance use treatment options, and transportation issues. Together, these factors contribute to unnecessary long-term stays. The findings highlight the need for coordinated, multi-level strategies to support safe and appropriate transitions to community care for residents with serious mental illness.

This work was supported by grant RF1AG08201 from the National Institutes of Health’s National Institute on Aging.

Authors: 

Charity M Hoffman ¹, Hannah C Ratliff ¹, Sarah L Krein ^2 3 4, Kierstdea Petzold ³, Kathleen T Unroe ⁵, Kali S Thomas ⁶, Molly Turnwald ¹, Erika Ratliff ¹, Terrence Gatton ¹, Donovan T Maust ^1 3 4

Affiliations: