Article Abstract

Article Abstract

Online ISSN: 1099-176X Print ISSN: 1091-4358
The Journal of Mental Health Policy and Economics
Volume 6, Issue 2, 2003. Pages: 59-65

Published Online: 3 Oct 2003

Assisted Living and Use of Health Services among Medicaid Beneficiaries with Schizophrenia

Todd P. Gilmer, ^1* David P. Folsom,² William Hawthorne,³ Laurie A. Lindamer,⁴ Richard L. Hough,⁵ Piedad Garcia,⁶ Dilip V. Jeste⁷

¹Ph.D., Assistant Professor, Department of Family and Preventive Medicine, University of California, San Diego, CA, USA
²MD, Assistant Clinical Professor, Department of Family and Preventive Medicine, University of California, San Diego, CA, USA
³Ph.D., Associate Clinical Professor , Department of Psychiatry, University of California, San Diego - Executive Director, Community Research Foundation, San Diego, CA, USA
⁴Ph.D., Assistant Professor, Department of Psychiatry, University of California, San Diego, San Diego. CA, USA
⁵Ph.D., Co-Director, Child and Adolescent Services Research Center, San Diego Children's Hospital and Health Center, Emeritus Professor of Sociology, San Diego State University, Adjunct Professor of Psychiatry, University of California, San Diego, Adjunct Professor of Psychiatry, University of New Mexico
⁶EdD, Clinical Director, San Diego County Health and Human Services, Adult and Older Adult Mental Health Services
⁷MD, Estelle and Edgar Levi Chair in Aging, Professor of Psychiatry & Neurosciences, Chief, Division of Geriatric Psychiatry, University of California, San Diego, San Diego. CA, USA#

*Correspondence to: Todd P Gilmer, Ph.D., Assistant Professor, Department of Family and Preventive Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0622, USA
Tel.: +1-858-534 7596
Fax: +1-858-534 4642
E-mail: tgilmer@ucsd.edu

Source of Funding: This work was supported, in part, by the Center for Health Care Strategies, Inc., National Institute of Mental Health grants MH49671, MH43693, MH59101, and the Department of Veterans Affairs.

Abstract

The aim of this study was to compare the use of health services among persons with schizophrenia who were residing in assisted living facilities compared to those received by patients living independently and those who were homeless. Medicaid claims and regression modeling were used to analyze whether living in a board-and-care facility was related to use of outpatient mental health services, hospitalization and costs. Residents of board-and-care facilities had greater use of outpatient mental health services and lower rates of psychiatric and medical hospitalization. Pharmacy costs and total health care costs were highest in assisted living. Our analysis suggests that assisted living was related to greater use of outpatient mental health services and lower rates of hospitalization. Thus, assisted living facilities may provide a suitable environment though which to provide outpatient mental health services, and policy makers interested in reducing homelessness through interventions might consider subsidizing these facilities.

Background: Considerable attention has been given to the appropriateness of mental and medical health care provided to residents of certain assisted living facilities specialized for the severely mentally ill. However, there exists little objective evidence regarding the level of services provided by these facilities in general.
Aims of the Study: To compare the use of mental and medical health services among persons with schizophrenia who were residing in assisted living facilities compared to those received by patients living independently and those who were homeless.
Methods: Medicaid claims were combined with person level data on living situation and psychological and social functioning for 1998-2000. Regression models were used to analyze whether living in a board-and-care facility was related to use of outpatient mental health services including case management, therapy, crisis stabilization, medication supervision, day treatment, and drug treatment, the probability of acute psychiatric hospitalization, the probability of hospitalization for physical health, and costs.
Results: Residents of board-and-care facilities had greater use of outpatient mental health services and lower rates of psychiatric and medical hospitalization. Pharmacy costs and total health care costs were highest in assisted living.
Discussion: Our data was observational, and selection processes related to illness severity likely affect living arrangement. Our analysis suggests that assisted living was related to greater use of outpatient mental health services and lower rates of hospitalization.
Implications for Health Policies: Assisted living facilities may provide a suitable environment though which to provide outpatient mental health services. Policy makers interested in reducing homelessness through interventions might consider subsidizing these facilities.
Implications for Further Research: Research studies should be designed to evaluate characteristics of assisted living facilities that lead to improved function and outcomes among residents.

Received 19 May 2003; accepted 6 August 2003