Quality of Nursing Homes Admitting Working-Age Adults With Serious Mental Illness

UMMS Affiliation

Clinical and Population Health Research Program, Morningside Graduate School of Biomedical Sciences; Department of Population and Quantitative Health Sciences

Publication Date


Document Type



Epidemiology | Health Services Administration | Health Services Research | Psychiatry and Psychology


OBJECTIVE: This cross-sectional study examined the association between nursing home quality and admission of working-age persons (ages 22-64 years) with serious mental illness.

METHODS: The study used 2015 national Minimum Data Set 3.0 and Nursing Home Compare (NHC) data. A logistic mixed-effects model estimated the likelihood (adjusted odds ratios [AORs] and 95% confidence intervals [CIs]) of a working-age nursing home resident having serious mental illness, by NHC health inspection quality rating. The variance partition coefficient (VPC) was calculated to quantify the variation in serious mental illness attributable to nursing home characteristics. Measures included serious mental illness (i.e., schizophrenia, bipolar disorder, and other psychotic disorders), health inspection quality rating (ranging from one star, below average, to five stars, above average), and other sociodemographic and clinical covariates.

RESULTS: Of the 343,783 working-age adults newly admitted to a nursing home in 2015 (N=14,307 facilities), 15.5% had active serious mental illness. The odds of a working-age resident having serious mental illness was lowest among nursing homes of above-average quality, compared with nursing homes of below-average quality (five-star vs. one-star facility, AOR=0.78, 95% CI=0.73-0.84). The calculated VPC from the full model was 0.11.

CONCLUSIONS: These findings indicate an association between below-average nursing homes and admission of working-age persons with serious mental illness, suggesting that persons with serious mental illness may experience inequitable access to nursing homes of above-average quality. Access to alternatives to care, integration of mental health services in the community, and improving mental health care in nursing homes may help address this disparity.


Nursing homes, Quality of care, Schizoaffective disorders, Schizophrenia, Serious mental illness

DOI of Published Version



Hugunin J, Chen Q, Baek J, Clark RE, Lapane KL, Ulbricht CM. Quality of Nursing Homes Admitting Working-Age Adults With Serious Mental Illness. Psychiatr Serv. 2021 Dec 16:appips202100356. doi: 10.1176/appi.ps.202100356. Epub ahead of print. PMID: 34911354. Link to article on publisher's site

Journal/Book/Conference Title

Psychiatric services (Washington, D.C.)

PubMed ID


Related Resources

Link to Article in PubMed