Admission and Care of Individuals with Mental Illness in Massachusetts Nursing Homes: An Exploratory Study

Abstract

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 ( N=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.