Risk of Nursing Home Admittance among Working Age Residents with Mental Illness

An individual's risk of nursing home placement over his or her lifetime is considerable. Several studies have explored factors which impact this risk over the life course. Factors such as "inadequacy--in finances, health, social supports, emotional strength, or other abilities to cope" (Smallegan, 1985, p. 364) have been linked to nursing home admittance (Miller & Weinstein, 2002; Schoenman, 1995). Also, factors such as functional and cognitive impairments, along with increasing age, and living alone, are associated with enhanced risk of institutionalization (Branch & Jette, 1982; Green & Ondrich, 1990). Although nursing home use is typically associated with the elderly, a substantial number of working age (18-64) individuals are at risk. The National Nursing Home Survey showed that 158,700 people, or 9.7% of all nursing home residents, were under age 65 in 1999 (Jones, 2002). Many of these working age nursing home residents suffered from mental illness. The number of working age nursing home residents nationwide with a diagnosis of mental disorder at admission rose from 70,600 in 1997 to 97,200 in 1999. In a study of 205 working age nursing home residents in Maryland, it was found that almost half (44.4%) of the sample had a prior or current mental health condition (Miller & Weinstein, 2002) In a study comparing a sample of working age individuals living in the community to those in institutions, such as nursing home facilities, it was found that those in institutions tended to be more functionally impaired than individuals living in the community (Schoenman, 1995). In addition to functional status, enabling factors such as knowledge of available community options, few support mechanisms, "fear of community living and level of desired autonomy in planning one's life" (Depoy & Werrbach, 1996, p. 24) were also significant factors (Tate, Maynard, & Forcheimer, 1992). Social support also plays a major role in nursing home admittance among working age individuals (Biegel, Sales, & Schulz, 1991). Social support includes psychosocial resources such as coping mechanisms and personal and family resources such as accessibility to needed information and services in the community. Data indicate that a major factor increasing a person's chance of nursing home admission is living alone (Foley, Ostfeld, Branch, Wallace, McGloin, & Cornoni-Huntley, 1992; Kelman & Thomas, 1990; Shapiro & Tate, 1985). This is evident in Depoy and Werrbach's (1996) study where individuals attributed their ability to live in the community to the availability of assistance from relatives and friends. Studies also show that when a spouse is caretaker, the risk of institutionalization is lessened (Donohoe, Wineman, & O'Brien, 1996; Fiore, Becker, & Coppel, 1983; Miller & Weinstein, 2002; Schoenman, 1995). Low socioeconomic status also places individuals at increased risk of nursing home admittance (Foley et al., 1992; Miller & Weinstein, 2002). In Miller and Weinstein's study of working age residents, the primary source of income for 38% of the respondents was Supplemental Security Income (SSI), 28.9% reported no income at the time of admission to a nursing home, and over 80% of the sample had an approximate yearly income between $0 and $14,000. A similar profile was found in Foley et al.'s study, which indicated that the use of nursing homes was highest among those with incomes less than $5,000 per year. Such findings suggest a variety of factors, including low socio-economic status (SES), lack of social support, low functional ability, and mental health concerns, are interacting to make nursing home placement a viable option among working age individuals. To further explore this issue, the Behavioral Model for Vulnerable Populations (Gelberg et al., 2000) was used to assess the role of such factors in nursing home admittance among working age individuals with mental illness. …