Institutional Factors of Nursing Homes That Predict the Provision of Mental Health Services Nicholas G. Castle, Ph.D., M.H.A. Dennis Shea, Ph.D. Abstract This article explores the likelihood of the provision of mental health services in a nursing home as a function of the home's institutional factors. Data from the Institutional Population Component of the National Medical Expenditure Survey were used, and a modified model of equilibrium quality and price in a multivariate logistic framework is employed. The results indicate that meeting the demands for active mental health treatment, as mandated by the Nursing Home Reform Act of 1987, may be more difficult in those institutions that are part of a chain, are small, or contain Medicaid skilled nursing facility beds. Previous research has focused on both the prevalence of mental illness in nursing homes, 16 and on the need for mental health services by nursing home residents. 7'8 Indeed, nursing homes have become a primary source of residential care for the mentally ill, and many nursing homes are in reality long-term psychiatric facilities. 5 This investigation examines the relationship between the institutional characteristics of nursing homes and the provision of mental health care services. Data from the Institutional Population Component (IPC) of the National Medical Expenditure Survey (NMES) were used. 9Employing a modified model of equilibrium quality and price;l~ nursing home bed size; ownership (for-profit, government, or chain); number of Medicaid skilled nursing facility (SNF) beds; number of Medicaid intermediate care nursing facility (ICF) beds; the presence of an institutional waiting list; and whether or not speech therapy, hearing therapy, occupational therapy, or respiration therapy were provided were investigated as the institutional factors that could possibly predict the provision of mental health care services by a nursing home. Significance of the Problem Nursing homes are an important health care provider for elders. A recent federal nursing home survey indicates that the United States had over 18,000 Medicare/Medicaid certified nursing homes with more than 1.8 million beds. 11The rapid growth of the population over the age of 85, 22% of whom are in nursing homes, also suggests that pressures for expansion of these institutional resources will continue ~2 despite the growth in alternative providers such as board and care homes and home care services. Nursing homes are also an important health care provider for persons with mental disorders. Persons with mental disorders in nursing homes total almost 1 million. 13 However, the residents of nursing homes are susceptible to abuse; and the cost, quality, and medical provisions of our nursing homes have in the past been far from stellar. 13'~4 Addresscorrespondence to Nicholas G. Castle,Ph.D,, M.H.A.,Research Fellow. Center forGerontology and Health Care Research, BrownUniversity, Box G-B201D,Providence, R102912. Dennis Sheais an assistantprofessor in HealthPolicyand Administration at the Pennsylvania State University. 44 The Journal of Mental HealthAdministration 24:1 Winter 1997