ArticleJAMA network open2025
Barriers to Discharge for Nursing Home Residents With Serious Mental Illness.
Article in JAMA network open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
2 citing papers in PubMed.
- Effectiveness of the PASRR Program Compared With Claims Data in Identifying Nursing Home Admissions With Mental Illness.Journal of the American Medical Directors Association · 2026Article
- The patient is still there: geriatric psychiatry and the legacy of deinstitutionalization.Innovation in aging · 2026Article
Corrections and comments
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Authors and funding
10 authors.
Funding
Abstract
Importance: Nursing homes deliver rehabilitative and long-term care for people with serious medical illnesses, functional impairment, and/or cognitive impairment. The population of nursing home residents with serious mental illness (ie, bipolar disorder, schizophrenia, other psychotic disorders) has grown substantially. Other than prisons and jails, nursing homes are the largest institutional care setting for adults (aged ≥18 years) with serious mental illness. Nursing home residents with serious mental illness become long-term residents despite less functional impairment, which may be a function of difficulty discharging these individuals to the community. Objective: To examine barriers associated with discharging nursing home residents with serious mental illness back to the community from the perspective of frontline staff and administrative leaders. Design, Setting, and Participants: This qualitative study included semistructured interviews conducted by phone and videoconferencing with staff members at nursing homes across the US between August 29, 2024, and January 9, 2025. Nursing homes that deliver care to patients with serious mental illness were identified using LTCFocus. Main Outcomes and Measures: Themes and subthemes that represented barriers to discharge were analyzed from interview notes and transcripts using a rapid qualitative analysis approach. Results: Interviews were conducted with 15 staff members (mean [SD] age, 44.7 [12.6] years; 13 women [86.7%]) from 8 nursing homes. Staff roles included social services directors (8 participants [53.3%]), social workers or related roles (3 participants [20.0%]), and administrators or other roles (eg, executive director, memory care coordinator, behavioral unit manager of a lock unit) (4 participants [26.7%]). Participants identified multiple barriers to discharge at individual (eg, behavioral issues, medication compliance, withholding information, refusal to leave, comorbidities), relational (eg, lack of family support, strain on professional relationships), and structural (eg, limitations of insurance coverage, barriers to facility admissions, lack of substance and psychiatric treatment, waiting lists, transportation) levels, which together limited pathways to community discharge for residents with serious mental illness. Conclusions and Relevance: This qualitative study found that multiple intersecting barriers are associated with discharging nursing home residents with serious mental illness back to the community, which may lead to clinically inappropriate long-term stays for those who could theoretically have been in a lower level of care setting. These findings suggest that enabling successful discharge to the community for nursing home residents with serious mental illness may require collaborative strategies that address individual, relational, and structural factors.
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