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Received August 20, 1997; revised December 24, 1997; accepted January 15, 1998. From the Division of Geriatric Psychiatry, University of Medicine and Dentistry of New Jersey (UMDNJ)–Robert Wood Johnson Medical School (RWJMS), and Department of Geriatric Services, UMDNJ, University Behavioral HealthCare. Address correspondence to Dr. Reichman, Div. of Geriatric Psychiatry, UMDNJ–RWJMS, P.O. Box 1392, Piscataway, NJ 08855-1392; e-mail: reichman{at}cmhc.umdnj.edu
The authors examined availability, characteristics, and perceived adequacy of psychiatric consultation in nursing homes, as reported by directors of nursing, who returned 899 questionnaires. Thirty-eight percent of nursing home residents were judged to need a psychiatric evaluation; current frequency of consultation was rated as adequate by half of nursing directors. Nearly two-thirds reported that psychiatrists adequately provided diagnostic and medication recommendations; however, advice on nonpharmacologic management techniques, staff support, and dealing with staff stress and family conflicts was largely viewed as inadequate. Findings suggest that perceived need for psychiatric services is far greater than the level actually provided. Overall, more attention must be directed to identifying incentives for psychiatrists to practice in nursing homes, determining clinical effectiveness of mental health services, and examining effects of alternative payment mechanisms on level of care.
Key Words: nursing homes • geriatric psychiatry • consultation
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