NURSING-HOME REFORM AND THE MENTALLY-ILL

New legislation targets Medicaid-funded nursing homes to improve the overall quality of care and provide more appropriate care for persons with mental illness. However, the 1987 Omnibus Budget Reconciliation Act also risks displacing the mentally ill from nursing homes with no other viable housing options. In this article, Marc Freiman, Bernard Arons, Howard Goldman, and Barbara Burns explore the national implications of these newly implemented reforms and estimate the number of mentally ill nursing home residents who might be displaced as a result. Freiman, a service fellow at the Agency for Health Care Policy and Research, holds a doctorate in economics from the University of Wisconsin at Madison. He was the project director for two National Institute of Mental Health (NIMH) studies to analyze Medicare reimbursement for psychiatric hospitalization. Goldman is director of the mental health policy center at the University of Maryland School of Medicine and coprincipal investigator at The Johns Hopkins University - University of Maryland Center on Organization and Financing of Care for the Severely Mentally Ill. He holds a joint medical/master of public health degree from Harvard University and a doctorate in social welfare from the Heller School at Brandeis University. Arons is the director for mental health financing, Division of Applied and Services Research at NIMH. Formerly a medical director and physician at St. Elizabeth's Hospital, he holds a medical degree from Case Western Reserve University. Burns is codirector of the psychiatric epidemiology and health services research program of the department of psychiatry at Duke University Medical Center. Burns, who was affiliated with NIMH's Division of Biometry and Applied Sciences from 1978 to 1987, holds a doctorate in psychology from Boston College.