Well, there could be a lot going on here. First and obviously,

medicaid and insurance both pay more for people labeled as mentally ill, because there's "treatment" to be billed for than it does for dementia so of course the vast majority of nursing homes will label all of their "dementia" clients as "mentally ill." Thus nursing homes get a higher dollar amount for a "mentally ill" person than for a "demented" one.

I'm not really sure why dementia wouldn't be considered a mental illness though.

Second, and more radical, being a senior in a nursing home results in a loss of liberty and miserable standard of living much like being involuntarily committed and thus causes the misery and violent behavior labeled as mental illness when it's really just a normal, spirited, admirable response to being imprisoned and otherwise tortured.

Young and middle aged persons with a mental illness a mental illness are increasingly being warehoused in nursing homes. The Centers for Medicare and Medicaid Services found that the number of individuals 22 to 64 in nursing homes with mental illnesses increased 41 percent to 124,997 in the six years ending 2008. As with many thing in mental health this was not supposed to happen. With the passage of OBRA in 1987, "Pre-Admission Screening and Annual Resident Review" nursing facilities were prohibited from admitting an individual with a serious mental illness unless the state mental health authority determined that the individual requires the level of medical services the facility provided."

A sad example can be found in Connecticut which paints itself as being in the forefront of recovery practices and was the recipient of a SAMHSA Transformation Action Grant in September 2005. In February 2006 it was the subject of a lawsuit claiming that it was forcing individuals discharged from State mental hospitals into nursing homes. It is only recently announced an initiative, WISE, which it claims will help place mental health consumers currently in nursing homes. (Of course, one has to wonder if Connecticut will realize this end given that its representations have not jibed with reality in the past. Connecticut's DMHAS, "A Recovery Oriented HealthCare Service Agency", was excoriated by the US DOJ about its operation of the very institution over which it had the unfettered authority to implement that which it routinely represented, i.e. Connecticut Valley Hospital.)

In the "Year of Community Living", well into the "Era of Community Integration" and a decade past "Olmstead", nursing homes, state psychiatric hospitals, shelters, residential healthcare facilities, and the streets continue to be routine placements for mental health consumers. We were promised better but we always are. Sans accountability systems rarely change; they too often merely represent it.

Well, if I was put in a nursing home I know I would certainly feel depressed...

The way the west treats its elderly and aged is horrible...
Dumped into nursing homes like rubbish ..

One minor (but important) correction... The article doesn't say that these patients are in nursing homes DUE TO mental illness, it simply says that more nursing home residents are diagnosed with depression than with dementia.

Still, it's a disturbing trend. In my experience, many physicians find it hard to treat elderly patients with dementia, so they slap a DSM-IV label like depression ("hey, it could just be pseudodementia!") or psychosis NOS on the patient, both for billing purposes and because it's then more "acceptable" (ie, covered by Medicare) to prescribe antidepressants or antipsychotics.

In the end, it's all about expediency.... The physician doesn't want to spend time helping the family, finding the most suitable housing situation, doing the referral paperwork, etc, because he's not PAID for it. He just wants to give a diagnosis, prescribe a med, and send the patient on his/her way.

Nothing really surprising in this report.

Create some new criteria and so called diseases, broaden the diagnosis of existing ones, and those statistical numbers; as do the drug company profits go through the roof.

Really is quite convenient that some of the most widely prescribed drugs on the planet are for diseases that have no verifiable test.

Quoting Dr. Frances from those brainiacs over at the DSM-V brawl

"The simple truth is that descriptive psychiatric diagnosis does not need and cannot support a paradigm shift. There can be no dramatic improvements in psychiatric diagnosis until we make a fundamental leap in our understanding of what causes mental disorders. The incredible recent advances in neuroscience, molecular biology, and brain imaging that have taught us so much about normal brain functioning are still not relevant to the clinical practicalities of everyday psychiatric diagnosis. The clearest evidence supporting this disappointing fact is that not even one biological test is ready for inclusion in the criteria sets for DSM-5."

My thoughts are how do you tell Dementia from Mental Illness, and wouldn't some people call Dementia a type of mental illness. Do you mean senility? def :the state of being senile, esp. the weakness or mental infirmity of old age.

The definition of Dementia fits beter into neurology than psychiatry.

In our neck of the woods (British Columbia, Canada) thousands of high-functioning seniors with short-term memory loss get pushed into these warehouses. When they express normal human emotions associated with loss of home, loss of privacy, loss of a companion, lousy food, an irritating roommate, anger at the family member who put them there, they get branded as mentally ill. The most common tags are anxiety and depression – subjectively applied by psychiatrists who have no accountability to no-one. Hence, these psychiatrists get away with medicalizing virtually all normal human emotions (as a quick read through the DSM manual will attest). Which opens the flood gates for the whole chemical arsenal of Seroquel, Zyprexa, SSRIs, benzodiazepines et al. It’s pretty much guaranteed that a healthy brain and central nervous system will crater under this toxic load, and the victim will then get labelled as psychotic. And on and on the death spiral goes. Meanwhile the big winners are the property developers who build the warehouses, the pharmaceutical companies who make the drugs, and the doctors whom they use to retail the drugs. Unfortunately those three camps are the puppet-masters of our current provincial government.
Gil Sampson, Victoria, BC

Philip Dawdy notes: victoria bc is the prettiest place on earth.

Not much to add, except that it might be interesting to find stats on closure of state mental hospitals, and also on the extent to which elderly people get warehoused because they cannot afford to live independently any more, and their relatives cannot or will not look after them any more. With more and more middle aged women in the work force, it is harder to help and support an elderly mother or inlaw still living independently, or mind one who has early dementia in the family home.

Another issue is the extremely high rate of sometimes inadvertant substance abuse (of prescription meds carelessly prescribed by multiple physicians) and alcohol abuse by seniors. Remember, those who grew up in the wake of WWII had cocktail hours, and drowned sorrows instead of seeing therapists. Many elderly people self-medicated at home to keep mood disorders and justified unhappiness at bay, but without their nightly relief once in (dry) nursing homes became more anxious and depressed. My 94 year old grandmother still happily drank two double whiskeys every evening all her adult life, and I think this helped her cope, tho it would nowadays be considered alcoholic.

that there are loads of elderly people with depression, bipolar disorder and schizophrenia in nursing homes, pretty much as a replacement for the old state hospital model.

DITTO In NZ-cos theres NO where else2put them--

Iam in Christchurch-they R wharehousing- also the ugly tread of young ppls with MS- CFS in Nursing homes-Jesus some are in there early 30"s-

NO one was thinking for the furture here-really-

It was ALL slash and burn mid 1980+s with the swing2the right-sale of State assets etc-pals of mine work in Nursing homes-they regular drug olds up with anti-psys too make them easy2manage-Zyprexa apairs2be there frist drug of choice-(

my mums just gone in2one-is a good one but when I saw the drug trays-so many anti-psycotics-

We managered so that mum has my doctor and NOTHING is changed drug wise until they speak too me or my sister-we also arranged so she can have her own pain med drugs on her-they dont normally allow this-

my mums lively at 85 we want too keep her that way as long as possible thanks-

there ae ppls at mums home who ae psy ill and druged2the gills-not fair-they get no attention2help them -just the drugs and an odd cow-boy singer on a thursday-the dancing nana"s once a month- I really do feel hopeless some days-so much needing attention-my hear dropps when I vist some of these places-

I hate nursing homes. I hate the current state of psychiatry in the USA.

That said, there are a few important mitigating factors here. First, the abstract you quote states only that the number of people with mental illness (who may also have dementia) is 50% greater than the number with dementia only. Although I don't have access to the underlying article, this may merely be a reflection of the fact that many (if not most) people with dementia are also depressed. Second, as pointed out by SteveBMD, it is not clear that the psychiatric condition was the reason for the admission, as opposed to an ancillary condition. Finally, the article mentions that depressed patients get more training on skills that might allow them to return to the community.

So all in all, I am not sure this story says much that is terribly alarming. You could even say that there is progress in the fact that clinicians are beginning to recognize that elderly people are often depressed, and need help with their moods. So maybe, as you suggest, it is 'a trend that's to the good yet filled with...tricky implications'.

Naturally, the depressed elderly person should not just be given antidepressants and stuck in a nursing home bed, which is no doubt what usually happens. But as the population ages it is important to recognize that people do get unhappy when they get older (bereavement, poor health, poverty, loneliness, boredom, disability, etc). To the extent possible, the 'system' should work to reduce their depression. Providing skills training to help with community reinstatement is a start. As difficult as it can be to help people get past depression, it is still easier than reversing dementia.

As a nurse in a LTC, I think it is a combination of factors. It is true that elderly individuals who otherwise would be in a state psych ward are now being sent to nursing homes. I have a few of them on my unit. The ones that come to us are those who often have medical complications (e.g. brittle diabetes or seizure disorders) in addition to a psych dx. Years ago these peeps would probably just pass on at the state hospital I suppose.

Another factor is that more and more depression is being identified whereas in the past it would have simply been ignored, dismissed as dementia or a complication of post CVA. For example, it is extremely common for post CVA elderly patients to have strange personality changes and depression. The changes to their brain as a result of the CVA make them incapable of self care for physical and mental reasons. Today these patients are diagnosed with depression, psychosis whatever... whereas in the past they wouldn't, they would just be considered CVA/dementia. Elderly CVA patients have always been a mainstay of nursing homes, the only difference is that now they are tagged with "depression" too by the MDS people so that they can get more medicare bucks.

I am reminded of one of our residents, elderly african american man, used to be an engineer, probably has mental changes as a result of dementia and CVA. He has bigtime aggression behavioral problems. Before we learned how to deal with him, he often would fly into rages and went out to the hospital for "change of mental status" (which is a medical way of classifying the resident is flipping his shit).

He always wound up on the psych floor of the hospital. When he would return to us, I would read his diagnoses/progress notes written by the psychiatrists. They described him as being "in an agitated hypomanic state" and he was treated as a psych patient.

I had to laugh a little bit, because this was more or less an eccentric demented elderly man, but yet the psychiatrists were classifying him as hypomanic. Sure he is agitated, sure he doesn't stop talking, sure he doesn't sleep much, but these traits are stable in his personality.

So, yea, the only thing that has changed is now psychiatrists are calling everything depression/bipolar/psychosis... the state of the elderly (or elderly in nursing homes ) hasn't changed as much.

We are getting more psych patients in nursing homes, but mostly it is an issue of demented/CVA elderly being called manics and depressives.

Also the anti nursing home comments are being unrealistic. Spare me.
I can't speak for elsewhere in the world but in the northern US people only end up in a nursing home if they literally cannot take care of themselves due to CVA dementias or other mental/physical impairments... very very rarely does someone end up here because they were "dumped by an uncaring family member". That simply does not happen. Sometimes people end up here who don't have family, but that's rare. Almost all of our residents are happy, at least the ones who have enough of a mind to truly feel happy. The ones who aren't happy are usually the ones who have medical complications which create depression/personality changes (CVA) or they were miserable before they ever got to our facility.

It's really not that bad of a way to live, if your 80 or 90 years old anyway, lol. When you're that age, you aren't doing much besides watching TV and sleeping anyway.

I mean, yea, if you're 30 or 40 50 or 60 a nursing home sounds like a nightmare but keep in mind the age of the patients.

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Also, another comment ... earlier I posted that there are two facets to this issue, one being that more psych patients are sent to nursing homes (the second being that nursing home patients are being given psych diagnoses).

I want to take a moment to say that the phenomenon of psych patients being sent to nursing homes is EXTREMELY FRIGGING UNSAFE for both the staff and the patients. As someone who works on the other side, rather than a psychiatric patient, I know first hand what it is like to deal with these patients as a caregiver. They are often aggressive and violent, and a nursing home does not have the state mandated facilities and tools to control these patients. We cannot use four point restraints, we don't have seclusion rooms, we don't have a bevy of one to ones/male orderlies (or whatever they are called in the state home), we don't have the IM shots of haldol for emergencies... we have absolutely nothing. I remember one of our psych patients, a 6 foot tall 200+ pound schizophrenic... when she would flip her shit, all we could pretty much do is run away. She would throw chairs, televisions, she was truly terrifying.
It was pathetic and unsafe.
Fortunately they finally either the state or some social worker got wise and she wound up going to a real psych facility. But those few months she was with us sucked horrid.

But really this is the way healthcare is going in this craphole country. Not only are they sending nursing homes psych patients (who are, in truth, dangerous at these types of facilities) but they are also discharging patients from hospitals earlier and earlier. Subacute care is now acute care. Patients leave after major cardiac surgery after just a few days.

Nursing homes are now "hospital lite" more or less, and it is very unstable and unsafe because you rarely have physicians on hand for the sort of emergencies this is bound to create.