COMPLIANCE WITH PASARR RECOMMENDATIONS FOR MEDICAID RECIPIENTS IN NURSING-HOMES

OBJECTIVE: To determine the rate of compliance with placement and ment al health recommendations of the preadmission screening and annual res ident review (PASARR) program. DESIGN: A retrospective observational s tudy using PASARR screening forms to identify recommendations of inpat ient psychiatric care for people needing more care than nursing homes provide, alternate disposition for individuals needing less than nursi ng home level care, and recommendations for new mental health services when needed but not provided. Service use as indicated in Medicaid bi lling data during the following year was used to determine receipt of service. PARTICIPANTS: All Washington state Medicaid recipients screen ed from 1992 through 1993. MAIN OUTCOME MEASUREMENTS: Compliance rates for placement and service recommendations. RESULTS: Inpatient psychia tric care was recommended for four of the 523 Medicaid recipients (0.8 %), all of whom received it. Screeners recommended alternate dispositi ons in 131 (25%) subjects, and compliance occurred in 29% of these. Re commendations for new services were made in 310 (59%) cases. Complianc e rates averaged 35%, ranging from 73% for medication recommendations to 7% for consultation. Depressed individuals were less likely to rece ive recommended services. CONCLUSIONS: Many individuals needed additio nal mental health services but did not receive them, and a significant minority of patients could have been given an alternate disposition b ut rarely were.