PSYCHIATRIC-CONSULTATION IN THE NURSING-HOME - A SURVEY OF 6 STATES

The authors examined availability, characteristics, and perceived adeq uacy of psychiatric consultation in nursing homes, as reported by dire ctors of nursing, who returned 899 questionnaires. Thirty-eight percen t of nursing home residents were judged to need a psychiatric evaluati on; current frequency of consultation was rated as adequate by half of nursing directors. Nearly two-thirds reported that psychiatrists adeq uately provided diagnostic and medication recommendations; however; ad vice on nonpharmacologic management techniques, staff support, and dea ling with staff stress and family conflicts was largely viewed as inad equate. Findings suggest that perceived need for psychiatric services is far greater than the level actually provided Overall, more attentio n must be directed to identifying incentives for psychiatrists to prac tice in nursing homes, determining clinical effectiveness of mental he alth services, and examining effects of alternative payment mechanisms on level of care.