Assisted living and use of health services among medicaid beneficiaries with schizophrenia.

BACKGROUND Considerable attention has been given to the appropriateness of mental and medical health care provided to residents of certain assisted living facilities specialized for the severely mentally ill. However, there exists little objective evidence regarding the level of services provided by these facilities in general. AIMS OF THE STUDY To compare the use of mental and medical health services among persons with schizophrenia who were residing in assisted living facilities compared to those received by patients living independently and those who were homeless. METHODS Medicaid claims were combined with person level data on living situation and psychological and social functioning for 1998-2000. Regression models were used to analyze whether living in a board-and-care facility was related to use of outpatient mental health services including case management, therapy, crisis stabilization, medication supervision, day treatment, and drug treatment, the probability of acute psychiatric hospitalization, the probability of hospitalization for physical health, and costs. RESULTS Residents of board-and-care facilities had greater use of outpatient mental health services and lower rates of psychiatric and medical hospitalization. Pharmacy costs and total health care costs were highest in assisted living. DISCUSSION Our data was observational, and selection processes related to illness severity likely affect living arrangement. Our analysis suggests that assisted living was related to greater use of outpatient mental health services and lower rates of hospitalization. IMPLICATIONS FOR HEALTH POLICIES Assisted living facilities may provide a suitable environment though which to provide outpatient mental health services. Policy makers interested in reducing homelessness through interventions might consider subsidizing these facilities. IMPLICATIONS FOR FURTHER RESEARCH Research studies should be designed to evaluate characteristics of assisted living facilities that lead to improved function and outcomes among residents.