{"doi":"10.1001/amajethics.2023.758","title":"How Should We Address Warehousing Persons With Serious Mental Illness in Nursing Homes?","abstract":"Despite long-standing efforts to keep patients with serious mental illness (SMI) out of nursing homes, many persons with schizophrenia, bipolar disorder, or psychoses become long-stay nursing home residents.This article discusses why this trend is inappropriate clinically and ethically and suggests how to reform federal review requirements to accomplish 2 goals: to better identify people with SMI at risk of nursing home placement and to support them to live in the community. Patients With Serious Mental Illness in Nursing HomesThe proportion of nursing home residents with a serious mental illness (SMI) has risen dramatically over the last 2 decades. 1,2In 2019, 1 in 5 long-stay nursing home residents had a diagnosis of bipolar disorder, schizophrenia, or another psychotic disorder. 3lthough hospital discharges to nursing homes are usually intended for short-term postacute care, they frequently turn into long-stay placements. 4Much like the criminal justice system, nursing homes have become an unwitting mental health provider-and not a very good one.This article examines factors that result in nursing home placement of persons with SMI and offers policy change recommendations. Preadmission ScreeningIn 1987, widespread concern over the warehousing of people with SMI and people with intellectual disability (ID) in nursing homes prompted Congress to establish the Preadmission Screening and Resident Review (PASRR) process.As part of this process, facilities and hospital discharge planners are required to screen for both SMI and ID, then refer those so identified to a state agency.The state must then assess the appropriateness of nursing home placement and, when necessary, provide specialized services for diversion to a different setting. 5vertheless, the proportion of nursing home residents with SMI continues to grow. 1,2lthough the Centers for Medicare and Medicaid Services (CMS) has recently indicated that a portion of nursing home schizophrenia diagnoses are potentially erroneous, 6 prior work relying on preadmission schizophrenia diagnoses shows that middle-aged persons with SMI are still significantly more likely to enter nursing homes than their peers","journal":"The AMA Journal of Ethic","year":2023,"id":367474,"datarank":0.26876392038420827,"base_score":1.791759469228055,"endowment":1.791759469228055,"self_citation_contribution":0.26876392038420827,"citation_network_contribution":0.0,"self_endowment_contribution":0.26876392038420827,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":5,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9609,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":663612,"name":"Ari Ne’eman","orcid":"0000-0001-7687-1265","position":0,"is_corresponding":true}],"reference_count":25,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-19T01:15:12.215513Z","pmid":"37801060","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}