Persons with Severe Mental Illness: How Do They Fit Into Long-Term Care?. Persons with Severe Mental Illness: How Do They Fit Into Long-Term Care? : Table 3

05/05/1995

: Table 3

 PROSCONSELIGIBLES
GAF Scores and Service Needscores are believed to be closely correlated with risk status for repeat, longstay mental hospitalizationmany states are already using similar systems; mechanisms already in placerelies on clinical judgment (i.e. usually a psychiatrist); cannot be applied by a generalist social worker in a one-hour home visitdiagnosis-specific approach that is a blend of functional and cognitive impairment measures; not a purely "functional" approachvaries on GAF score used with other measures
Executive Cognitive Functionaccording to Royal et al.: accurately captures disability for people with both mental and cognitive impairments; possibility of use for persons with physical disabilities; determines eligibility without being age or disease specificcan be administered in a short amount of time (15 minutes) by laypersons and nonmedical personnel; internal consistency has been shown; interrater reliability is highability to capture stress of caregivers; more sensitive to detecting mild impairments than Folstein Mini-Mental Statenational estimates of the population are not available, currently unable to predict eligible population, utilization, and costs of long-term services using this methodvery recent approach, effects are hard to predictunknown
Combinations of ADLs/IADLssome national data exists on people affectedeasier to apply universally to other groups needing long-term serviceswhile adequate data exists on older populations, less data is available about non-elderly groupsnot sure if this is best measure of disability for people with SMI, may be biased towards elderly care or physically disableddifficult to show severity with IADL scalesunder estimates for HSA: 1.25 million (cognitive and mental impairment)
Use of Individual States' Criteriaeach state may be best able to tailor its program to its particular needsservice availability may differ widely among states; some states may underserve or overserve individualsvaries by state
SSI or SSDIsystem already in placemeasures for determining eligibility include medical and nonmedical methods (income and work history, not just ability to engage in "substantial gainful activity")SSDI is tied to sufficient earnings from work history and ability to workSSDI: 731,500; SSI: 596,800 (1991)(these persons have mental health problems, may or may not have SMI)