A Description of Board and Care Facilities, Operators, and Residents. 6.3 Mental Status


Disability levels in the area of psychiatric conditions, other than Alzheimer’s and other dementias, were about the same as in the 1980s, with one-third of the residents in the DRI study, as in this study, reporting a mental, emotional, or nervous condition. Similarly, as shown in Exhibit 6-4, the percentage of residents with a diagnosis of mental retardation or developmental disabilities (about 10 percent) is essentially the same.

Exhibit 6-5 compares cognitive and mental status of residents in facilities with different regulatory environments and characteristics. Mental and emotional problems were twice as prevalent among residents in licensed homes than those living in unlicensed facilities. Additionally, there was a substantially larger percentage of mentally retarded/developmentally disabled residents (11 vs. 4 percent) in licensed homes compared to unlicensed homes. Extensively regulated facilities tended to have a smaller percentage of mentally retarded/developmentally disabled residents than homes in States with more limited regulations.

Some of this increase in the average age of residents appears to be attributable to the aging-in-place of persons with psychiatric disorders. Although nearly a third of the residents reported having a mental, emotional, or nervous condition, and 11 percent had a diagnosis of mental retardation/developmental disabilities, only 22 percent of the residents were age 18 to 64.

6.3.1 Use of Psychotropic Medication

Although State licensure often prohibits the administration of medications in board and care, Dittmar and colleagues report that 43 percent of residents needed assistance in taking medications and that 34 percent were taking one or more psychotropic medications, with 50 percent of those on medications taking antipsychotic tranquilizers. Mor et al. (1986) reported that 23 percent of the older residents were taking an antipsychotic agent, 10 percent were taking a tranquilizer, and 9 percent were taking an antidepressant. Fully 32 percent of respondents were taking either an antipsychotic agent or a tranquilizer. Prior history of mental illness was related to taking psychotropic medication (61 vs. 20 percent), and those in large homes were more likely to be taking a psychotropic medication than were similar residents in small homes.

EXHIBIT 6-4. Comparison of Health and Functional Status of Board and Care Residents: Results of Three Studies
Health and Functional Status   Total Population (%)  
(ASPE, 1993)
  DRIa Study (%)  
  SSAb Study (%)  
Bladder continence 23 7 7
Moderate to severe cognitive impairment 40 30 confused 24
Mental/emotional/nervous condition 33 33 NA
Mental retarded/developmental disability 11 11 NA
Bedfast/chairfast 7 2 NA
Wheelchair 15 NA NA
Received help in bathing 45 27 NA
Received help with medications 75 43 71
NA = Not available.
  1. Dittmar and Smith (1983).
  2. Mor et al. (1986).

Given the level of confusion and disorientation among the board and care residents in our study, the ability of staff to assist residents properly with medications is an important aspect of care and services, especially since residents appear to take as many as 5.6 medications, many of which are prescribed PRN and thus may require staff to make therapeutic decisions (Hartzema et a., 1985).

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