Nursing Assistants as Providers of Mental Health Care in Nursing Homes

By Beck, Cornelia; Doan, Rebecca et al. | Generations, Spring 2002 | Go to article overview

Nursing Assistants as Providers of Mental Health Care in Nursing Homes


Beck, Cornelia, Doan, Rebecca, Cody, Marisue, Generations


As the U.S. population ages, issues related to quality of care in nursing homes will become critical, and none more so than the prevalence, effects, and treatment of psychiatric and behavioral problems among nursing home residents. Approximately 1.3 million older Americans live in nursing homes today (Magaziner et al., 2000). In the next 30 years, the proportion of the population of individuals 85 and older is expected to increase to five times what it is today (Reinhard and Stone, 2001). By 2030, the estimated demand for long-term care is expected to more than double (Feder, Komisar, and Niefeld, 2000). And, unfortunately, nursing home residents are at a high risk for psychiatric and behavioral problems.

The number of nursing home residents who have mental health problems has been estimated to be as high as 80 percent to go percent of all residents (Tariot,1996). Behavioral disturbances may be present in two-thirds to three-quarters of all residents and are a frequent complication upon admission (Streim, Rovner, and Katz, 1996). Behavioral disturbances are clinically significant in nursing home facilities because they cause symptomatic distress to residents, complicate the course of other medical illnesses, and interfere with and complicate nursing and medical care. These disturbances also increase disability, caregiver burden, and healthcare costs, and diminish quality of life (Colenda et al.,1999). Yet, fewer than 5 percent of nursing home residents receive mental health care (Rovner et al., 1996).

In the past, psychotropic drugs and physical restraints were routinely used in nursing homes to treat mental health symptoms. However, in the past twenty years the federal government has implemented regulations that significantly restrict the use of these practices because of the prevalence of negative side effects. Instead, increased use of nonpharmacological or behavioral interventions has been encouraged. The majority of studies of these interventions have reported not only a statistical and clinical decrease in behavior symptoms, but also the added benefit of improvement of the quality of life for elderly individuals (Cohen-Mansfield, 2001).

The quality and consistency of behavioral interventions are largely based on the performance of nursing assistants, who provide eight of every ten hours of paid care in a facility (McDonald, 1994). The interventions include simple tasks such as matching the level of assistance to the remaining abilities of the resident, repetition of directions, reinforcement of positive behaviors, distraction, anticipation of needs, and the like. However, for such interventions to be effective, they must be specific to the individual and applied consistently across time. Thus the nursing assistant must be familiar with individual residents, have knowledge of the team care plan, have time to provide the interventions, and receive encouragement to continue the intervention until positive results are observed.

However, there is a growing national shortage of nursing assistants (Childs, 2001). During the past several years, competition to hire entry-level workers has increased. Thus, the number of workers available to be nursing assistants is expected to decrease. Through the year 2008, the U.S. Bureau of Labor Statistics (1999) has projected a reduction in the number of women ages 25 to 39 in the workforce. Women in this age group fill the majority of nursing assistant positions.

At the same time that this shrinkage in the pool of potential workers will occur, the demand will increase. Nursing assistant is listed as one of the top ten fastest growing occupations in the country (U. S. Bureau of Labor Statistics,1999). However, few jobs are more physically demanding and emotionally draining than the position of nursing assistant in a nursing home (Reinhard and Stone, 2001). Staff turnover rates in nursing homes currently range from 49 percent to 143 percent per year (National Citizens' Coalition for Nursing Home Reform, 2001), with some reports as high as 500 percent per year (Cohen-Mansfield,1997). …

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