Patterns of Care for Older People with Schizophrenia

Many people with schizophrenia live well into later life and, with demographic shifts, this population will continue to grow. The needs of older persons with schizophrenia are complex and include treatment of comorbid physical and mental conditions; we describe patterns of service use. Inpatient care in both general and psychiatric hospitals has substantially declined, but hospitalizations still account for more than half of Medicare spending for people with schizophrenia. The rapid decline in inpatient care without appropriate community support continues to drive inappropriate placement in nursing homes. Persons with schizophrenia are at greater risk of being admitted to nursing homes than the general population, even with low levels of disability. Because of their dependence on public insurance, these patients are more likely to be admitted to poorer-quality nursing homes. There are promising developments in health policy that may increase access to care, such as expansion of public insurance programs, mental health parity and models of integrated care. However, there continue to be gaps in service use and underutilization of mental health services, even among Medicare recipients.