{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T09:33:04Z","timestamp":1790242384979,"version":"4.1.0"},"reference-count":31,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Nursing homes deliver rehabilitative and long-term care for people with serious medical illnesses, functional impairment, and\/or cognitive impairment. The population of nursing home residents with serious mental illness (ie, bipolar disorder, schizophrenia, other psychotic disorders) has grown substantially. Other than prisons and jails, nursing homes are the largest institutional care setting for adults (aged \u226518 years) with serious mental illness. Nursing home residents with serious mental illness become long-term residents despite less functional impairment, which may be a function of difficulty discharging these individuals to the community.<\/jats:p><\/jats:sec>Objective<\/jats:title>To examine barriers associated with discharging nursing home residents with serious mental illness back to the community from the perspective of frontline staff and administrative leaders.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This qualitative study included semistructured interviews conducted by phone and videoconferencing with staff members at nursing homes across the US between August 29, 2024, and January 9, 2025. Nursing homes that deliver care to patients with serious mental illness were identified using LTCFocus.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Themes and subthemes that represented barriers to discharge were analyzed from interview notes and transcripts using a rapid qualitative analysis approach.<\/jats:p><\/jats:sec>Results<\/jats:title>Interviews were conducted with 15 staff members (mean [SD] age, 44.7 [12.6] years; 13 women [86.7%]) from 8 nursing homes. Staff roles included social services directors (8 participants [53.3%]), social workers or related roles (3 participants [20.0%]), and administrators or other roles (eg, executive director, memory care coordinator, behavioral unit manager of a lock unit) (4 participants [26.7%]). Participants identified multiple barriers to discharge at individual (eg, behavioral issues, medication compliance, withholding information, refusal to leave, comorbidities), relational (eg, lack of family support, strain on professional relationships), and structural (eg, limitations of insurance coverage, barriers to facility admissions, lack of substance and psychiatric treatment, waiting lists, transportation) levels, which together limited pathways to community discharge for residents with serious mental illness.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>This qualitative study found that multiple intersecting barriers are associated with discharging nursing home residents with serious mental illness back to the community, which may lead to clinically inappropriate long-term stays for those who could theoretically have been in a lower level of care setting. These findings suggest that enabling successful discharge to the community for nursing home residents with serious mental illness may require collaborative strategies that address individual, relational, and structural factors.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.34685","type":"journal-article","created":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T15:30:22Z","timestamp":1759246222000},"page":"e2534685","source":"Crossref","is-referenced-by-count":3,"title":["Barriers to Discharge for Nursing Home Residents With Serious Mental Illness"],"prefix":"10.1001","volume":"8","author":[{"given":"Charity M.","family":"Hoffman","sequence":"first","affiliation":[{"name":"Department of Psychiatry, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah C.","family":"Ratliff","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah L.","family":"Krein","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Michigan, Ann Arbor"},{"name":"Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan"},{"name":"Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kierstdea","family":"Petzold","sequence":"additional","affiliation":[{"name":"Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen T.","family":"Unroe","sequence":"additional","affiliation":[{"name":"Department of Medicine, Geriatrics, Indiana University, Indianapolis"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kali S.","family":"Thomas","sequence":"additional","affiliation":[{"name":"Johns Hopkins School of Nursing, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Molly","family":"Turnwald","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erika","family":"Ratliff","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Terrence","family":"Gatton","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donovan T.","family":"Maust","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, University of Michigan, Ann Arbor"},{"name":"Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan"},{"name":"Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2025,9,30]]},"reference":[{"issue":"5","key":"zoi250970r1","doi-asserted-by":"publisher","first-page":"434","DOI":"10.1016\/j.jagp.2020.09.011","article-title":"Trends in serious mental illness in US assisted living compared to nursing homes and the community: 2007-2017.","volume":"29","author":"Hua","year":"2021","journal-title":"Am J Geriatr Psychiatry"},{"issue":"38","key":"zoi250970r6","article-title":"Long-term care providers and services users in the United States: data from the National Study of Long-Term Care Providers, 2013-2014.","volume":"3","author":"Harris-Kojetin","year":"2016","journal-title":"Vital Health Stat 3"},{"issue":"3","key":"zoi250970r7","doi-asserted-by":"publisher","first-page":"286","DOI":"10.1080\/08959420.2011.579511","article-title":"Nursing home admissions and long-stay conversions among persons with and without serious mental illness.","volume":"23","author":"Aschbrenner","year":"2011","journal-title":"J Aging Soc Policy"},{"key":"zoi250970r9","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1016\/j.jsat.2015.09.006","article-title":"Treatment access barriers and disparities among individuals with co-occurring mental health and substance use disorders: an integrative literature review.","volume":"61","author":"Priester","year":"2016","journal-title":"J Subst Abuse Treat"},{"issue":"6","key":"zoi250970r10","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1093\/intqhc\/mzm042","article-title":"Consolidated Criteria for Reporting Qualitative Research (COREQ): a 32-item checklist for interviews and focus groups.","volume":"19","author":"Tong","year":"2007","journal-title":"Int J Qual Health Care"},{"issue":"4","key":"zoi250970r13","doi-asserted-by":"publisher","first-page":"1893","DOI":"10.1007\/s11135-017-0574-8","article-title":"Saturation in qualitative research: exploring its conceptualization and operationalization.","volume":"52","author":"Saunders","year":"2018","journal-title":"Qual Quant"},{"issue":"1","key":"zoi250970r14","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1186\/s13012-024-01397-1","article-title":"Planning for and Assessing Rigor in Rapid Qualitative Analysis (PARRQA): a consensus-based framework for designing, conducting, and reporting.","volume":"19","author":"Kowalski","year":"2024","journal-title":"Implement Sci"},{"issue":"10","key":"zoi250970r15","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-019993","article-title":"Can rapid approaches to qualitative analysis deliver timely, valid findings to clinical leaders? a mixed methods study comparing rapid and thematic analysis.","volume":"8","author":"Taylor","year":"2018","journal-title":"BMJ Open"},{"issue":"1","key":"zoi250970r17","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1080\/02701960802074321","article-title":"Serious mental illness in Florida nursing homes: need for training.","volume":"29","author":"Molinari","year":"2008","journal-title":"Gerontol Geriatr Educ"},{"issue":"6","key":"zoi250970r18","doi-asserted-by":"publisher","first-page":"683","DOI":"10.1016\/j.jamda.2019.03.018","article-title":"Preparing long-term care staff to meet the needs of aging persons with serious mental illness.","volume":"20","author":"Muralidharan","year":"2019","journal-title":"J Am Med Dir Assoc"},{"issue":"6","key":"zoi250970r19","doi-asserted-by":"publisher","first-page":"627","DOI":"10.1177\/1077558710362538","article-title":"Quality of mental health care for nursing home residents: a literature review.","volume":"67","author":"Grabowski","year":"2010","journal-title":"Med Care Res Rev"},{"issue":"4","key":"zoi250970r20","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1176\/appi.ps.202000241","article-title":"Clients\u2019 preferences for family involvement and subsequent family contact patterns within onTrackNY early psychosis services.","volume":"72","author":"Jones","year":"2021","journal-title":"Psychiatr Serv"},{"issue":"10","key":"zoi250970r21","doi-asserted-by":"publisher","first-page":"860","DOI":"10.1176\/appi.ps.201900028","article-title":"Family involvement in psychiatric hospitalizations: associations with discharge planning and prompt follow-up care.","volume":"70","author":"Haselden","year":"2019","journal-title":"Psychiatr Serv"},{"issue":"5","key":"zoi250970r22","doi-asserted-by":"publisher","first-page":"976","DOI":"10.1007\/s10900-013-9681-1","article-title":"Traveling towards disease: transportation barriers to health care access.","volume":"38","author":"Syed","year":"2013","journal-title":"J Community Health"},{"issue":"4","key":"zoi250970r23","doi-asserted-by":"publisher","first-page":"200","DOI":"10.1177\/2045125312474019","article-title":"Medication adherence in schizophrenia: factors influencing adherence and consequences of nonadherence, a systematic literature review.","volume":"3","author":"Higashi","year":"2013","journal-title":"Ther Adv Psychopharmacol"},{"issue":"9","key":"zoi250970r24","doi-asserted-by":"publisher","first-page":"790","DOI":"10.1097\/MLR.0b013e31821b3548","article-title":"Facility and market factors affecting transitions from nursing home to community.","volume":"49","author":"Arling","year":"2011","journal-title":"Med Care"},{"issue":"7","key":"zoi250970r25","doi-asserted-by":"publisher","first-page":"1312","DOI":"10.1093\/geront\/gnaa044","article-title":"Quality concerns in nursing homes that serve large proportions of residents with serious mental illness.","volume":"60","author":"Jester","year":"2020","journal-title":"Gerontologist"},{"issue":"5","key":"zoi250970r26","doi-asserted-by":"publisher","first-page":"769","DOI":"10.1080\/08959420.2022.2083882","article-title":"Serious mental illness in nursing homes: stakeholder perspectives on the federal Preadmission Screening Program.","volume":"34","author":"Bucy","year":"2022","journal-title":"J Aging Soc Policy"},{"issue":"3","key":"zoi250970r27","doi-asserted-by":"publisher","first-page":"330","DOI":"10.1176\/appi.ps.201300023","article-title":"Integrated IMR for psychiatric and general medical illness for adults aged 50 or older with serious mental illness.","volume":"65","author":"Bartels","year":"2014","journal-title":"Psychiatr Serv"},{"issue":"12","key":"zoi250970r28","doi-asserted-by":"publisher","first-page":"1199","DOI":"10.1176\/appi.ajp.2018.18020169","article-title":"Integrating health and mental health services: a past and future history.","volume":"175","author":"Druss","year":"2018","journal-title":"Am J Psychiatry"},{"issue":"3","key":"zoi250970r29","doi-asserted-by":"publisher","first-page":"234","DOI":"10.1037\/prj0000404","article-title":"Coordination of services for people with serious mental illness and general medical conditions: perspectives from rural northeastern United States.","volume":"43","author":"Storm","year":"2020","journal-title":"Psychiatr Rehabil J"},{"issue":"1-3","key":"zoi250970r30","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1016\/j.schres.2010.11.020","article-title":"Oral versus depot antipsychotic drugs for schizophrenia\u2013a critical systematic review and meta-analysis of randomised long-term trials.","volume":"127","author":"Leucht","year":"2011","journal-title":"Schizophr Res"},{"issue":"7","key":"zoi250970r31","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.24163","article-title":"Association of long-acting injectable antipsychotics and oral antipsychotics with disease relapse, health care use, and adverse events among people with schizophrenia.","volume":"5","author":"Wei","year":"2022","journal-title":"JAMA Netw Open"},{"key":"zoi250970r2","doi-asserted-by":"crossref","DOI":"10.1353\/book.3252","volume-title":"Better But Not Well: Mental Health Policy in the United States Since 1950","author":"Frank","year":"2006"},{"key":"zoi250970r5","year":"1999"},{"key":"zoi250970r8","volume-title":"Key Substance Use and Mental Health Indicators in the United States: Results from the 2023 National Survey on Drug Use and Health","author":"Substance Abuse and Mental Health Services Administration","year":"2023"},{"key":"zoi250970r16","volume-title":"The Constitution of Society: Outline of the Theory of Structuration","author":"Giddens","year":"1984"},{"key":"zoi250970r3","unstructured":"Bureau of Justice Statistics special report mental health problems of prison and jail inmates. US Department of Justice, Office of Justice Programs. September 2006. Accessed April 18, 2025. https:\/\/bjs.ojp.gov\/content\/pub\/pdf\/mhppji.pdf"},{"key":"zoi250970r4","unstructured":"2019 PASRR national report: a review of Preadmission Screening and Resident Review (PASRR). Centers for Medicare & Medicaid Services. 2019. Accessed July 11, 2025. https:\/\/www.medicaid.gov\/medicaid\/long-term-services-supports\/downloads\/2019-pasrr-national-report.pdf"},{"key":"zoi250970r11","unstructured":"LTCFocus Public Use Data sponsored by the National Institute on Aging (P01 AG027296) through a cooperative agreement with the Brown University School of Public Health. Accessed July 9, 2025. https:\/\/www.ltcfocus.org"},{"key":"zoi250970r12","unstructured":"Five-Star Quality Rating System. Centers for Medicare & Medicaid Services. 2018. Accessed July 2, 2024. https:\/\/www.cms.gov\/medicare\/health-safety-standards\/certification-compliance\/five-star-quality-rating-system"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2839481\/hoffman_2025_oi_250970_1758638232.03382.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T15:30:26Z","timestamp":1759246226000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2839481"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,30]]},"references-count":31,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2025,9,2]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2025.34685","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,30]]}}}