Another View: State not prepared to handle mentally ill and aging population

The Sacramento Bee article, “Shifting population in California nursing homes creates ‘dangerous mix’ ” (Page 1A, April 3), identifies growing challenges for our state’s nursing homes, but it fails to focus on the root cause of what got us here. State and local policy on mental and behavioral health care, and its lack of dedicated services in this area, are key to this issue.

California, by conservative estimates, is several thousand beds short of adequately serving those with mental illness or behavioral issues. The shortage of 24-hour care – and the beds required for that treatment – places a strain throughout the health care system, and specifically in long-term care and skilled nursing facilities.

Statewide, 71 institutions for mental diseases are primarily engaged in diagnosis, treatment or care of persons with mental diseases. Among them are fewer than 13,000 beds. Simply put, California’s resources are not scaled to serve a population approaching 40 million.

Add to this the aging baby boomer generation who, moving forward, will need those skilled nursing home beds at an increasing rate, and you have a collision course with crisis.

Until recently, occupancy rates had hovered at about 88 percent, but they are now climbing. By 2020, it’s estimated the demand for those beds will outstrip supply. This issue is magnified by seniors simply living longer. The population of elders over 85 – skilled nursing’s largest user group – has increased 30 percent in just 15 years.

There’s no quick fix, but we clearly need to increase 24-hour mental health care services at the local level. We should look to local mental health authorities and the Department of Health Care Services for this change.

In health care, our primary concern is resident/patient safety and quality care. In that spirit, the risks of placing a frail elderly person in the same environment as a younger resident with mental illness or behavioral issues is problematic. Hospitals, too, are a poor fit, because they are too expensive. Community placement is the right answer. But in the absence of capacity and capability, where can we place all those in need to get the help they require?

This will be a major challenge for local mental health and the Department of Health Care Services.

James Gomez is CEO and president of the California Association of Health Facilities.