A Study of Mental Health in Nursing Homes

According to a 2010 study, 65-91% of nursing home residents are afflicted with a mental health disorder. This includes depression, anxiety, dementia, and other serious conditions that significantly impact their quality of life–yet these mental illnesses are often not properly cared for.

One explanation is the lack of appropriate training given to nursing home workers, as well as a lack of access to professional mental health providers. Although nursing assistants are crucial in treating mental illnesses in nursing homes, these workers are often only trained in physical and not mental care. A 2000 study reports that only 36% of nursing home residents with mental illness received mental health visits from a psychiatrist, clinical psychologist, or licensed clinical social worker.

In addition to certain medications and therapy, people affected by mental health disorders require extra attention and focus on their mental wellbeing—such as patient communication specifically adopted to address seniors with dementia. Kelly Chiat, a staff member at Jefferson House Memory Care Community in Kirkland, stated that “without proper training, staff can sometimes unintentionally create more confusion or frustration for residents.” Many staff members are unprepared for the challenges attached to working with residents who experience mental health issues. For example, dementia—which is associated with the highest rate of hospitalization among mental health conditions in nursing homes—affects each person differently and changes from day to day, requiring staff to remain flexible and “constantly adjust [their] approach.” This is a job in which empathy is crucial and a lack of understanding by the staff member can directly worsen the patient’s condition, causing a vicious cycle where effective communication becomes even harder to achieve. Exacerbating this deficiency is the fact that people with mental illnesses are also more likely to enter nursing homes in the first place: four times more, in the case of schizophrenia. This inflow of seniors in need further strains staff, forcing them to spread their attention among various residents.

The federal government has previously attempted to address this problem. In the Omnibus Budget Reconciliation Act of 1987, Congress enacted the Nursing Home Reform Act, which established regulations regarding the unmet mental health needs of nursing home residents. After noting a pattern of abuse and neglect in nursing homes, the NHRA required that nursing homes must provide periodic assessments and personalized care plans for each patient, among other services. Furthermore, it established the Nursing Home Residents’ Bill of Rights. Like the Bill of Rights in the US Constitution, this document lists certain fundamental guarantees of nursing home residents that their homes are required to uphold—on top of the rights they already possess as US citizens. These include the rights to necessary care, including psychological and social care; the right to remain informed and participate in the review of their care plans; and the right to voice grievances, among others.

Although this act established strong standards for care in nursing homes, it also exemplified how the implementation of a law is often separate from its enactment. While states are required to enforce acts of Congress and conduct regular surveys of nursing homes, the reality is that many homes continue to provide inadequate services without facing consequences. A decade after the NHRA was passed, the issues became extremely clear when only 2% of California nursing homes were found to have minimal or no deficiencies, and law enforcement lacked the power to improve the conditions within.

Once again, this poor performance can be attributed to staffing—this time a lack of staff members overall, properly trained in mental health care or otherwise. Even now, 90% of facilities are unable to meet staffing standards outlined in 2000. One reason is because of a high job turnover related to underpay, limited health benefits, and mental health pressures associated with the occupation itself. Even with more money being allotted to nursing homes, this would most likely go towards a higher standard of care for seniors and not the workers facilitating that care–especially in states like New York, which have passed budget laws containing clear specifications for nursing homes.

Most nursing home residents continue to rely on Medicare, the federal health insurance program for US residents aged 65 and over. Medicare is an entitlement program—in which benefits are promised to anyone who meets certain requirements—and was the third-largest category for mandatory federal spending in 2026. Its Part B covers “screenings, services, and programs that aid in the treatment and recovery of mental health and substance use disorders,” including inpatient and outpatient services. It does not cover long-term care in nursing homes—meaning that for stays longer than 100 days, residents are forced to draw from their own savings for aid that might not come.

In the same Budget Reconciliation Act that established the NHRA, Medicare was amended to require annual reviews of mentally ill residents, as well as require nursing facilities to provide care for residents needing treatment for mental illness regardless of discharge status. However, Medicare is still criticized for its lack of adequate support for mental health. Many mental health professionals refuse patients paying with Medicare in the first place given the low reimbursement rates compared to private insurance.