The authors found that 85% of 74 patients supported by Medicaid in two
skilled nursing facilities had significant psychiatric disorders in
addition to serious multiple medical illnesses. Almost two-thirds of the
psychiatric disturbances had not been diagnosed. Although staff were more
concerned with the psychosocial than the physical aspects of patients'
problems in more than half of the cases, they often had difficulty
recognizing the legitimacy of psychological complaints and relating to
patients with psychological disturbances. Staff were not clear about the
orders for psychotropic medications that were prescribed for more than half
of the patients. The authors point out that more psychiatric consultation
is needed to ensure appropriate and effective care for psychiatric patients
in such facilities.