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Adults With I/DD & Mental Illness Five Times As Likely To Have Delayed Hospital Discharges

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Adults with intellectual and developmental disabilities (I/DD) who also have a co-occurring mental illness are almost five times as likely to experience a delayed hospital discharge as adults with mental illness only, according to data collected by the Ontario, Canada-based Institute for Clinical Evaluative Services (ICES). Over a six-year data collection period ICES found that 6.1% of adults with I/DD and a mental illness had a hospital stay in which they stayed at least one day after being ready for discharge, compared to 3.3% of adults with I/DD alone, and 0.7% of adults without I/DD.

Additionally, 11.0% of adults with I/DD plus a mental health and/or addiction diagnosis were readmitted within 30 days. Among people with I/DD only, the readmission rate was 4.5% compared to 2.3% for people without I/DD.

A separate analysis of factors contributing to delayed discharges and rehospitalizations identified four key elements: lack of community housing, fragmented support systems, non-inclusive transition planning, and inadequate workforce training. Additional details about each element are as follows:

  1. Lack of community housing: People with I/DD are less likely to return to their previous home after a hospitalization; discharge delays may be due to a desire to find supported, appropriate, and affordable community housing. Discharge delays cause pressure on hospitals to discharge the individual to less appropriate settings, such as family homes with inadequate supports, homeless shelters, or nursing homes.
  2. Siloed and fragmented systems: The mental health and I/DD service sectors are not well integrated in North America. Many psychiatric services exclude people with I/DD. Organizational policies may prohibit cross-sector services during the transition period meaning that that I/DD provider organizations would not be able to engage with consumers before discharge, and hospital clinical professionals may not be able to continue to provide mental health support after discharge.
  3. Non-inclusive transition planning: Individuals and their families are often not included in transition planning. They may be excluded if the hospital assumes that people with I/DD cannot effectively participate in decisionmaking. Adult-oriented health care systems may fail to include family caregivers in transition planning.
  4. Workforce issues: Clinical professionals in both the mental health and I/DD sectors often lack the training knowledge, and skills to identify community housing, staffing, and clinical supports needed by people with both I/DD and complex mental health needs. Hospital based clinical professionals may struggle to correctly diagnose and care for people with I/DD and/or mental health conditions, and may not be able to effectively connect with I/DD provider organizations to support successful transitions. Additionally, community-based mental health and I/DD provider organizations may be reluctant to provide post-transition community care.

The challenges and recommendations were reported in “Addressing Delayed Hospital Discharges for Patients With Intellectual and Developmental Disabilities and a Mental Illness” by Avra Selick, Ph.D.; Tiziana Volpe, Ph.D.; Susan Morris, M.S.W., R.S.W.; and Yona Lunsky, Ph.D., C.Psych. The authors conducted a literature review of studies that reported discharges for people with I/DD. They also consulted with more than 100 stakeholders, to include hospital systems, community mental health providers, I/DD agencies, system planners, and consumers and their families. They developed processes to adapt existing hospital transition quality standards. The resulting practice guidance includes 10 core components.

The ICES statistics about long stays and readmission rates were reported in “Addressing Gaps in the Health Care Services Used by Adults With Developmental Disabilities,” by Elizabeth Lin, Ph.D.; Robert S. Balogh, Ph.D., BHSc; Anna Durbin, Ph.D.; and colleagues. From April 2010 through March 2016, the researchers followed a cohort of 64,699 adults with I/DD living in Ontario, Canada. The goal was to identify differences in health outcomes between adults ages 19 to 65 years with and without I/DD. The analysis focused on five health-related outcomes, and stratified the outcomes by age, sex, neighborhood wealth/poverty, and type of I/DD. The health-related outcomes were: 30-day repeat emergency department visits, 30-day repeat hospitalizations, alternate level of care, long-term care, and premature mortality.

For more information about the recommendations, contact: Avra Selick, Ph.D., Project Scientist, Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario Canada; M5T 1R8; Email: avra.selick@camh.ca; Website: https://www.camh.ca/en/science-and-research/science-and-research-staff-directory/avraselick

For more information about the ICES findings, contact: Institute for Clinical Evaluative Sciences, G1 06, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5 Canada; 416-480-4055; Email: communications@ices.on.ca; Website: https://www.ices.on.ca/