The changing role of the psychiatrist in board-and-care homes

The role of the psychiatrist in board-and-care homes has been changing dramatically since a job description was published in 1989. The role has become more complex as a result of advances in psychopharmacology, the trend toward polypharmacy regimens, the necessity to evaluate the interaction potentials of drug combinations, and the emergence of more sophisticated treatment algorithms. Broad social trends have added to the complexity of board-and-care treatment, such as the tendency to release more severely disturbed patients from long-term-care facilities because of the increasing costs associated with institutionalization. However, treatment of these patients will continue to be expensive because of the higher costs of new drugs and of using medication combinations. Continued high-cost treatment will increase pressure to control costs by managed care companies, third-party payers, and government agencies. Although this paper describes the effects of these trends on board-and-care psychiatrists, they are also relevant to psychiatrists in general and to other practitioners.