Hi to all!
I am a nurse manager for a 47 bed Behavioral Health Unit which is private, not for profit and is located in a fairly large metropolitan area. The county complex is closing units left and right due to decreased fundings at the state level. My question(s) is(are) this(these).....What are hospitals doing out there that may be new? Different types of therapy? Moving towards more outpatient? CSP(Community Support Program) changes? Changes in LOS-(ours currently is 4.68 days)? Unit set ups?
I am interested in the overall trends for Behavioral health.
Jul 18, '01
This is a good question. Unfortunately I am not sure of the answer, but I am interested on the other replies you receive.
However, this trend to closing psychiatric units/hospitals is not a good sign. Where are we going to put all those clients that all need to be in a locked, controlled environment??? Are they going to be in transitional housing with little control and supervision. If they do, I hope that they protect the rest of society from the clients who cannot help themselves from doing harm to themselves or others. One thing I believe, is if they do a mass closing of many psychiatric facilities....that in the long run....we as tax payers will have to pay to have other facilities built. Would it not make more sense that to just fix up these old facilities than close them and allow them to fall apart over time due to weathering and lack of fixing up. This is a typical way of many state run facilities. It does not make sense, but because it does not make sense....this is the reason they do it. This is your good tax dollars at work. Also it shows that the people we voted for in office just are not doing their job for whatever state we live in.
In addition, I hope that future of all of the medical world in the USA does not turn into Socialized Medicane as some people I have talked to. This would not be good, because other countries who have Socialized Medicane state that it does not work and that the quality of care drops dramatically.
Jul 18, '01
Thanks, Greg. I agree. I am in the midst of expanding my unit from a 28 bed to a 47 bed to be completed in the next 6 weeks.
the county is privatizing these chronically mental ill patients which i itself is difficult.
The CSP's(Community Support Programs) are also downsizing leaving few resources for this population. The private sectors that I am familiar with do not seem to be interested in doing their part to assist the community at large.
I agree, our government needs to evaluate their "mission" to meet the needs of this suffering population.
Oct 18, '01
I suppose your expansion has already taken place by now.
In my area, (inpatient acute county facility)we have really been pushing our partial hospitalization program which is a part of our outpatient dept. We discharge a lot of personality D/O to partial which decreases their length of stay. Partial hosp is a great idea but it is very difficult to get full reimbursement. I know money making is not your concern but programs have to be cost effective in order to continue. There is a lot of competition from area hospitals trying to get that same patient to their partial program. Some offer full day programs but there is a waiting list forever long.
There is an area long term facility that has a mild mental illness license and it is a locked facility. They will take some non-violent patients but not many. Mostly dementia there with a smattering of schiz.
My friends in the community mental health settings and I talk about what to do with these patients we in the "system" set up to fail by expecting them to be able to function out there when they are not equipped. Not even with daily case management. Our community has a system of intense interaction with those who need it most but the staff turnover is high, pay is poor and satisfaction is non-existant so it becomes bandaid therapy.
What do you do with the not guilty by reason of insanity? Where do they go? Put them in jail? Nursing homes won't take them. Ohio is trying to close long term state run facilities. There is a definite need for institutionalization of some of the sickest. Our county does not force outpatient med compliance. We have a lot of issues here to deal with too. So in the meanwhile, it is getting cold out there and many people who should be in a state run institution are in shelters, in crack houses or under bridges. That is better for them right?
ps Our county was part of a pilot program for medicaid patients switching to HMO's. The big private hospitals won't take them as they pay dimes on the dollar for services. Being a county facility, we don't turn anyone away. So who do you think we get for patients? We call it charity.
pps My grand idea is to get the area long term care facility that specializes in mild mental health to expand to take care of younger, sicker patients. I am sure the state would love that. There has to be money to be made there. I am not sure why the state is not courting anyone to just take over their facilities.
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