Finding a balance between inpatient and community-based services

The trend toward community-based services versus inpatient treatment continues to prompt state hospital closures/mergers across the country. In New England, the situation reflects the nationwide movement with reportedly few negative repercussions.

In Connecticut, for instance, the state’s current bed count remains steady from five years ago, according to James Siemianowski, public information officer for the Department of Mental Health and Addiction Services (DMHAS). “We did close Cedarcrest Hospital several years ago and a portion of those beds went to Connecticut Valley Hospital. We also purchased more beds in the community for intermediate care at St. Vincent Hospital,” he says. “So there has been very little net loss.” He says that the current state-run bed capacity is 558.

Connecticut’s emergency rooms have not seen a noticeable increase in waiting times as a result of the bed reduction, Siemianowski adds. Mary Kate Mason, also from DMHAS, says, “It’s important to note that the wait in the ER is not usually for DMHAS patients. We have a good system of identifying our patients and reducing the time they spend in the ER.”

Additionally, Connecticut has contracted with eight or 10 hospitals around the state, which makes two beds available for people who don’t need long-term stays. Siemianowski says, “We divert them from state-run hospitals to community hospitals.”

According to Siemianowski, increased funding to develop more customized community resources offset the loss of beds at Cedarcrest. “We specifically look at a particular patient and see what they need. We develop a range of services that are very much individualized,” he says, emphasizing the goal of stimulating movement within the inpatient system.

Massachusetts has also been realigning its state-wide inpatient system, says Marcia Fowler, commissioner at the Department of Mental Health. She says that 45 beds remain open at Taunton State Hospital, as mandated by the legislature pending a task force study, and Tewksbury State Hospital added 45 beds with two medically enhanced units for those who require both psychiatric and skilled nursing care.

Fowler adds that the new Worcester Recovery Center and Hospital has filled seven of 10 units with full capacity expected by early spring.

Last year, DMH created 80 community placements for those who had a two plus year length of stay, thanks to $10 million in state funding, according to Fowler. “By discharging 80 patients we took those beds offline for day-to-day needs. In effect, we added 80 beds. It was like opening a new facility.”

Fowler says the current bed count stands at 671, but will be reduced to “the optimal number of 626” at the end of the fiscal year when funding for the Taunton beds ceases.

David Matteodo, executive director of the Massachusetts Association of Behavioral Health Systems (MABHS), reports that private facilities face serious challenges. “My hospitals are struggling. We have a wait list of between 30 and 70 people on a given day,” he says.

At the end of 2011, MABHS had 2,396 total beds in its system, according to Matteodo. “Some are geriatric, pediatric and adult beds. There are 1,700 adults beds spread among 60 hospitals,” he says, noting that the aging population has prompted an increase in geriatric beds, while the demand for pediatric beds has decreased because of an influx of funds following the Rosie D. decision.

Fowler notes that DMH has 1,200 admissions each year, while private admissions range between 70,000 and 73,000 annually and admits that DMH is “just a slice of the pie.” She says, “We are not choosing community care over inpatient care. We want to ensure appropriate continuum of services at the right level for the people we serve. We are working toward striking the right balance.”