         |
 |
Memo ponders
Rhode Island budget cuts
(November
2005 Issue)
By Elinor Nelson
An internal memo from CEO Richard Freeman of Rhode Island's state-run
Eleanor Slater Hospital to the state's Department of Mental Health,
Retardation and Hospitals, written and leaked to the press in August,
outlined a potential $12 million in savings from "hospital size
reduction and outsourcing" and unnerved some in the mental health
community. However, it's too soon to tell if the suggested cuts
will find their way into the next state budget.
Freeman, who declined to comment on the memo, had written it in
response to a call from the state budget office to all state agencies,
for a ten percent across the board budget cut. The memo outlined
various programs and personnel cutbacks that could generate the
$12 million savings.
Joseph Monteiro, president of Local 1350, AFSCME, Council 94, which
represents many of the employees at Eleanor Slater, states that
he would find the proposed cuts "worrisome," but for now views the
memo as a response to a budget exercise. He labels some of the memo's
suggestions as "fairytales" because of enforceable labor contracts,
while others "may or may not pick up momentum as we go through the
budget process."
Eleanor Slater Hospital was created in the mid-1990's, consolidating
three state hospitals then known as the Institute for Mental Health,
the General Hospital and Zambarano Memorial Hospital. According
to Reed Cosper, J.D., Rhode Island's mental health advocate, the
consolidation allowed the state to qualify for millions of dollars
of Medicaid funding for treating the mentally ill.
The hospital has 490 beds but is currently at about 360-bed capacity,
with about 80 psychiatric patients, says Monteiro. And, he says,
there are approximately 40 people waitlisted for long-term care,
some of whom are being treated for mental illness. The wait list
is tied to staffing levels.
Freeman's memo suggests savings via "reducing patient flow," "aggressively
discharging patients," and "possible closing of admissions." He
talks of "reducing psychiatric capacity from 96 to 72," outsourcing
dietary and laundry services and reorganizing nursing, administrative
and medical services.
Roberta Hawkins, executive director of the Alliance for Better
Long Term Care, a Rhode Island-based nonprofit organization, says
that if implemented, the cuts would "dramatically upset" the state
hospital system. Even now, she says, nursing homes are overwhelmed
with patients who should rightly be receiving full-time psychiatric
services at Eleanor Slater. Some patients are overmedicated in nursing
homes, she adds, just so that they can be treated. "The state hospital
doesn't keep those who can live in less restrictive environments,"
Hawkins says. "The people left there really need to be there."
Cosper concurs. In 1975, he says, there were 3,900 mentally ill
inpatients in Rhode Island's state hospitals. "Long term care doesn't
mean institutionalization like it used to," he says. "It's not like
they are here forever. They are not warehoused." While Cosper doesn't
recommend returning to 1975's high levels of institutionalization,
he is distressed by the current shortage of long term beds, and
offers four dire predictions for consequences of insufficient care
for the mentally ill. First, he says, acute beds fill with stable
long term care patients. Secondly, nursing homes fill with mentally
ill adults under the age of 50. Next, mentally ill people may go
to jail. And finally, sometimes mentally ill people die.
Cutting ten percent from all state agencies is not a realistic
goal, says Monteiro. "It's not a fair process when you're not prioritizing
which citizens need your help the most." The ten percent reduction
"is not inspiring or responsible" when it is taken from "the people
who are most vulnerable."
|
 |
