Budget shortfalls are once again prompting staff and service cuts in the Green Mountain State. According to Nancy Rollins, associate commissioner for the Department of Health and Human Services (DHHS), both programmatic and physical changes planned for New Hampshire Hospital are intended to accommodate patients’ needs and work within a reduced budget.
As of June 30, the Anna Philbrook building, originally constructed as a long-term residential facility with a full school program, will be shuttered. While admissions have continued to decline, Anna Philbrook’s physical condition also raised concerns in recent years. “Several proposals suggested building a new unit or adding on to the existing hospital,” says Rollins. “There were some piecemeal attempts to address heating and cooling issues. But architecturally the building was not meeting standards. The building was no longer appropriate.”
With the closure of Anna Philbrook, children will be admitted to F Unit, previously a 14-bed adult ward in the main hospital. “It will become a children’s acute psychiatric facility,” says Rollins, adding that any remaining adult patients will be relocated within the hospital or receive services in the community.
The current educational format will also undergo some changes. Rather than keeping licensed teachers on staff, the hospital will engage tutors and utilize technology and configure online classes in collaboration with each school district. “We will work with each school district where the child lives. We’ll get a tutor if they’ll be here for more than three or four days,” Rollins says.
New Hampshire Hospital has also reconfigured its psychology staff, Rollins notes. “Rather than being a standing member of the treating team, we’ll use psychologists on an as-needed basis per the child’s needs,” she says.
Michael J. Cohen, executive director of the National Alliance on Mental Illness in New Hampshire (NAMI-NH), says, “We are all concerned about the level of services for the children and whether the environment is appropriate. When we eliminate a facility and transfer kids to an adult unit, you impact both sides.” He applauds the state’s efforts to move adults into the community when appropriate, but points out that those services are also being cut in the wake of reduced revenues.
Another major concern revolves around replacement staff, according to Cohen. “We don’t want the positions filled with people who don’t want to work with children,” he says. “Their license might fill the scope of the position, but they may not be the best people for the job.”
NAMI-NH enjoys good rapport with New Hampshire Hospital and also comprises an advisory committee for the facility. “We monitor things within the hospital and will continue to do so on the new unit. We will make sure the standards are appropriate,” Cohen says. “Until we see [the new model] in operation, we’ll be cautious. We have a close working relationship with the hospital and the physicians. We’ll watch the situation carefully.”
Liz Iacobucci, public information officer for the State Employees’ Association of New Hampshire, SEIU Local 1984, confirms that at least four staff members classified as Psychological Associates II have been laid off. The reduction in staffing raises concerns about the ability to deliver appropriate services, she says. Given the high acuity level of patients at New Hampshire Hospital and demand for services, experienced staff with specialized training is critical for optimal treatment. Under the provision of state personnel rules, laid-off employees are to be recalled if circumstances change. “Hopefully New Hampshire Hospital would call [these staff members] back if their services are needed,” says Iacobucci.
The union has also been in discussions with DHHS regarding whether the academic component will maintain adequate standards. In a recent article, SEIU 1984 points out that DHHS is under no obligation to notify the School Administrative Unit regarding a child’s educational needs until he has been without academic services for 10 days. With an average stay of seven to 10 days, the union concludes that some children would have no access to education while at the hospital.
According to minutes from a June 7, 2010 New Hampshire Hospital executive committee, the facility had 221 admissions in May, but is currently deferring admissions because of bed capacity issues. Only one female adolescent bed is available; the number of available beds has been reduced by 30 due to the closure of I Unit in October 2009 (neuropsychiatry), the changeover from adults to adolescents on F Unit and the capping of admission on D Unit due to insufficient psychiatric coverage. Recruiting is ongoing for several psychiatry positions. The minutes also revealed that findings from a federal audit of the Disability Rights Center (DRC) suggest more monitoring; the DRC plans to have a more visible presence at the hospital.