Taunton Hospital in trouble again with $12.7M tab, Gov. taking aim
After averting closure of Taunton State Hospital last year with a veto override, lawmakers are once again facing questions about what to do with the long-term care mental health facility, which some believe is eating up resources that could be better spent elsewhere in the field.
If the Legislature elects to keep the 45 beds in operation at Taunton State Hospital, it could come at a cost of $12.7 million and add to the state’s total inventory of beds at a time when institutionalized mental health care is on the decline, according to an independent report.
If the state elects to spend that money instead on the newly built Worcester Recovery Center and Hospital and community-based housing and services, the southeast would lose its mental health hub in Taunton.
“Naturally, I’d like to see more beds,” said House Speaker Pro Tem Patricia Haddad (D-Somerset) who acknowledged she is “not unbiased in this situation” as a legislator from the region. Haddad told the News Service, “Maybe we’re just not using the system to its capacity and we need to change exactly how we move people through the system.”
The Legislature previously blocked a Department of Mental Health plan to shutter Taunton, and move patients to the new Worcester facility. Another year of keeping Taunton running would come at a cost, according to Massachusetts Association for Mental Health Deputy Director Timothy O’Leary.
“If the Legislature were to decide that they want to keep Taunton running fulltime then what they spend to do that would be, we feel, better spent shoring up community-based services,” O’Leary told the News Service. O’Leary who backs the administration’s plan to close Taunton, also said, “If the state could afford to have all of them, I guess I wouldn’t be saying close them.”
Gov. Deval Patrick attempted to close the then-169-bed Department of Mental Health facility last year, but the Legislature opted to keep the place open in a diminished capacity, overriding a Patrick budget veto in order to keep 45 beds in operation, and commissioning a study.
Gauging whether the beds at Taunton are needed presents analytical challenges for state officials, as the March 15 report by Abt Associates and Technical Assistance Collaborative noted.
“There is no scientific or objective basis to assess whether Massachusetts and DMH have too many or too few continuing care beds in the system,” the report stated in the first of its conclusions, which also said, “We conclude that Massachusetts would be best served by a multi-faceted set of system improvement and accountability strategies rather than solely increasing the supply of continuing care beds.”
Rep. Ruth Balser (D-Newton), who is on the committee studying the issue, said the question goes beyond whether to include funding for the beds in the budget, and highlighted the constraints of the current mental health system by noting there are 100 people under DMH care who are ready to be discharged from continuing care, but have to remain because systems aren’t in place to support them when they leave.
“They can’t leave because there’s no place to send them that’s appropriate,” Balser told the News Service. She said, “What is really being said here is there are many problems in the mental health system at other points on the continuity of care such that it obscures the number of beds that you need.”
O’Leary said that there is constantly a “backlog” of patients who are unable to leave long-term care, caused in part by a reluctance to leave an institutional setting, but also because of a dearth of housing that is available close to mental health services.
“They have to now find the place for them to live with the community based services that will allow them to be a successful tenant,” O’Leary said.
The report, commissioned for the Mental Health Advisory Committee, noted the cost of keeping the Taunton facility open and that the administration has not included funding for that particular hospital in its budget for fiscal year 2014.
“The proposed DMH budget for FY 2014 assumes an inpatient capacity of 626 beds with none at TSH. If Taunton were to remain open at 45 beds, another $12.7 million would need to be added to the DMH budget to cover Taunton’s operating costs,” the report said. “Essentially DMH would be carrying a budget for 671 patients, roughly 85 beds more than it has been averaging over the past six months.”
The money spent on Taunton would sap funding for operation of the new Worcester facility as well as community placements. The governor’s budget recommends using $5 million from the inpatient facilities line-item to fund “community services for clients formerly receiving inpatient care at the department facilities.” The budget itself does not make explicit reference to the Taunton or Worcester facilities.
“It’s an incredible facility,” said O’Leary of Worcester, mentioning that the staff at Taunton is professional and committed, as well. Apart from modernities such as wifi Internet, the Worcester facility has “a village-type atmosphere with common areas” to ease the transition out of the institution, O’Leary said.
The Taunton campus is a jewel in its own right, and much more convenient for patients’ families who live in the southeastern part of the state, according to Rep. Shaunna O’Connell (R-Taunton).
“We need the full spectrum of care, and I think it is our obligation to fund mental health care for every region,” O’Connell told the News Service. Asked about the hospital in her city, O’Connell said, “It’s a very beautiful sprawling campus, a very large campus.”
When the number of beds was reduced last year, the Taunton hospital, which also includes a Department of Youth Services facility, stopped admitting people charged with a criminal act who have been court-ordered to DMH custody, according to the report and O’Connell.
The report notes that the southeast region includes acute Corrigan Mental Health Center, in Fall River, and the Cape Cod & The Islands Community Mental Health Center, in Pocasset. Both facilities, which draw roughly 96 percent of their patients from the region, are “unique” because of the relatively long length of time they allow patients to stay at an acute-care facility, a period “approaching 30 days,” the report said.
A centralization in Worcester is not the only trend affecting long-term mental health care. According to the recent study, institutionalization is on the wane.
A number of factors have contributed to less usage of continuing care beds, even as the number of insured has risen because of advancements in care, shorter lengths of stay and “more people successfully served in the community,” according to the report.
The average number of patients in continuing care has dropped from 900 in 2004 to less than 590 people over the last six months, the report said.
“We conclude that Massachusetts should continue the practice of seeking integrated community settings as the first choice, rather than electing to provide increased amount of institutional care,” the report said.
Both Haddad and O’Connell suggested that the range of services provided at Taunton hospital could be expanded.
“Why are we wasting this facility that we have?” Haddad asked.
Unlike other locations outside Worcester where continuing mental health care beds are offered, such as Tewksbury Hospital or Shattuck Hospital, in Jamaica Plain, O’Leary said, Taunton served too many long-term care patients to make it eligible for Medicaid reimbursements, a factor noted by the report as well.
“Massachusetts has a financial incentive to provide hospital levels of care in settings that can be reimbursed by Medicaid,” the report said. “Taunton State Hospital, as long as it operated with a daily census exceeding 16 adults, is an Institution for Mental Disease and thus does not qualify for Medicaid reimbursement.”
Members of the committee studying the issue met for two hours on Monday, Haddad said, and another report will be made before the end of the calendar year. O’Connell said that the hospital will not close before the study is complete. That could set up another budget battle between Patrick and the Legislature over how to distribute mental health services around the state.
Meanwhile, the committee has broadened its scope beyond just the fate of the Taunton hospital.
“To me, the problems are not just in one place. I think we’re going to find there are problems throughout the system. There are backups throughout the system. There are bottlenecks and jams throughout the system,” said Haddad, suggesting that the Taunton facility could be part of the solution for a more effective mental health system.
Lawmakers also said it is possible, though too early to tell, that other legislation could arise out of the study.
“I think that there’s a growing awareness within the group of the complexity of this issue,” Balser said. She also said, “What’s becoming clear is we need to really pay closer attention to our entire mental health system.”
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