By Brian M. Boyce
TERRE HAUTE — State budget cuts means fewer rooms will be available in residential care settings for the mentally ill in 2010, and at least one Wabash Valley facility plans to close its doors because of the cuts.
A Nov. 30 memo issued by the Indiana Family and Social Services Administration regarding the Residential Care Assistance Program stated: “Current recipients will continue to be funded. Absent sufficient appropriations to FSSA, new applicants determined to be eligible for RCAP assistance will not receive this assistance” after Nov. 30, 2009.
According to the memo, RCAP is a state-funded program providing assistance to residents living in “room and board facilities” and “county homes.”
Tom Hein, administrator for Lee Alan Bryant Health Care just east of Rockville, operates four such facilities: two in Parke County, one in Indianapolis and another in South Bend.
When reached by phone by the Tribune-Star, Hein declined to discuss the possibility of a facility closure, but said the state’s sudden decision to terminate funding for future patients will have “a drastic effect on our ability to house residents with severe mental illness going forward.”
However, a letter from Hein to Arlene Franklin, state Long Term Care Ombudsman for the Division of Aging — a copy of which was obtained by the Tribune-Star — stated his group’s Parke County Residential Care Facility in Rockville has given notice of its plans to close Feb. 12. According to the letter dated Monday, residents, family members and legal representatives will be given notice of the closure on or before Jan. 12 and information on an option for other living arrangements and eligibility guidelines.
The recipients in question, Hein said in the phone interview, are typically those with severe mental or developmental disabilities ranging in age from the early 20s upward. The cost of care at his facility is $49.35 per day, of which the state typically pays between $20 and $25. The balance is deducted from the patient’s Social Security Disability or Income check.
Hein’s other Parke County facility in Rockville — Lee Alan Bryant — can house up to 253 patients, and those admitted before Nov. 30 will continue to receive state funding. As current patients are released, those needing residential services afterward will have to pay either the entire amount of fees or not be admitted, he said.
“The freeze is going to limit us very much,” he said. “These people have no place to go.”
Most of his patients are referred from correctional facilities, jails or community mental health centers such as Hamilton Center in Terre Haute.
Galen Goode, CEO of the Hamilton Center, said the lack of referral outlets for patients could produce something of a “domino effect.”
While Hamilton Center operates its own acute and sub-acute in-patient hospitals, other facilities will be forced to refer more patients to state psychiatric hospitals such as the one in Logansport.
If the beds in the state hospitals become full, there aren’t many options left to house the patients, Goode said. “It’s not usually a denial so much as it is how much time it takes to get someone in,” he said of the potentially lengthy wait some patients may face before getting admission to a facility.
Hein and Goode both said jails and other correctional facilities inevitably will bear some of the burden, along with the state hospitals.
“A lot of [mental patients] will end up in the correctional system, which is a shame,” Hein said, describing his residents’ ability to live independently as negligible.
Also, long-term costs to the state could increase, he said. His daily rates of less than $50 pale in comparison to rates at state hospitals, which range from $500 to $700 a day, or even county jails’ $200 per day, he said.
But FSSA spokesman Marcus Barlow said the state doesn’t have much choice because of “incredible revenue shortfalls.”
“In this environment, we don’t have the luxury of being able to fund [RCAP],” he said.
Judgments must be made on the physical, mental and developmental abilities of patients, and according to Barlow, those using in-residence programs are on a “lower rung of need” compared to patients in nursing homes. The priority for funding, he said, must go to people who aren’t able to care for themselves before those with needs that can be serviced at county homes and room-and-board facilities.
Regarding the impact to businesses providing such services, Barlow said basing a business plan on state funding is dicey. “When tough times hit, they hit the state and they hit everyone,” he said.
Goode described the decision to cut off funding after a specific date as too “arbitrary.” More dialogue is needed between the state and local health care providers, he said, adding no one from the state seems to have asked local officials what the impact might be of such a decision.
In the meantime, Barlow said the funding cut is a “suspension” rather than a termination, and given an economic turnaround, the decision could be rescinded.
“It’s a good program and we’d love to do it,” Barlow said. “There just isn’t the money.”
Brian Boyce can be reached at 812-231-4253 or brian.boyce@tribstar.com.
