The complicated finances and history of the state-run Eleanor Slater Hospital may take another turn.
The network of four satellite hospital buildings, which care for less than 200 people with significant psychiatric and medical conditions, is proposed for a restructuring that would close two hospital buildings and create a new nursing home facility instead.
Involved in all that is the movement or discharge of patients, many of whom have lived in those hospital buildings in Cranston and Burrillville for years. Some families and patient advocates have been critical of the state’s reorganization plan, which has taken various forms over the past year.
In recent weeks, Eleanor Slater employees have sent letters to the House Finance Committee, which will review the plan. “This hospital should not be downgraded to a small nursing home in an attempt to save money, which would be a disservice to our state’s most vulnerable patients,” wrote Daniel Nelson, a member of the hospital’s microbiology department.
Kathryn Power, director of the R.I. Department of Behavioral Healthcare, Developmental Disabilities and Hospitals, said a reorganization will allow the state to provide the appropriate care, a nursing home level of care, and will also provide discharged patients – nearly 100 people – with a community-based setting that is more appropriate for them.
“What we have found is the individual patients we have, many of them should not even be in a hospital,” Power said in an interview.
Megan Clingham, mental health advocate for the state of Rhode Island, said in an interview recently that the state over the years has made insufficient investments in community-based care, which complicates the reorganization.
“It’s not a realistic plan because there is insufficient capacity in the community,” she said of the idea of transferring patients into nursing homes or group homes. “It’s not a problem if those settings exist. What I’m saying is they don’t exist.”
But Power insists that Rhode Island has enough locations that could accept people leaving the hospitals. “There are multiple places in the community where some of our patients would flourish and have an opportunity to be in the least restrictive environment,” she said.
What’s driving the reorganization? In August 2019, the state stopped billing for federal Medicaid reimbursement for Eleanor Slater patients, after discovering it had allowed the hospital system to admit too many psychiatric patients. Falling out of compliance with federal Medicaid reimbursement requirements – which mandate that no more than half of a medical-psychiatric hospital’s patient volume be psychiatric patients – led to a loss of about $20 million in federal reimbursement last year.
The patient-mix issue has been resolved, according to Power. But now the state has determined that it still cannot bill for Medicaid reimbursement because it has not been providing hospital-level care at Eleanor Slater Hospital, and was told by the federal agency overseeing Medicaid services that it has to amend its service agreement. The state plans to pursue the nursing home status to more appropriately reflect the kind of care it is providing, Power said.
The hospital for many years has failed to adequately plan for the regular discharge of patients, a process that should begin as soon as the patients are admitted, Power said. While some people are not suited to living outside the hospital setting, many are, she said.
“I was around many, many years ago when we closed the Ladd School [in Exeter], when we closed the Institute of Mental Health [in Cranston],” she said, referring to the former state institutions for people with developmental disabilities and significant mental illness, respectively.
“We moved those very, very complex patients into group homes and into the community,” Power said. “We just should have been doing that continuously for some of the people in this hospital, and we didn’t.”
Under her reorganization proposal, the Regan and Adolf Meyer buildings will be closed at the Pastore Medical Center in Cranston, and the state will open a new or significantly renovated Zambarano facility in Burrillville with the status of a nursing home rather than a hospital. The unaffected building is the Benton Building in Cranston, which has patients either civilly or criminally committed by the Rhode Island court system.
The timeline will be gradual, but the discharging of patients has already begun. According to an analysis by the House fiscal officers, the proposed reorganization would cost $65 million for a new, or renovated, nursing home facility at the existing Zambarano campus, using $53 million in bonds and $11.3 million from other state funds.
Because the volume of patients would decrease over time, the state would save money on operations.
Any reorganization will require approval from the General Assembly, potentially in fiscal 2022.
Mary MacDonald is a PBN staff writer. Contact her at Macdonald@PBN.com.
Correction: A previous version of this story inaccurately identified how many patients were being treated for significant psychiatric and medical conditions at Eleanor Slater Hospital.
