By CRISTINA JANNEY
Hays Post
The director of the community mental health center for northwest Kansas is concerned the closure of acute care psychiatric beds in Hays will create a barrier to treatment in western Kansas.
Children in western Kansas will have to travel as much as four to five hours one way to receive in-patient acute care.
Walt Hill, High Plains Mental Health director, said the closure of the only beds in western Kansas was breaking a promise made when those services were privatized 10 years ago.
Andy Brown, commissioner for Behavioral Health Services for the Kanas Department for Disability Services, said the closure of the acute care beds in not ideal, but children in Kansas have been traveling long distances for decades to receive treatment.
KVC has cited changes in Centers for Medicaid and Medicare regulations and issues with the space it rents at the Hadley Center for the closure. However, Brown said the decision to close the beds with made by KVC and was based on finances.
The acute care beds at KVC Hospital-Hays were the only acute care beds for youth in western Kansas. These placements were short-term stays for youth who are dangerously suicidal, aggressive or have made threats to hurt others.
Youth from Hays and western Kansas are being placed as far away as Denver, Kansas City or Kearney, Neb. New acute care psychiatric beds just opened in Wichita. However, Hill said it was his understanding that all the beds in Wichita have not opened yet.
Hill said the transportation of the children is complicated, because some of these children are threatening to jump out of vehicles, which makes parents frightened to transport the kids so far.
Hill also expressed concern the barrier of distance from treatment might discourage caregivers from seeking treatment for children or delay them from seeking treatment for kids.
Placing children so far from home might also interfere with their treatment, Hill said.
“It will be harder to do the type of family care that is needed often when children are in a psychiatric hospital,” he said. “How can you work with the family when the child and the treatment team is in Kansas City or Denver or Kearney or Topeka as opposed to here, relatively close by?”
HPMH has a 20-county catchment basin in northwest Kansas and refers 180 youth per year to acute psychiatric treatment. KVC-Hays’ catchment area includes all of western Kansas. Hill said Garden City has already had to send youth to Kansas City.
KVC had operated both a psychiatric residential treatment facility and acute care beds out of the Hadley Center in Hays since 2010. KVC, a nonprofit, was awarded a contract to provide youth acute care when the state closed juvenile acute care beds at Larned State Hospital. Juvenile psychiatric care is now privatized across the state.
In 2017, Brown said KDADS was informed that CMS was no longer going to allow residential treatment and acute care treatment to operate under the same license.
During a Joint Legislative Budget hearing on Oct. 2, Brown said CMS rules had been in place for a number of years, but Brown said KDADS was enforcing the rule now “because I am aware of it now,” and KVC had operated despite these rules by the “Grace of God.”
In that hearing, Brown said one of the concerns about commingling residential and acute care children was acute care children had become aggressive in the past and hurt residential children. However, he said he did not know an exact number.
KVC said none of these incidents had occurred at KVC.
KDADS sent a letter to KVC in February saying it would have to split the residential and acute care programs by April 2019. It did so, but opted to close the acute care beds in October and announced it would convert those beds to residential beds in the near future.
In its announcement of the closing of the acute care beds, KVC said it needed $1 million in renovations to keep the acute care beds open and suggested “legislators could create a line item in the governor’s budget, similar to funding provided for adult state psychiatric hospitals, that would assist with overhead costs and KVC would be open to exploring that as a sustainable operation.”
Hays Post asked KVC what specific renovations were needed and why these infrastructure needs had not been an issue earlier.
KVC responded, “The Class 1 psychiatric residential treatment facility (PRTF) regulations allowed different parameters for a facility than what is required to operate a standalone acute unit. Standalone acute units have higher levels of requirements. Over the past 10 years, we have made continuous enhancements to the space we lease in the Hadley Center to remain within compliance with these regulations and provide a safe and therapeutic environment for the children we serve.”
Hill, in his testimony at the budget hearing, said he was told there was an issue with a ceiling in the area of the acute care facility that did not meet standards and could be a hanging hazard.
However, Brown in the budget hearing said, “It’s not a matter of accommodations. It’s a matter of finances.”
He went on to say later in the hearing, “You could put it in terms of billing, the amount coming into the facility to cover the cost of the care was not sufficient in the eyes of KVC, to continue the facility as a split facility.”
KVC in its response Hays Post said “KVC is not able to financially sustain a standalone acute hospital unit in the western region.”
Hays Post asked what factors made providing care in western Kansas unsustainable. The Post specifically asked about cost of staffing, Medicaid and Medicare reimbursement rates, and the possibility of the center not operating at capacity.
KVC avoided answering this question directly saying, “The dual license was an innovative and necessary way to meet the psychiatric needs of children in the less populated areas of rural and frontier western Kansas where census numbers tend to be lower. It provided flexibility to meet different levels of need in a way that was sustainable for nonprofit providers such as KVC Hospitals.”
KVC also was asked how much money would be required to provide a sustainable acute care facility in western Kansas, but KVC would not assign a number to this question.
Hays Post asked KVC about the issue of distance.
KVC responded “At KVC, we believe it is beneficial for children to receive treatment as close to their families and support systems as possible. This is why it has always been our intent to maintain the license we have held since 2010, allowing us to provide acute services to children from Hays and surrounding areas.
“To further that effort, we opened a new hospital in Wichita to expand access to acute services for families in southwestern Kansas, due to many of these counties being nearly equal distance to Hays and Wichita.”
Hill said if the private sector can’t sustain acute care beds in western Kansas, it is the responsibility and duty under the state constitution to provide them. He suggested reopening juvenile beds at Larned Stated Hospital. He said instead of giving $1 million to remodel the Hadley Center, he said he would rather that go to Larned.
“It has always been the role of the state to provide that safety net for adults and children in the state,” he said. “The community-based services have their role for those people who don’t need to be in a hospital. Some would say the constitution of the state requires the state to take care of the welfare of the folks at that kind of level and the safety of the communities.”
Hill was very involved in the process of privatization.
“When the beds were privatized some 10 years ago, the commitment was made that there would be beds to replace those state hospital beds in western Kansas. We spent a lot of time with policy makers and local legislators, the city, talking about that,” he said. “I was very involved in those discussions. What I understood was that there was a commitment and a promise when the beds at Larned were closed, we would keep beds in western Kansas in some form.”
In his phone interview with Hays Post on Friday, Brown said the state was interested in providing acute psychiatric services in western Kansas, but no plans were in the works to do so. He said the juvenile psychiatric services were privatized nine years ago, because it was not sustainable for the state to offer those services.
The state is working on other treatment options he hoped would help keep children out of acute care. This includes crisis lines, mobile crisis units, peer support networks for parents and families, screeners who could come into people homes and other programs through the Family First Preservation Act.
KVC has announced it intends to convert its acute-care beds to 50 PRTF beds. This type of treatment generally lasts 30 to 90 days and is for youth who have been stabilized.
Hill said he was pleased more PRFT beds will be coming online. Kansas has about 200 children on a waiting list for residential treatment with a wait time of about five months. When all the acute care beds in Wichita and residential beds in Hays become available, Hill said there should be a net increase in psychiatric beds for youth in the state.
However, Hill said residential care “is really not helpful in the kinds of situations we are talking about where a youngster is talking about hurting themselves or somebody else or just out of control.”
Hill said community mental health centers do all they can do to keep children out of acute care. However, he said some kids need to be in the hospital.
“We need the services,” he said.