Medicaid: cld cover all low income,uninsured Americans and NC could do away w/ the paperwork mess re: state funded folks needing mental health care

There's a massive amount of paperwork, consumer disatisfaction, and professional disatisfaction concerning the state funded clients (the working poor; those w/o health insurance; no medicaid and no medicare; no insurance from their employer).

There's a great number of people like this in western NC.

Here is a great proposal to expand Medicaid to these uninsured citizens and it would remove the administrative costs of the LME's and lighten their load so that they could adequately peruse Medicaid in an effective manner.

***********************

Center on Budget & Policy Procedures:

IMPROVING MEDICAID AS PART OF BUILDING ON THE CURRENT SYSTEM TO ACHIEVE UNIVERSAL COVERAGEby January Angeles

http://www.cbpp.org/2-24-09health.htm
"Expanding Medicaid an Effective Way to Cover Low-Income, Uninsured Americans
Medicaid’s proven success at providing comprehensive, affordable coverage to tens of millions of low-income children, parents, seniors, and people with disabilities makes it an excellent option for expanding coverage to a broader group of low-income, uninsured Americans. A substantial portion of uninsured people have characteristics that are similar to current Medicaid beneficiaries: two-thirds of them are poor or near-poor, 10 percent are in fair or poor health, and almost half suffer from a chronic condition.[6] Medicaid’s benefit package and cost-sharing structure are well-matched to this population’s needs."

Painting lipstick on the pig: Family Homes to get a rating per NC DHHS for making mental health patients wards of their homes

There is this 'window dressing' remedy which NC DHHS has created in terms of 'rating' the Family Homes; see: Adult care homes receive star ratings in 2009 Release Date: February 20, 2009 Contact: Jim Jones, 919-733-9190 http://www.ncdhhs.gov/pressrel/2009/2009-2-20-adultcarestar.htm

I say, NC DHHS: do you think that the people without the internet connection or the education to use the internet are going to CHECK to see what the '5 start Michelin Guide rating' is as re: the Family Home in which to place their 'loved one'?

*************************

Dunno, maybe stink of Family Homes is wafting towards Raleigh.

On Sunday evening I was threatened w/ arrest by Buncombe County Sheriff's Department who sided w/ the owner of WNC Homes, Jeff Clifton, as I sat and tried to have therapy w/ my head injured client with chronic pain (they won't let me see the medical records because they don't want me and the resident to look at the financial records and start asking yet more questions about WHY does the resident get so little back from his social security disability check and why it appears that his funds are comingled---illegally---with their administrative funds).

See the law here: 10A NCAC 13G .1101 Management of Resident's Runds "Residents shall manage their own funds if possible." AND 10A NCAC 13G .1103 "....A resident's personal funds shall not be commingled with facility funds...."

The sheriff's department escorted me off the property using their three parole cars.

The Community Support Service workers last week were told they could not enter certain houses 'or the police will be called', though there were clients in there who had contracted w/ the Endorsed Provider company for services.

I say persue the class action lawsuit. I'm waiting to hear back re: my formal investigation request from DSS Buncombe but I don't have much hope that anything will take place re: that.

Here's the outline of that matter:

Important points:
*90,000 approximately NC impacted citizens; citizens impacted in every state who have mental illnesses and physical illnesses. If WNC Homes is reflective of the usual clients, probably 75% have diagnoseable DSM, psychiatric diagnoses. So that would be approx 60,000 affected citizens.

*42 U.S.C. 1963, I think, Statute (still searching for this; concerning mental illness discrimination and violation of civil rights) gives key to open to door in terms of federal lawsuits e.g., 'suing the government'

*payments to keep mentally ill clients is Medicaid bound which means federal money which means federal court. I am speaking about two stream funding for payment for room & board for Family Homes which comes via: 1. Medicaid 2. DSS funds, which I assume are federal.

*I understand that 4th District Court (I think I have my numbers right) is conservative system. Relatedly, NY lawsuit , specifically, Disability Advocates, Inc.,Plaintiff v.George Pataki, In His Official Capacity As Governor Of The State Of New York, et al was another less conservative district. see: http://www.bazelon.org/issues/disabilityrights/incourt/nycomplaint/nyadulthomescomplaint_final.htm

*class action lawsuit could be referred (not sure about this mechanism) to Justice Department which would be more amenable, perhaps, under Obama, re: these matters. they would argue case and psychologists such as myself would be 'friend of the court', as I understand it.

*only portion of Family Homes law, specifically, Subchapter 13G licensing of family care homes, that has to do w/ people OUTSIDE the home---as interfacing w/ Family Home administration and residents and Supervisors-in-charge of home is the following (save for physicians and there is information around the use and charting of medication): "10A NCAC 13G 0908: "Cooperation with Case Manager: The administrator shall cooperate with and assure the cooperation of facility staff with case managers in their provision of case management services to the appropriate residents." Caveat: I have asked DSS Buncombe to render decision, as per their legal advisor if necessary, if clinical psychologist receives the same 'cooperation' as 'case manager.' I do not know if their legal person can determine this or not. There are no case managers associated with this which leads me to the next matter:

*Community Support Services (CSS), a Service Definition created by NC DHHS, in order to upgrade skills of people like those living in Family Homes, is harnassed to notion of CSS workers being able to work w/ clients which is being blocked by WNC Homes and more or less by all Family Homes in NC in terms of access to financial records/ medical records, etc. In that NC DHHS has a desire to upgrade the skills of these clients----but bearing in mind that the regulatory agency of these Family Homes is a division within NC DHHS, specifically, NC Division of Health Service Regulation (see: http://www.dhhs.state.nc.us/dhsr/reports.htm).

*Only other part of Family Homes Law which seems to allude to civil rights is this: "Resident Rights 10A NCAC 13G .0909: A Family Care homes shall assure that the rights of all residents guaranteed under GS 131D 21, Declaration of Residents Rights, are maintained and may be exercised without hindrance." Checking on GS 131D 21, RE: mental health treatment, the clause, as per the below, seems to be the most pertinent re: mental health treatment, specifically, "(15) To have freedom to participate by choice in accessible community activities and in social, political, medical, and religious resources and to have freedom to refuse such participation."

*There is this 'window dressing' remedy which NC DHHS has created in terms of 'rating' the Family Homes; see: Adult care homes receive star ratings in 2009 Release Date: February 20, 2009 Contact: Jim Jones, 919-733-9190 http://www.ncdhhs.gov/pressrel/2009/2009-2-20-adultcarestar.htm
********************************************
http://www.ncleg.net/EnactedLegislation/Statutes/PDF/BySection/Chapter_131D/GS_131D-21.pdf
§ 131D-21. Declaration of residents' rights.
Each facility shall treat its residents in accordance with the provisions of this Article.
Every resident shall have the following rights:
(1) To be treated with respect, consideration, dignity, and full recognition of
his or her individuality and right to privacy.
(2) To receive care and services which are adequate, appropriate, and in
compliance with relevant federal and State laws and rules and
regulations.
(3) To receive upon admission and during his or her stay a written
statement of the services provided by the facility and the charges for
these services.
(4) To be free of mental and physical abuse, neglect, and exploitation.
(5) Except in emergencies, to be free from chemical and physical restraint
unless authorized for a specified period of time by a physician according
to clear and indicated medical need.
(6) To have his or her personal and medical records kept confidential and
not disclosed without the written consent of the individual or guardian,
which consent shall specify to whom the disclosure may be made,
except as required by applicable State or federal statute or regulation or
by third party contract. It is not the intent of this section to prohibit
access to medical records by the treating physician except when the
individual objects in writing. Records may also be disclosed without the
written consent of the individual to agencies, institutions or individuals
which are providing emergency medical services to the individual.
Disclosure of information shall be limited to that which is necessary to
meet the emergency.
(7) To receive a reasonable response to his or her requests from the facility
administrator and staff.
(8) To associate and communicate privately and without restriction with
people and groups of his or her own choice on his or her own or their
initiative at any reasonable hour.
(9) To have access at any reasonable hour to a telephone where he or she
may speak privately.
(10) To send and receive mail promptly and unopened, unless the resident
requests that someone open and read mail, and to have access at his or
her expense to writing instruments, stationery, and postage.
(11) To be encouraged to exercise his or her rights as a resident and citizen,
and to be permitted to make complaints and suggestions without fear of
coercion or retaliation.
(12) To have and use his or her own possessions where reasonable and have
an accessible, lockable space provided for security of personal
valuables. This space shall be accessible only to the resident, the
administrator, or supervisor-in-charge.
G.S. 131d-21 Page 2
(13) To manage his or her personal needs funds unless such authority has
been delegated to another. If authority to manage personal needs funds
has been delegated to the facility, the resident has the right to examine
the account at any time.
(14) To be notified when the facility is issued a provisional license or notice
of revocation of license by the North Carolina Department of Health and
Human Services and the basis on which the provisional license or notice
of revocation of license was issued. The resident's responsible family
member or guardian shall also be notified.
(15) To have freedom to participate by choice in accessible community
activities and in social, political, medical, and religious resources and to
have freedom to refuse such participation.
(16) To receive upon admission to the facility a copy of this section.
(17) To not be transferred or discharged from a facility except for medical
reasons, the residents' own or other residents' welfare, nonpayment for
the stay, or when the transfer is mandated under State or federal law.
The resident shall be given at least 30 days' advance notice to ensure
orderly transfer or discharge, except in the case of jeopardy to the health
or safety of the resident or others in the home. The resident has the right
to appeal a facility's attempt to transfer or discharge the resident
pursuant to rules adopted by the Medical Care Commission, and the
resident shall be allowed to remain in the facility until resolution of the
appeal unless otherwise provided by law. The Medical Care
Commission shall adopt rules pertaining to the transfer and discharge of
residents that offer at least the same protections to residents as State and
federal rules and regulations governing the transfer or discharge of
residents from nursing homes. (1981, c. 923, s. 1; 1983, c. 824, s. 13;
1983 (Reg. Sess., 1984), c. 1076; 1997-443, s. 11A.118(a); 1999-334, s.
1.6; 2000-111, s. 3.)

NC DHHS/ CenterPointe LME/ Old Vinehard Behavior Health colluding to create non-Medicaid psychiatric hospital in eastern NC?

February 23, 2009

RE: Deal being struck between Old Vineyard Behavioral Services/ NC DHHS/ and CenterPointe LME which would create a 14% Medicaid psychiatric beds @ newly proposed $14 million free standing psychiatric hospital

To Whom It May Concern:

Forsyth County Commissioners---those people who are elected by the people and report to the people----- are assumably not very happy on being left out in the cold re: the proposed $14 million expenditure in order to create a free standing psychiatric hospital in eastern NC near Winston Salem, NC.

As per the WSJ article: 'The application is for a two-story, 48,000-square-foot building at 3637 Old Vineyard Road. Old Vineyard also wants 50 beds to be transferred from Broughton Hospital in Morganton.'

In relation to that matter (read: silencing of the dissenters) It seems that my comment at the WSJ on the newly proposed 50 bed FREE STANDING psychiatric unit in the eastern part of the state have been removed twice now.

If this is the kind of harassment mental health advocates have been subjected to in eastern NC, I can understand why everyone has run for cover. I don't get that in western and central NC via the papers. We may bicker online but our opinions are presented. Let's see if the WSJ will redeem itself by fleshing out the article.

Here is the link to that article with foxmulder's comment sitting below it and evidence that my two comments were removed. It would be useful if people would comment, I believe. http://www2.journalnow.com/content/2009/feb/21/mental-health-unit-is-proposed/ I am admittedly piggybacking onto a mental health advocate's e mail list as per an e mail alerting people to these important issues.

At the WSJ website associated with the article which provides incomplete information in terms of WHY would you have a psychiatric unit that allows for only 14% Medicaid beds, one can flag comments. I imagine that my two comments were flagged by the LME employee identified as 'foxmulder.' So, I flagged as inappropriate the comment that is there which I understand was created by someone associated w/ CenterPointe LME, namely 'foxmulder.'

I do not see why foxmulder's comment is OK and my two were not. Indeed, 'foxmulder's' comment was irksome to mental health advocates in that this person stated the following:

"Yet once again, the so called local mental health advocates find something to complain about. Typical."

I'd call that inflammatory. I am asking that it be removed and I have here as per this e mail contacted the writer of the story and I am asking that the journalist investigate WHY one would want to have psychiatric beds AS PART OF rather than APART FROM a general hospital. It seems to me that the journalist would be interested in the statements of an expert, Mike Mayer, below, and as per Doug Trantham, Emergency Services Director at Smoky Mountain Center LME, in western NC.

My comments were not inflammatory. Contrarily, foxmulder's comment IS inflammatory.

Moreover, who is hiding behind this 'foxmulder' ? I assume someone associated w/ the three entities that appear to be striking a deal: NC DHHS; Centerpointe LME; or Old Vineyard Behavioral Health.

My two removed comments were questions about why would you want to have a psychiatric unit where only 14% of the beds were for Medicaid clients when most of the Severe and Persistent Mental Illness patients are Medicaid clients?

I did a bit of research and asked the very gracious, hard working Smoky Mountain Center LME Emergency Service Director Doug Trantham about WHY one would not want to have a free-standing psychiatric unit, unattached from a hospital.

Here is what he told me:

1. He concurs w/ Mike Mayer (see below) that there are good reasons to have psychiatric beds as part of a general hospital: "There are many benefits for a psychiatric unit to be a part of a general hospital. Many of the individuals we serve in psychiatric crisis have serious health problems which must be attended to. In a free standing psychiatric hospital, this can be a big problem. In a general hospital, the ancillary medical services are always available when needed. "

2. Trantham reiterates what Mayer is speaking about below, re: 16 bed unit matter: "Another barrier is something called the IMD exclusion. Free standing psychiatric facilities can not have more than 16 beds and still bill Medicaid. This limits their size and feasibility, since you must have all the same services available for a 16 bed unit, that you do for a 50 bed unit. "

******************

Additionally, here is what Mike Mayer ( mikem@cra.cc; at the CRA website), Senior Partner at Community Resource Alliance (http://www.craconferences.com/aboutus.html) had comments in an e mail to a mental health advocate in eastern NC regarding the same questions but more specific to your situation in eastern NC re: the proposed 50 beds w/ only 14% Medicaid beds.

I believe these are comments that such an expert would make to anyone interestesd in listening and they so well outline the issues that I am admittedly jumping at the opportunity to blog them.
Mayer suggested that mental health advocates should be concerned that adult patients will continue to be denied to a free standing, non attached to a general hospital, such as Old Vineyard Behavioral Health Services, because the SPMI are dependent on Medicaid. Here are his other comments as passed to me by a mental health advocate in eastern NC as re: the article in the Winston Salem Journal (WSJ):

1. buying existing beds, such as is being proposed re: taking 50 of Broughton (in western NC, Morganton) beds and moving them closer to eastern NC has no construction costs.

2. with buying beds, if JCAHO standards have been met, Medicaid can be billed.

3. under 16 beds (which is size of Haywood Regional Hospital's Behavioral Health Unit which is co-run by Smoky Mountain Center LME, one of the two LME's in western NC) can 'usually', Mayer states, bill Medicaid if free standing but 'not always.'

4. Having access to medical care in the general hospital wherein the psychiatric beds are housed means access to MD's and other staff in the 'event that someone suddenly decides to detox without warning (about 80% inpatient admissions will have substance abuse issues as well', per Mayer.

5. Having access to medical care in the general hospital wherein the psychiatric beds are housed means the ability to handle major medical problems which 'also show up in high numbers for people with Severe and Persistent Mental Ilness (SPMI) problems.

6. Why did the free standing Balsam Center in western NC (Waynesville, NC; managed by Smoky Mountain Center LME w/ Doug Trantham as Emergency Director of SMC LME) close their doors to inpatient treatment? Mayer indicates that the 'financial piece' could not be figured out by SMC LME (comment: that was with Tom McDevitt, an accountant, as CEO, a person w/ mental health experience of about two decades).

7. The difficulties associated with creating psychiatric beds has to do with, according to Mayer, "$ and federal regs and wanting to avoid spending state $'

8. Mayer states that 'the Feds won't pay if there are more than 16 beds'--- (assumably) associated with the free standing psychiatric hospital, non-attached to the general hospital.

9. Mayer states that the following is generally true: ""Federal laws disallows payment for medicaid patients in any free standing psychiatric hospital, not attached to a general hospital. "

He notes exceptions: 'Most free standing psychiatric hospitals cannot make the $$ work if there are less than 16 beds and so the free standing psychiatric hospitals, unattached to the general hospital, are generally larger than 16 beds. The Feds can make an exception, but not usually. In Montana, for instance, re: to a shortage of MD's, they have allowed more leeway, Mayer states.

*****************

It seems to me that if Mayer's information is correct, then there is good reason for mental health advocates to be very concerned about spending $14 million on a free standing psychiatric hospital that has a markedly diminished ability to treat Medicaid clients and most SPMI clients are Medicaid clients. Therefore, it appears to be a waste of money to embark on such an endeavor.

A caveat, as per Mayer: 'there are a few providers nationally who have figured out the formula and make the beds open for everyone such as Strategic Behavioral Health.'

Maybe someone should go and ask them some questions.

Maybe someone in eastern NC---like elected officials----as in the GOVERNOR-----should see why NC DHHS/ CenterPointe LME/ and Old Vinehard Behavioral Health are colluding to block mental health advocates, concerned mental health providers, and county commissioners from having a say in this important process.

When Family Care Homes go bad: citizen s w/ mental health issues live in PRISON are HOMELESS or in FAMILY CARE HOMES LIKE THIS

This is all public information now. I'm namin' names.

*****************

Marsha V. Hammond, PhD: Clinical & Health Psychology: Licensed Psychologist, NC Lic # 2748
E mail: hammondmv@netzero.com cell: 404 964 5338 fax: 828 254 2013

February 23, 2009

Formal Complaint on WNC Homes

Dear Sarah Tarpey, Adult Protective Services Buncombe County DSS:

I am making a formal complaint on WNC Homes, Leicester, Country Time Circle. Their mailing address is in your files, I believe. Please consider this e mail as outlining that complaint.

I was seeing my client, ----, in Hse # 12, Country Time Circle, Leicester, NC at 1900 hours in agreement w/ their schedules and mine when the Supervisor in Charge (SIC) attempted to call me to the phone, interrupting our session, in order to speak to someone from administration of WNC Homes. As you may recall, I asked Jeff Clifton , administrator for WNC Homes in a US Post delivered letter to fax to me information from the WNC Homes Policy and Procedures manual any information as associated with ‘visiting hours.’ He did not fax that to me. Neither did he send this to me or have posted on any of the walls of the WNC Leicester Homes information which is demanded by law to be posted as re: visiting hours.

In any case, as WNC administration have insisted on berating me on the phone in the past several weeks, I refused to speak to the person on the phone; the SIC stated that the sheriff’s department was being called upon which I advised her that I was calling the Emergency Worker on call for DSS Buncombe. I spoke briefly at 1910 w/ Joann Amato, the emergency on call person for Buncombe DSS. Shortly, I stated to her that there were three sheriff’s cars on the premises. She advised me to call her if necessary after I left. I called back at 2215 in order to obtain her name.

Jeff Clifton, one of the administrators w/ WNC Homes, was present when the Buncombe Sheriff’s department arrived @ approximately 1930. Arriving were: Deputy Hannah and Deputy Ernst. Their supervisor that evening was Sgt. Styles. He was not present. Their contact information is: 828 250 4496. The case number is: 2009-001831. There was no report filed, Deputy Hannah, stated to me. The sheriff’s department sided w/ the administrator, Jeff Clifton, and told me I had to leave immediately as it was the property of WNC Homes and he stated that I could no longer see clients which I intended to do for about thirty more minutes. The sheriff’s department stated that I was forbidden, in keeping w/ administrator’s request, from coming onto the property any more or I would be arrested. The administrator indicated that he ‘owned’ the property. The clients were given no opportunity to express their desires though it is my understanding that it is ‘their home.’

So, my complaint, issuing from Subchapter 3G-Licensing of Family Care Homes is below. Please consider this a formal complaint. I await your ruling on this matter prior to filing it with the Division of Health Service Regulation. I want to know what the trajectory of this complaint is and what I can expect in terms of a timetable. I will accordingly advise my clients living at WNC Homes Leicester, NC.

These are the specific items of my complaint:

Item 1: 10A NCAC 13G .0208 Renewal of License : “All applications for license renewal shall disclose the names of individuals who are co-owners, partners, or shareholders holding an ownership or controlling interest of 5% of more of the applicant entity.”
I would like to know who the owners, co-owners, partners, or shareholders or those holding an ownership or controlling interest of 5% of more are as re: WNC Homes.

Item 2: 10A NCAC 13G .0209 Conditions for License Renewal: “In determining whether to renew a license under G.S. 131D-2 (b) (6), the Department shall take into consideration at least the following……
(3) the extent to which the conduct of a related facility is likely to affect the quality of care at the applicant facility….”
I am filing this complaint as I maintain that the noxious inability to cooperate with case manager and other professional providers offering services to the clients living at WNC Homes Country Time Circle Leicester NC affects adversely the quality of care at the applicant facility. Specifically, these are the matters which impact the ability to care for these residents:

a. the residents’ charts and medical information inclusive of medications is not available to this clinical psychologist who informs the physician in care of the resident. Residents with chronic pain conditions cannot be assessed without the current medication or difficulties or documented side effects of the medication. Residents taking psychotropic medications cannot be assessed as per behavioral difficulties or side effects which could assist the physician in dosing or choice of medications. WNC administration has stated that this psychologist can have no access to client medical records.

b. the residents’ financial information which impacts their mental health as associated w/ no spending money and thus limited ability to interface w/ the community, is not available to this psychologist.

c. the curtailment of hours available to see the clients which is determined solely by the WNC Homes administration is impacting the ability to care for these residents as per psychological therapy and additionally, Community Support Services, provided by a private Endorsed Provider Company.


Item 3: 10A NCAC 13G .0213 Appeal of Licensure Action: (a) In accordance with G.S. 150B-2(2), any person may request a determination of his legal rights, privileges, or duties as they relate to laws or rules administered by the Department of Human Resources. All requests must be in writing and contain a statement of facts prompting the request sufficient to allow for appropriate processing by the Department of Health and Human Services.”

I am formally asking Buncombe DSS, and by default, the Department of Health and Human Services as to my rights, privileges, or duties, to see clients during a reasonable hour, at a time of client and psychologist mutual choosing.

Item 4: "10A NCAC 13G .0216 Administrative Penalty Determination Process (a) The county department of social services of the Division of Health Service Regulation shall identify areas of non compliance resulting from a complaint investigation or monitoring or survey visit which may be violations of residents’ rights contained in G.S. 131D 21 or rules contained in this Subchapter. "

I am asking the Buncombe County of Social Services to determine and identify areas of non compliance as associated with actions taken by WNC Homes County Time Circle Leicester NC as pertaining to residents’ rights to health care delivered by a licensed mental health professional at reasonable hours and hours of their mutual choice. I want to know if this is a Type A or Type B violation.

Item 5: 10A NCAC 13G .0704 Resident Contract and Information on Home The administrator or supervisor in charge shall furnish and review with the resident or his responsible person information on the family care home upon admission and when changes are made to that information. A statement indicating that this information has been received upon admission or amendment as required of the home’s resident contract specifying rates for resident services and accommodations, including the cost of different levels of service, if applicable, any other charges or fees by this Rule shall be signed and dated by each person to whom it is given. The statement shall be retained in the resident’s record in the home. The information shall include:

(1) a copy of the home’s resident contract specifying rates for resident services and accommodations, including the cost of different levels of service, if applicable, any other charges or fees…..

(2) a written copy of any house rules, including the conditions for the discharge and transfer of residents, the refund policies, and the home’s policies……

(3) a copy of the Declaration of Residents’ Rights as found in G.S. 131D-21

(4) a copy of the home’s grievance procedures which shall indicate how the resident is to present complaints and make suggestions as to the home’s policies and services on behalf of self or others….”

I am asking that the rates for resident services and accommodations be made available in writing for the residents in keeping with the law; I am asking that a copy of the home’s grievance procedures be made available to the residents (no it is not sufficient to have the telephone number of the ombudsman on the wall) ; I am asking that the hours associated w/ visitations with professional providers be posted for the residents.


Item 6: 10A NCAC 13G .0902 Health Care (b) The facility shall assure referral and follow up to meet the routine and acute health care needs of residents. ….(c) The facility shall assure documentation of the following in the resident’s record: (2) all visits of the resident to or from the resident’s physician, physician service of other licensed health professional, including mental health professional, of which the facility is aware (3) written procedures, treatments or orders from a physician or other licensed health professional, and (4) implementation of procedures, treatments or orders specified in Subparagraph c3 of this Rule. Moreover, as per 10A NCAC 13G .0906 Other Resident Services: “(a) Transportation. The administrator must assure the provision of transportation for the residents to necessary resources and activities, including transportation to the nearest appropriate health facilities, social services agencies, shopping and recreational facilities, and religious activities of the resident’s choice. The resident is not to be charged any additional fee for this service. Sources of transportation may include community resources, public systems volunteer programs, family members as well as facility vehicles. I am asking that WNC Homes Leicester, NC provide transportation to all appointments w/ myself, Dr. Hammond, at my office at: -------Biltmore Avenue, Suite 313, Asheville, NC 28801, as agreed upon by this psychologist and the client. I am documenting that WNC Homes Country Time Lane, Leicester, NC did not provide services to client ---, Hse 13, on 1.26.09: “I waited for over an hour after the Supervisor in charge indicated she would rendezvous w/ me and bring Mr. -------- so he could go with me to the SSA but apparently she talked to her boss who forbid it. I therefore contacted DSS Buncombe and will be speaking to them re: the client’s rights re: living in a personal care home.” I am asking DSS Buncombe vis a vis the Administrative Penalty Process to render a verdict re: residents’ right to health care as per that event.

Additionally, in that WNC Homes Country Time Lane Leicester, NC has declared that all Community Support Services must cease by 5 pm every day and in that residents have events which are not constrained by this e..g, AA meetings, etc., and in that this psychologist signed off the medical necessity matter assuring Community Support Services----which makes possible said services-----I am asking DSS Buncombe to require that WNC Homes make available transportation for residents to events which are associated with their healthcare e.g., AA meetings, support groups meetings after 5 pm in that WNC Homes has stated that no CSS activities may take place after 5 pm any day of the week. There is no bus service to this residence which is 30 minutes outside Asheville, NC.

Additionally, I am asking that DSS Buncombe demand that current medications list of residents is carried w/ the residents to meetings with Dr. Hammond in accord with: “10A NCAC 13G .1201 Resident Records: When a resident leaves the facility for a medical evaluation, records necessary for that medical evaluation such as Items 1,4,5,6,7 above may be sent with the resident” (those items include “ orders or written treatments or procedures from a physician or other licensed health professional and their implementation”

Item 7: 10A NCAC 13G .0906 (f) Visiting (2) There must be at least 10 hours each day for visitation in the home by persons from the community. If a home has established visiting hours or any restrictions on visitation, information about the hours and any restrictions must be included in the house rules given to each resident at the time of admission and posted conspicuously in the house." I am asking that the hours associated w/ professional services and Community Support Services be posted conspicuously in the homes so that clients may know what the administration of WNC Homes demands.

Item 8: "10A NCAC 13G .0908 Cooperation with Case Managers The administrator shall cooperate with and assure the cooperation of facility staff with case mangers in their provision of case management services to the appropriate residents."

Let it be known that I am filing a formal complaint on the inability of the WNC Homes management to cooperate with this mental health provider as pertaining to therapy sessions for WNC Homes residents. Moreover, I wish to underline this complaint with the fact that several residents prefer not to go off the property of the home as associated with diagnoses. Specifically, client ------, Hse # 11, with a diagnosis of Avoidant Personality Disorder, prefers to not go off of the campus (though Community Support Services is working with her as re: this matter); client -----, Hse 10, has Irritable Bowel Syndrome which causes him to have to use the bathroom frequently; and, client -----, Hse # 13, also has gastrointestinal difficulties which cause him to stay close to home---as documented in his medical records. Instead of being supported for providing services close to home, and in the community, this mental health provider, since WNC Homes took over the management of these Family Care Homes in August, 2008, has been harangued particularly as re: questions prompted by the clients pertaining to their personal funds whenever I have asked questions and attempted to find out what personal funds they were to be accessed.

Thank you for considering these matters and I would like to have a timeline as to when these matters will be resolved.

Marsha V. Hammond, PhD
Cc: ---------------(Endorsed Provider company)

NC Disability Rights blames the mental health workers for losses of Medicare/ Medicaid funding

"Vicki Smith (newly appointed Executive Director) with Disability Rights North Carolina said the problems keep popping up in North Carolina mental health hospitals because of the ongoing attitude of the workers.

'There is a culture within these state hospitals which is embedded and which will be near impossible to eliminate,' Smith said."

http://www.news14.com/content/local_news/triangle/605335/mental-hospital-funding-still-intact/Default.aspx

********************

That's one of the most egregious statements I've ever heard, NC Disability Rights. I'm all for not mincing words, and sure there have been abuses within these psychiatric hospitals, and definitely there should be zero tolerance for that.

By the way, just who is Disability Rights NC?:

http://triangle.bizjournals.com/triangle/stories/2007/12/10/tidbits3.html

"DRNC has a total of 30 full-time equivalent employees, including 10 attorneys and 10 non-attorney advocates.

DRNC was founded 25 years ago as Carolina Legal Assistance. In July 2007, the organization was designated by Gov. Mike Easley to assume the responsibilities of the state's protection and advocacy agency. Carolina Legal Assistance subsequently changed its name to Disability Rights North Carolina to reflect its broader focus. ..."

********************

There's a lot of people in powerful positions that would like nothing more than to lay into the undoubtedly more or less-----as in any profession----hard-working people of psychiatric hospitals.

They would just LOVE to take all of NC DHHS's bad management and stick it to the workers.

I am repulsed by your statement. If its a mistake the 'news team' quoted you out of context, it would be wise for you to make a correction.

As I have stated on this blog before, the psychiatric hospital workers NEED TO UNIONIZE in order to protect their own rights which include not being overworked by a system in chaos and churn re: tremendously increased rates of admissions associated with the failure of NC mental health reform.

So, let's have some statistics re: the churn and chaos as associated w/ mental health matters in NC:

1. Rural is affected more than City

2. NC is bleeding psychiatrists due to the chaos and churn and mis-management of

mental health by NC DHHS

3. Longer waits for medications or inability to get psychiatric care means sicker people

who get admitted to the psychiatric hospitals as they crash and burn.

NC Psychiatric Association Report Card on mental health in the early years (not even as it got worse and worse) of NC mental health reform:

The Report Card reveals that in the two years from 2003 to 2005:
• North Carolina lost 48 full-time equivalent community psychiatrists.
• Per capita community psychiatrists fell by 16.1%.
• NCPA estimates that as a result at least 31,070 LME-sector patients with mental illness are unable to access psychiatric care. The losses in community psychiatrists result in more difficulty getting appointments and longer waits to be seen.
• Losses of community psychiatrists affected rural MH agencies more than urban agencies.

http://ncpsychiatry.org/NCPA%20Press%20Release%20Report%20Card%20III.pdf

****************

How bad has the chaos gotten (this was several years ago and no improvements have taken place, indeed, it has only worsened):

North Carolina Mental Health Officials Cap Admissions At State Psychiatric Hospitals
Date: 20 Feb 2007 Find other articles on: "NC psychiatric hospital admission rates"North Carolina mental health officials have placed a cap on admissions at the four psychiatric hospitals administered by the state as the number of mentally ill patients continues to increase, the AP/Winston-Salem Journal reports. According to Mike Moseley -- director of the North Carolina Division of Mental Health, Developmental Disabilities and Substance Abuse Services -- state psychiatric hospitals no longer will accept mentally ill patients from community hospitals after they reach 110% capacity in their short-term wards (AP/Winston-Salem Journal, 2/14). Community hospitals will have to continue to house mentally ill patients until state psychiatric hospitals can admit them, Moseley said. Community hospitals have raised concerns about the cap because emergency departments have become the "first stop" for many mentally ill patients, according to Mike Vicario, vice president of regulatory affairs for the North Carolina Hospital Association. Deby Dihoff, executive director of the North Carolina chapter of the National Alliance on Mental Illness, said that the cap "very much scared" her. She said, "Crises are going to happen. There (have) to be beds to serve people with mental illness," adding, "I think the division is doing a good job planning for the future. It's the present we're all a little worried about" (Bonner, Raleigh News & Observer, 2/13).

http://www.medicalnewstoday.com/articles/63202.php

**************************

Problems at the Family Care Homes in NC where low income people w/ mental health concerns live: how common are they?

This is the second of two letters I have now sent to Buncombe DSS Adult Protective Services, regarding a Family Care Home in Buncombe County, western NC. I have asked DSS Buncombe to make clear clients' rights pertaining to mental health services that take place as associated w/ residents who live in Family Care Homes in NC.

If you want to know where some of the homeless people are, clearly, if they have Medicare or Medicaid services, many of them are living in Family Care Homes where they are provided a place to sleep and keep their things, food on the table, transportation to medical appointments (some of the time).

While these homes do prevent people from being homeless, the down-side is that the residents' disability checks are almost always controlled by the businesses that run the homes. This means that residents have little to no spending money and essentially become wards of the homes-----rather than wards of the psychiatric hospitals.

A better alternative, which is written into a carefully thought out law governing Family Care Homes, is to allow---as is possible---the residents to manage their own money and pay for their room and board. This would take the management of the residents' money out of the control of the Family Care Homes. Indeed, the law supports residents managing their own money but this is seldom done.

There are two streams of funding that pay for their room and board: 1. their disability checks which are of varying amounts (see below) and 2. the balance if made up by the county DSS. It costs approximately $1275/ month for the room and board at these homes. As I understand it, this is a uniform amount across all of NC.

I did receive a reply back from Courtney Landis of Western Highlands Network, the LME in Buncombe county, re: matter of a resident being able to obtain their own financial information in order to obtain certain services, such as a discounted YMCA membership. Ms. Landis stated to the Family Care Home which is alluded to below----a matter which assumably would include all Family Care Homes----that it is not unusual for residents to have to evidence their own financial information for such purposes as IPRS (state funding) mental health services. Thus, it appears that Western Highlands Network has come down on the side of residents having the right to make evident their financial information.

This being said, as has been the case re: this family care home, they can still continue to drag their feet re: the necessary paperwork, thus blocking necessary and requested services----requests that were made by the clients.

Eventually it comes down to how many hours in a day are there to be spent trying to get an answer and an appropriate response to a reasonable question. How many chains of command does a provider or resident have to climb in order to make something happen----the something being the release of the client's own paperwork in order that services be obtained?

It would be nice if the public agencies such as the LME and the Department of Social Services would come down more firmly on the side of the client.

What I am trying to suggest is this: the enforcement of the law appears to be neglected.

Marsha V. Hammond, PhD

*****************

Marsha V. Hammond, PhD: Licensed Psychologist: NC
fax: 828 254 2013
cell phone: 404 964 5338
e mail: hammondmv@netzero.com (please utilize WORD 'save as' security options when passing confidential information; send your passwords in a separate e mail)

February 18, 2009

HI Ms. (Sara) Tarpey of Buncombe DSS:

I assume that you, Cheryl Simcox, and Rebecca Sizemore, all associated w/ Adult Protective Services, and speficially attending to matters associated w/ Family Care Homes, received the letter I sent to you last week pertaining to a telephone conversation I had w/ one of -------Homes administrators, J of =========Homes, regarding several issues of concern for him.

I am guessing as to Ms. Simcox's and Ms. Sizemore's e mail addresses. Please forward this letter to them if I have miscalculated.

I am forwarding the letter (see below) also to Western Highlands Network (specifically Courtney Landis: land0803@westernhighlands.org) ---which you were sent the first week of February, 2009, as ---------- Homes has filed a complaint w/ WHN re: me seeing clients at hours of my availability and of their choosing which is commonly early Sunday evenings, specifically, 5:30 pm until 8 pm. This is a quiet time to meet w/ residents and has diminished activity as associated w/ medical, etc., appointments which have taken place during the week.

-------Homes administration has also suggested that I somehow strong-arm clients into working w/ me and/ or (Endorsed Provider company). Nothing could be further from the truth and the signed (by the resident) Consent to Treatment attests to this. This is in the charts of clients who currently work w/ me.

Additionally, I am being blocked----as the clinical psychologist----from obtaining medication information which is in the charts of the residents at ------ Homes. This cannot continue as I interface w/ the medical providers regarding medication issues which are commonly not addressed by ------ Homes.

This all began, you might remember, as associated w/ my desire to simply have the financial information (the amount of the disability check) for resident whose initials are BK, living in ------- Home # 13, so that he could get a discounted YMCA membership. The YMCA cannot give that to him w/o the financial information. However, though I have asked 3 x since November, 2008, -------Homes will not give me the disability check information. ------- Homes also blocked me from taking the client to the SSA in order to get the information. Three months down the road, resident BK still has no YMCA membership because of the lack of financial information.

My suspicion is that -------Homes wants to run me off pertaining to me asking very pointed questions----in letters which were created as I sat w/ concerned residents----- about the monies that are received or not received by the clients/residents as pertaining to the varying amounts of their disability checks and the associated money 'left over.'---which is their monthly spending money.

Their monthly spending money is my concern, I maintain, as with no money to spend, they are left unable to participate in CSS and they become wards of ------ Homes, unable to do anything or purchase anything. I maintain that this is related to their mental health.

Moreover, my questions about their spending money is wrapped around therapy sessions and I seek to present a role model of assertive behavior as regards residents' mental health and welfare.

Additionally, Community Support Services has as a central tenet increasing the independence and responsible functioning of clients/ residents.

In keeping with the tenets of NC mental health reform, I communicate these issue w/ the Endorsed Provider company, ---------. I am demanded by NC mental health reform to be aligned w/ a company as associated with enhanced services. Community Support Services is an enhanced service.

As you are aware, the residents' disability check is one of the two funding streams paying for their room and board at ------ Homes (or any other family home); the other is DSS funding. Residents have varying disability check amounts as regarding the basis for their disability. Some have disability checks based on a parents' social security account. Some have simply Medicaid and SSI. Others have SSDI and a bigger disability check that those who receive simply SSI. However, the amount of money received by residents, issued by ------ Homes, varies tremendously from client to client and unfortunately, it appears that if no questions are asked by the residents about their funds, then the monies simply are swallowed by ----- Homes. This is against the law.

Here is the entire law of which I am aware currently. I have given copies of this to residents so that they can know their rights.

http://ncrules.state.nc.us/ncac/title%2010a%20-%20health%20and%20human%20services/chapter% 2013%20-%20nc%20medical%20care%20commission/subchapter%20g/subchapter%20g%20rules.html

The law states: (chapter 13G-Licensing of Family Care Homes: 10A NCAC 13G.1101 Management of Residents Funds):

"Residents shall manage their own funds if possible."

and

(10A NCAC 13G .1103)
"Accounting for resident's personal funds: (d) A resident's personal funds shall not be commingled with facility funds. The facility shall not commingle the personal funds of residents in an interest-bearing account."

http://ncrules.state.nc.us/ncac/title%2010a%20-%20health%20and%20human%20services/chapter% 2013%20-%20nc%20medical%20care%20commission/subchapter%20g/10a%20ncac%2013g%20.1103.pdf. .

The difficulty w/ ------- Homes cooperating w/ some of the residents' choice of mental health providers in terms of enhanced services (meaning, Community Support Services), is not isolated to me as evidenced by difficulty encountered by L---------, a Community Support Services worker for (Endorsed Provider company).

This being said, I want my encounters with -------Homes vis a vis residents to be completely separate from what is experienced and overviewed by (Endorsed Provider company) in that as re: Medicare and Medicaid clients,I am a completely autonomous professional. All the residents of -------- Homes are Medicare or Medicaid clients.

However, I did want to pass that along to you and ------- can give you more information. Contact person for that is: A----------- . Also cc'd here is L--------- who works w/ Direct Care LLC as well as T--------------- who works w/ -------------as a CSS worker.

I want to make it very clear that I receive no monetary compensation at all from -------- for the task I do for them, specifically, testifying to the medical necessity as pertaining to enhanced services for residents of ------ Homes who choose to work w/ myself and (Endorsed Provider company). We do share clients that are referred to each other. All professionals have referral networks with whom they participate.

The clients are always informed of their ability to make a choice re: their mental health care. The Consent for Treatment forms that are in their charts at ------- Homes, indicates this also.

These are the two items about which I am hopeful that DSS Buncombe can comment, given that you seem to have been assigned (via statute, I suspect as it is not specified in the law governing family homes) the job of overseeing Family Homes. I posed these questions in the letter that I sent you last week via US Post. .

Item 1: "I am asking DSS Buncombe to state whether this matter is applicable to licensed psychologists as the law indicates 'case managers.' This is the specific question DSS Buncombe: is the administration of a family care home to 'cooperate' with a provider who is a psychologist?"

Item 2: "I am asking DSS Buncombe to make a judgment about whether a psychologist who has a written agreement with clients----with the permission of the client----has a right to look at the charts of the residents and to peruse information that is associated w/ the mental functioning of the client."

When can I expect an answer to the two questions?

Here again is the letter I sent to you in the US Mail.

By the way, as regards Item 1 below, I have no fax from the administration of ------ Homes as re: my request for their policy and procedures re: hours of contact w/ clients who reside in their homes. Therefore, as before, I will continue to see clients as associated w/ my availability which is, I believe, reasonable.

----------, administrator w/ ------- Homes, did call me back after receiving my letter. He left a message degrading my professional skills. I will not speak to him on the phone, which I advised him in the letter.

I am looking forward to your response.

I have also routed this to Western Highlands Network, specifically Donald Reuss and as stated above, Courtney Landis. Additionally, the two Community Support Services workers, ----------, as well as their supervisor, -------------- MA, QP, are cc'd.

I have also placed it on my blog, taking out salient names. The purpose of my blog is to inform re: mental health issues in NC. As per other professionals with whom I have spoken, specifically, Tom Smith, MD, psychiatrist, Asheville, NC----there is much to be concerned about as re: these family homes.

Please feel free to forward this information to any pertinent person or entity.

Thanks for your hard work.

Marsha V. Hammond, PhD
*************************************:
Marsha V. Hammond, PhD: Clinical Licensed Psychologist, NC
E mail: hammondmv@netzero.com
Fax: 828 254 2013
Cell phone: 404 964 5338

February 12, 2009

RE: our phone conversation

Dear J --------------- of --------Homes:

I am outlining what we talked about today on our phone call so that we can both be clear and be in accord as pertaining to what we decided.

1. You stated that you wanted providers to be finished w/ seeing clients at ----- Homes facilities by 6 pm. I asked you to fax to me at 828 254 2013 your policy from your policy and procedures manual. For, no client has ever advised me that they do not want to see me. If they do not want to see me (and I have typically come in the early evening on Sundays as this is a quiet time and they have not had their evening meds which commonly make them sleepy), they have advised me and I have always attended to that. When I have received your fax, J-----, from your policy and procedures manual, I agree to not be working with clients after 6 pm. NC state law, specifically, Subchapter 13G, licensing of Family Care Homes, indicates : (10A NCAC 13G .0908): "The administrator shall cooperate with and assure the cooperation of facility staff with case managers in their provision of case management services to the appropriate residents." I agree to not see clients after 6 pm but I wish to have a statement from DSS Buncombe on this matter of cooperation. I am asking DSS Buncombe to state whether this matter is applicable to licensed psychologists as the law indicates 'case managers.' This is the specific question DSS Buncombe: is the administration of a family care home to 'cooperate' with a provider who is a psychologist?

2. You stated that the e mail letter from Donald Reuss, Provider Relations at Western Highlands Network LME, associated with what you term 'conflict of interest' as pertaining to -------- my husband, referring to me clients for assessment and therapy----which is in my jurisdiction as a licensed clinical psychologist in NC---- was not satisfactory as 'anyone could write that.' ------------------ has relayed your dissatisfaction with the e mail venue to Donald Reuss and you can take this up w/ --------------and/ or Donald Reuss, donaldr@westernhighlands.org) at your convenience. During our telephone call, I advised you that the clients are informed about their having choice of providers and I advised you that as per the clients that I see there would be given to the SIC of the various homes a document testifying to this. I will also keep this in my files and ------(Endorsed Provider company) will be forwarded the document also.

3. You stated, J----, that you believe that my looking in the residents' charts while the residents are with me and requesting the information, is not acceptable to you. It is very important for me, as the psychologist, who does the assessments and provides therapy if the client desires this, to look at their charts. First of all, I need to know the medications which are administered to the client. This impacts their physical and mental health and both these domains are in my area of expertise as a psychologist. Moreover, I write letters to physicians re: medications which need to be, perhaps, changed. I call physicians re: these matters. However, your concern re: me looking in the residents' charts seems to be associated with me looking at their personal finances ---while I sit w/ the client who is voicing questions about having no spending money-----which is to say, the information associated w/ co-pays that is extracted from the monies which they are due after their check is utilized to pay for their living expenses to live in the ------- Homes. I advised you on our phone call that having no spending money was impacting the mental and emotional well being of my clients. Moreover, as I have learned more about matter, I believe that some clients----who receive larger disability checks-----merit more money in their pocket than others who receive smaller checks. After talking with Sara Tarpey for 15 minutes the first week of February, and as associated with my concern about these matters, and as re: your concern, J------, that clients do not have the right to allow a mental health care provider to peruse their charts at the homes for important information which affects their physical, mental, and emotional well being, I am asking DSS Buncombe to make a judgment about whether a psychologist who has a written agreement with clients----with the permission of the client----has a right to look at the charts of the residents and to peruse information that is associated w/ the mental functioning of the client.

4. You advised, me, J-------, that you had not received my two phone calls which I made to your cell phone this past month, the phone on which you called me today. I advised you that I would send you letters as we appear not to be able to communicate via phone. You stated 'don't send me letters.' However, you indicated you did receive a letter on the matter of a client w/ the initials BRC pertaining to his funds. Therefore, I assume you receive letters. It is my intention to communicate with you only utilizing the US Post. I consider this to be associated with the matter of 'cooperation' which I hope we can foster.

I hope we can work cooperatively, ------- Homes.

Sincerely,
Marsha V. Hammond, PhD
Cc: Group home/ personal care home manager: Cheryl Simcox: 8282505870
Worker Sara T DSS: 2505660;cell 775 1538
Her supervisor: Roxanne Sizemore 828 250 5721
Sara Tarpey, investigates complaints at family homes: 250 5660, office

Mental health providers seeking bridge loans to continue functioning in western NC : Two Models in WNC, neither which works re: state funded clients

There are two models of rendering mental health services to state funded clients in western NC and neither works for different reasons. These are the two models which are guiding one quarter of all of NC's countiesas per the only two LME's in western NC.

1. Western Highlands Network model which was created post New Vistas failure (which covered 10,000 lives) about 3 years ago, such that many Endorsed Provider companies picked up clients w/ mental health challenges

2. Smoky Mountain Center (SMC) LME which privileged one company, Meridian Behavioral Health Services, run by retired SMC LME employee Joe Ferraro----effectively cutting out most of the other Endorsed Provider companies.

Word out is that SMC LME will have to shed Meridian or have a name change re: it being de facto its clinical arm.

REMEMBER THIS: all the LME's have so far done is to manage the state funded mental health care authorizations and reimbursements. Yes, they have scrutinized Medicaid services associated w/ Community Support Services but their main agenda so far has been associated with THE UNINSURED OF NC. No Medicaid/ no medicare/ no health insurance of any kind: the working poor.

Western Highlands Network (WHN) LME spread out the services to various Endorsed Provider companies for state funded clients when New Vistas crashed (the day I heard Mike Moseley talk in Culowhee, NC, home of Smoky Mountain Center LME, stating what a 'swell job we've done').

Guess what: the larger Endorsed Provider companies can't make it pertaining to delays and problems w/ the funding/ payment of the state funded system.

Someone better rethink these problems AND FAST.

Mental health providers feel economic strain
Leslie Boyd • LBoyd@CITIZEN-TIMES.com
• published February 7, 2009 12:15 am

http://www.citizen-times.com/apps/pbcs.dll/article?AID=/20090207/NEWS01/902070337

Read all 18 comments »
ASHEVILLE – The economic meltdown has hit mental health service providers, and several are asking the area management agency for bridge loans because they can't get credit to keep their cash flow up.


Alpha-Omega Mental Health Services, which operates in rural Madison, Mitchell and Yancey counties, asked for $350,000, and Patton Counseling Services in Asheville asked for $125,000 from Western Highlands Network.

“It's a timely reimbursement issue,” said Christine Kudlate, CEO of Patton.

Dan Zorn, CEO of Families Together, said state-funded services can take months to be reimbursed, leaving businesses short on cash.

Joe Martin of Alpha-Omega said he has paid some bills out of his own pocket.

“Without this help, we will have to sit down and make some serious business decisions,” Martin said.

Alpha-Omega is the only mental health services provider in the three-county area; five other service providers have either closed or stopped providing mental health and substance abuse services.

“We stepped into the breach when New Vistas/Mountain Laurel closed in 2006,” Martin said. “We took on the services for these three counties. We have undergone a restructuring to cut costs.”

The board agreed to lend Alpha-Omega $175,000 Friday, and the rest could be granted after a meeting with the provider.

Western Highlands has helped a number of service providers in the last two years. New Vistas, the large nonprofit created when mental health reform took effect six years ago, went under in 2006, and dozens of smaller agencies took on the estimated 10,000 people served by New Vistas.

Several agencies have needed help to support the expansion of their businesses.

Board member Steve Wyatt, of Henderson County, was concerned about the number of agencies coming to Western Highlands for help.

“I'm starting to feel like the federal government bailing out all these failing businesses,” he said.
But Martin said the money is a loan, not a grant, and posed it as a pay-now-or-pay-later deal.
“The question becomes: Do we help someone who stepped into the breach, or do you bring in someone else when we can't do the job anymore?” Martin said.

Families Together got a bridge loan of $450,000 recently as an advance on money it is owed by the state."

NC Taxpayers take another hit: new mental health/ psychiatric hospital can't teach staff how to keep patients from falling

amazing, really, the standard kind of problems these psychiatric hospitals have.

All hospitals have written standards of procedures/ protecols as pertaining to how to deal w/ every situation. They would have one re: protecting patients against falls.

Why would that be important? Well, duh, that's how Stephen Sabock probably lost his life re: closed head injury from having fallen WHILE BEING WATCHED apparently by someone administering him medication. And so, they put him in a chair, close to where they were playing cards, and assumably watched him drool until he died.

So, two of the four mental health hospitals are about to AGAIN lose CMS (Centers for Medicare and Medicaid Services: the main payor for mental health services in the state) because the administration cannot create the setting so that people who work at the hospitals can effectively keep patients from falling.

WHAT'S WRONG W/ THESE PEOPLE? Why don't they just extract sums of money from the checks of administrators until they can get the personnel to follow the rules associated w/ keeping patients from falling?

Well, but if you look at the pdf that the Raleigh News Observer made available which is the letter to Dr. Mike Hennike, the head administrator at the new Central Hospital, you will see that there were many complaints and continuing difficulties including :

patients rights
lack of governance

**************************

http://www.wlos.com/template/inews_wire/wires.regional.nc/2f657127-www.wlos.com.shtml

NC mental hospitals could lose federal fundingFebruary 06, 2009 19:07 EST

The News & Observer of Raleigh reported Friday the Centers for Medicare

Medicaid Services said in a letter this week that Central Regional Hospital no longer meets the requirements to participate in the Medicare program. Inspectors found that staff at the Butner campus failed to follow rules designed to prevent patients from falling.

**********************

Funding for Dix and Butner at risk
Hospital inspectors review complaints
By Michael Biesecker - Staff Writer
Published: Sat, Feb. 07, 2009 12:30AM

RALEIGH -- State psychiatric hospitals in Raleigh and Butner could lose federal funding as soon as Feb. 20, potentially costing more than $1.2 million a month in lost revenue.
Meanwhile, federal inspectors were at the state facilities Thursday and Friday reviewing new complaints of patient abuse and neglect, including that of a child who was victimized twice.
The loss of Medicaid and Medicare money at Central Regional Hospital, which includes a new $130 million building in Butner and the Dorothea Dix Hospital campus in Raleigh, comes at a critical time for a state Department of Health and Human Services already facing deep cuts.

It costs about $10 million a month to operate the two hospitals.

****************
What is one of the reasons that CMS cited Butner?
see pg 3/ 25:Feb 3, 2009, letter fo Director of Central Hospital, Dr. Mike Hennike: http://www.newsobserver.com/content/media/2009/2/6/CMS%20survey.pdf:


THE GOVERNING BODY. Remember them? They were the physicians and psychologists who were dismissed by the 'new campus' of Dix e.g., Central (Butner) campus.

very very funny. chalk up one for the governing body who apparently didn't roll over and play dead.

Close some Broughton Hospital beds & upgrade mental health services within locally available psychiatric units

Nobody I know----in terms of clients----ever EVER wanted to go back to Broughton.

This hospital's reputation in western NC is such that I have had clients state that they 'would take everyone out before I would go back there.'

I say: CLOSE THE BROUGHTON BEDS (see below article) and use any monies to localize the psychiatric services.

Wanna get double value for your money? Instead of warehousing patients in the psychiatric hospitals where they stare zombie like at the walls and wonder when they can get out or how many group therapy sessions they can avoid, not sleeping because it is so noisy out in the hallways------why don't you have the professional mental health providers come INTO the psychiatric hospitals and begin individual therapy w/ the clients who have been assigned to various mental health professionals.

I commonly go into thte psychiatric hospitals to see clients. Why not? Good to follow up people in this manner.

NAH: won't happen.

In western NC, in the newly opened Haywood Regional Behavioral Health Unit, coming up soon to 16 beds, won't allow any interference with Meridian Behavioral Health Services which was created by Tom McDevitt's side-kick, Joe Ferraro, CEO of Meridian.

Yesterday I saw a long-term client in the home and a relative who had been at Haywood Regional Behavioral Health Unit for almost 3 weeks (a long stay, these days) had tears rolling down cheeks describing continuing depression. The hospital had a great opportunity to create an individual therapy relationship while client was in the hospital.

You'd be surprised at this fact but basically NOTHING takes place in psychiatric hospitals other than medication management and some groups if people choose to show up.

What a helluva missed opportunity. But in order to create what appears to me to be an efficient re-ordering, psychiatric hospitals' administrators will have to change how they think about things : its not WAREHOUSING -----it's TREATMENT.

But I forgot: the mental health professionals haven't been asked their opinion by ANYONE.

************************

http://www.newsobserver.com/579/story/1394259.html

Pain management
Budget-cutting specifics lay bare the truth of how the national recession could affect North Carolina state services

"......Consider, for example, that in the Department of Health and Human Services, there are suggestions to eliminate 50 beds at the Broughton and Cherry psychiatric hospitals, saving $6 million. But that would come at a time when the state's mental health system is underserving people and is in a state of management flux, to put it mildly...."