Hundreds await placement for residential care after mental health vacancies

JEFFERSON CITY, Mo. There are more than 1,700 vacancies within the Missouri Department of Mental Health, which leave hundreds on waiting lists for appropriate resources.

More than 600 people with developmental disabilities and intellectual disabilities are waiting for resident caregivers to have an open space, the administration said in a House subcommittee on health, mental health and social services provisions on Wednesday. This means that some of these patients occupy hospital rooms.

“The average hospital stay while waiting for a caregiver is 116 days,” said Jessica Backs, director of Developmental Disabilities. “The longest we have at the moment is 450 days.”

In Missouri, more than 100 individuals have waited for more than a year to be placed in residential care. As of July, Missouri was in a state of emergency for contract workers, DMH Administrator Valerie Hoon said. One of the largest facilities in the state has an open wing due to a lack of staff.

“We have a shortage of staff in psychiatric hospitals in the state right now,” Hoon said. “We, in Fulton, have one 25-bed suite that is not currently staffed, so it is vacant.”

The main obstacle to the department is the shortage of workers. Huhn and other providers testified before the committee on Wednesday, explaining to members what the department needs.

“Solutions where there are appropriate living situations, creative solutions to help these individuals thrive in our community and be in the right environment that isn’t a hospital,” said Shannon Griggs Phyllis, chief operating officer of the Research Hospital of Psychiatry in Kansas City.

Phyllis said nearly 100 patients in the Kansas City area are in emergency rooms or hospitals awaiting care because resources are tied to a single patient who needs a nurse and mental health technician for just one individual.

Patti Morrow, vice president of behavioral health services at Mercy Health, told the committee a similar story.

“We have had to shut down a 10-bed unit to house this young man for the past 290 days,” Morrow said. “Not only did we calculate its costs, but we calculated the proceeds for those beds that are not being used, and keeping people back up in our emergency department, we’re looking at north of a million dollars.”

Morrow described the state’s situation within the mental health department as a “crisis.”

“Between the pediatric department and developmental disability clients, our health system in general, we house roughly 12 to 20 people every day in our hospitals,” Morrow said. “We are seeing a growing crisis of young people and vulnerable adults who are really being left on the doorstep of our hospitals without the necessary resources.”

Earlier this year, state employees received a 5.5% increase in the cost of living adjustment. Hoon said that while there has been an improvement, providers are still describing it as a crisis.

“We have always relied on contract employees for those positions, but the job market is not available to us even at this point,” Hon said. “If you look at July of 2021, just for this support care assistant category, we hit 104% turnover. Last July, our turnover was 53%, so we are seeing some improvement.”

Hoon told members that there are currently 210 prisoners awaiting admission to a psychiatric hospital. Rep. Peter Meredith, de St. Lewis asked Huhn and Bax if raising a worker’s wages to $30 or $40 would help fill the vacant positions.

“It cost us four times that of the contract people, and if we paid more, we might not need the contract people,” Meredith said.

“I don’t think you can really work in a world now where you’re going to have the whole cast the way you used to, so let’s start being smart about what we’re doing,” Huhn said. “If I can convince someone to stay over a year, I’d be really excited at this point.”

It costs $78 an hour to hire a contracted certified nursing assistant and $195 an hour to hire a contracted practical nurse, Hon said. Depending on the recent increase, certified nursing assistants, who are employed by the state, earn about $15 to $25 an hour.

“We have vacant full-time staff in the Behavioral Health Department, of about 1,000 individuals and in the Developmental Disabilities Department of 742 individuals,” Hon said. “We’re seeing some improvements in direct care staff, and unfortunately we’re not seeing improvements in clinical staff.”

Justin Alverman, director of advocacy at SSM Health, said the health care provider had 25 patients awaiting placement who had a combined wait of 1,866 days. Last year, the SSM had 106 adults who waited 7,242 days for placement.

“It’s clear that keeping them in acute care they don’t need is necessarily more expensive,” Alverman said.

During Wednesday’s hearing, acting Director of Social Services (DSS) Robert Nodel told the committee that the state eventually no longer had a backlog of Medicaid applications. At one point, people waited 100 days for their applications to be processed, when federal guidelines state that patients must be approved within 45 days.

“We kind of had an unprecedented triple-hit in the department,” Noodle said. “We were the only state in the country to try to expand Medicaid at the height of the pandemic, in addition to unprecedented staff shortages and vacancy rates we’ve never seen before.”

Last month, the Center for Medicare and Medicaid Services (CMS) had to step in to help the state process the excess requests. Knodell DSS is now processing applications within the 45-day federal requirement.

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