PROVIDENCE, R.I. (WPRI) – Gov. Dan McKee is seeking to build a new $65 million long-term care facility on Eleanor Slater Hospital’s Zambarano campus in Burrillville, which would be part of a larger consolidation plan that includes eliminating 100 full-time positions.
The massive overhaul of the state-run hospital system – with campuses in Cranston and Burrillville – would also entail shutting down its Aldolf Meyer and Regan units and creating a standalone Institute for Mental Disease, or IMD, at the hospital’s Benton facility in Cranston.
As part of the consolidation, Rhode Island would eliminate 100 full-time positions currently authorized in the the state’s budget, although it’s not entirely clear how many of those jobs are currently filled. Budget documents show the reduction would help save the state $38.7 million.
“We don’t have a breakdown at this point in terms of those positions,” said Kathryn Power, director of R.I. Department of Behavioral Healthcare, Developmental Disabilities and Hospitals, which oversees Eleanor Slater.
“We are expecting, frankly, that the reduction is going to be achieved through attrition and through some early retirement positions,” Power added. “As we close the Adolf Meyer building and the Regan building, there may be some layoffs going forward.”
McKee proposed the idea as part of his newly unveiled $11.2 billion state budget for the 2021-22 fiscal year, which begins July 1. In addition to the savings expected from the reduction of positions, McKee has proposed to borrow at least $53.6 million to help pay for the new long-term care facility at Zambarano – which comes with a total price tag of $65 million.
The proposed 98,000-square-foot facility with 85 beds would replace the existing hospital, which provides care to patients with complex medical conditions, such as brain trauma and spinal-cord injuries. State officials said patients would be allowed to continue to live in the existing hospital throughout the construction period, which is estimated to take three-and-a-half years.
“If we’re going to construct new units, they can stay in the old units,” Power said during a budget briefing with reporters.
The plan is likely to be met with fierce pushback from unions and advocates who have criticized the downsizing effort at the state-run hospital for months, arguing it will be harmful to patients who have come to rely on the facilities.
“The frontline workers at Zambarano are dedicated to their patients and have been ringing the alarm bell about the troubling changes to patient care at this critically needed state facility for months,” Cynthia Lussier, president of the United Nurses and Allied Professionals Local 5019, which represents employees at Zambarano, said in a statement Wednesday.
J. Michael Downey, president of Rhode Island Council 94, expressed some concerns with McKee’s overall budget, pointing out his union represents 500 members at the hospital’s Cranston campus.
“During the Pandemic our members have continued to provide high quality services in challenging environments,” Downey said in a statement. “As always, Council 94 will continue to advocate for the provision of strong state/municipal services, and oppose the elimination of middle-class jobs.”
The state-run hospital has been hemorrhaging tens of millions of dollars since September 2019 when Rhode Island fell out of compliance with the federal government and stopped billing for Medicaid reimbursement. The funding still hasn’t been reinstated, despite the state having applied for it last last May. The noncompliance has cost Rhode Island taxpayers at least $60 million in general revenue during that time period.
Through a review of hospital operations in the wake of falling out of compliance, the state determined many patients were receiving services that could be provided elsewhere at community-based care facilities. As a result, the state started discharging more patients – mostly out of its Cranston facilities – and stopped accepting new people into Zambarano beginning last spring.
The effort to move long-term patients out of state-run hospitals and into community-based care centers – a process known as deinstitutionalization – has been codified in federal law dating back to the 1960s.
“Now, because we have this opportunity to look at the status of every patient, in some cases it is a deinstitutionalization process because there are many individuals who have been in the hospital for a long period of time and may have never been given the opportunity to consider living in a community placement,” Power said.
McKee’s budget clearly supports deinstitutionalization in Rhode Island, although it would also create a standalone IMD at the Benton facility. The Cranston unit is where court-ordered psychiatric patients – known as “forensic” patients – currently go for treatment. And while the federal government does not allow states to use Medicaid funding for IMDs, it also doesn’t pay for forensic patients, meaning state money would go toward funding the facility either way.
Rhode Island is also the only state without its own standalone, state-run psychiatric facility, according to budget officials.
“The intent is that the Benton facility – which only treats forensic psychiatric patients ordered by the court – because it’s a specialized facility, would be for that purpose only,” Power said.
The long-term care facility, meanwhile, would be eligible for federal reimbursements. And by separating the two types of facilities, the state may be able to avoid future compliance issues like the one it’s currently facing. State officials also said the restructuring will help Rhode Island come into compliance with the federal Olmstead Act, which aims at eliminating the unjustified segregation of people with disabilities.
McKee’s proposal is a holdover from Gov. Gina Raimondo’s administration, as his processor hired the well-known consulting company Alvarez & Marsal last summer to come up with transition and redesign workplans for the hospital. By October, the company delivered a report with various options, including the one McKee is now backing.
The hospital costs an estimated $550,000 per patient each year to operate, which has become a major drain on general revenue now that there’s no federal support. But patient advocates and local and state lawmakers argue that there aren’t many options outside of the state-run hospitals for certain types of patients with complicated needs.
The network of community-based behavioral health resources is not particularly robust in Rhode Island, according to some advocates, and that has been a source of some criticism surrounding the recent effort to discharge patients.
While some of the critics have accused the state of pressuring patients to leave Zambarano, data from BHDDH obtained by Target 12 shows the Burrillville campus had only five discharges in all of 2020 and none so far this year. In Cranston — where some psychiatric patients are admitted by court order — there have been 10 civil discharges and 68 forensic discharges.
In an effort to address some of the shortcomings in community- and home-based care, McKee has proposed spending $4 million in general revenue to try and strengthen those types of services.
He’s also seeking to expand eligibility for at-home programs, increase nursing home rates and allocate $15 million to improve quality and access to “integrated community day and employment support programs for individuals with developmental disabilities,” according to budget documents.
The Eleanor Slater proposal goes next to the R.I. House of Representatives, where lawmakers will review it as part of the overall budget approval process.
“The proposal involves a complex set of intersecting issues,” House Speaker Joe Shekarchi said in a statement. “The House Finance Committee will continue to do its diligence to determine if these issues are addressed appropriately and ensure that whatever proposal advances is in the best interests of the state.”