Hospitals in ‘crisis’ as staffing shortages persist at Missouri mental health facilities

Missouri hospitals are facing a ‘crisis’ of care for patients in acute care facilities who cannot find long-term care through the Department of Mental Health due to chronic shortages of hospital workers. agency.

Patty Morrow, vice president of behavioral health services for Mercy Health, testified at a legislative hearing on Wednesday that “the problem is pervasive and systemic” as residents languish on waiting lists for services.

“We are seeing a growing crisis of vulnerable young people and adults being left really at the doorstep of our hospitals without the necessary resources…” Morrow said. “We are not doing well by the citizens of our state in terms of serving their needs.”

Between 12 and 20 people are housed in Mercy hospital facilities each day awaiting placement with the Department of Human Services or the Department of Mental Health, Morrow said. A patient is currently spending 290 days in Mercy’s care, with a 10-bed unit closed to dedicate resources to him, Morrow said.

“We are really approaching two Christmases that he will be at our facility,” Morrow said, later adding, “At the end of the day, there’s not a lot of light at the end of the tunnel, we expect that. be with us for a much longer period.

To date, Mercy Health has received $21,000 for her care, Morrow said. Overall, the system estimates her care cost over $1 million when it also weighs lost revenue, such as the 10 beds being offline.

Mercy Health was not alone at Wednesday’s hearing, with representatives from SSM Health, BJC HealthCare and Research Psychiatric Center sharing similar experiences of long-term housing for patients with intellectual and developmental disabilities.

Justin Alferman, former lawmaker and director of health advocacy for the SSM, said patients’ mental health often declines when they live in a hospital for months. Across SSM’s eight hospitals, 25 patients are awaiting placement that has been held for more than 1,800 days in total. Last year alone, 106 adults were waiting for a placement for a total of 7,242 days.

“Put simply,” Alferman said, “there just isn’t enough manpower.”

Dirk Deaton, R-Noel and chairman of the House Appropriations Subcommittee – Health, Mental Health and Human Services, said delays in placements extend to hospitals, which in these cases are not the appropriate place for long-term care.

“I wonder, 150 years from now, what people will think of us with this kind of problem,” Deaton said, later adding, “We can and must do better.”

Over the past year, the Department of Mental Health has continued to face high staff vacancies, which has resulted in declining access to care at its state-run mental health facilities. , as the wings are closed due to a lack of sufficient staff to staff the available beds. .

There are currently 210 people awaiting admission to a Mental Health Department psychiatric hospital. An additional 266 people have yet to meet with a medical examiner to determine if they are competent to stand trial, and it is estimated that around 50% of these people will be deemed incompetent to stand trial and will be referred to DMH, Valerie Huhn, the director of the department, lawmakers told Wednesday.

Within the department’s Developmental Disabilities Division, Huhn said 652 people are currently on an open referral list for placement with a residential provider.

A graph shared with lawmakers shows that figure is set to potentially increase to more than 1,400 people in fiscal year 2023. There are 20 people who are currently hospitalized due to a lack of residential provider, with the average stay in hospital waiting for a provider at 116 days. Currently, 127 people have been waiting for a residential provider for over a year.

“Our challenge is actually to place individuals in placements,” Huhn said.

In the behavioral health and developmental disabilities divisions of the Department of Mental Health, 1,743 full-time positions are vacant. Although there has been an improvement in turnover, as with health care aides, vacancy rates for clinical staff range from 26-50%.

“It’s very difficult once we have someone to get them back in shape if we don’t have that treatment aspect,” Huhn said.

Contract staff are currently used to maintain operations, with 213 employed in rehabilitation centers and psychiatric hospitals. The bulk of those, Huhn said, are at Fulton State Hospital.

Huhn said the goal is to move away from contract staff, who are paid more than their state counterparts.

Rates for certified practical nurses paid to the staffing company were $78 per hour for certified practical nurses and $195 per hour for behavioral health registered nurses. That’s compared to non-contract support staff starting at $15.31 an hour, Huhn said.

“It’s costing us four times as much for people on contract, and if we paid more, we might not need people on contract,” said Rep. Peter Merideth, D-St. Louis.

In an effort to address staffing shortages, Missouri last year entered into an emergency, no-tender contract with a Texas-based construction company called SLSCO.

The Independent previously reported that the contract was marred by no-shows and high costs.

DMH continues to pay temporary staff through the contract, said Debra Walker, spokeswoman for the department.

In fiscal years 2022 and 2023, SLSCO received more than $73 million, according to the State Accountability Portal.

In a competitive labor market, the department has struggled to stay competitive, despite wage increases approved by lawmakers earlier this year, Huhn said. Raising wages for permanent employees and workers who take evening shifts are strategies that Huhn says could help address the problem.

“We’re not going to ask for extra beds next year. I’m not going to have them staffed,” Huhn said, later adding, “There’s no history in a job market like this. -this.”


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