Two Category 5 Healthcare Crises Hitting RI, Addiction & Slater Hospital - Rep. Fenton-Fung
Wednesday, April 21, 2021
Right now, two category five hurricanes are swirling inside Rhode Island's public health arena: the fire inside the Eleanor Slater Hospital system, and the opioid overdose epidemic. While seemingly unique situations, both of their answers lie in properly investing in the community-based mental & behavioral health infrastructure in our state.
The Eleanor Slater Hospital system's problems are enormously complex. While the Attorney General has stepped in to investigate, and hopefully will address concerns in regards to billing and patient classifications, our forward focus needs to start with listening to the hospital clinicians. They are screaming at the top of their lungs about discharge concerns because when you work with patients for a decade they become family, and these clinicians know there are not enough community mental health centers, day programs, or step-down level skilled nursing facilities that can properly care for these "extended" family members. We as a state have lagged at making those investments, and those programs that do exist are stressed out, understaffed, and lack the bandwidth to fully solve the problem.
In reality, do some of these patients at ESH no longer fit the definition of long-term acute care (LTAC) patients? I've been told by the dedicated staff that this is true, but there is no "next level" here in RI that can currently accommodate them, and they get stuck in the system. Now, as discharges appear to be at pace, one gets concerned as while they might not meet LTAC criteria, some aren't truly ready to be in the regular community either. A step-down level skilled nursing facility with a mental health focus would be a great option, yet that doesn't exist today. The rest of the state's skilled nursing facilities have been reeling from UHIP billing disasters, COVID, and now staffing shortages. For those patients who might even be able to survive at home with family part-time, we don't have enough adult day programs that specialize in traumatic brain injuries, or home health aides that have been upskilled in working with patients with complex disorders like schizophrenia. This isn't easy.
GET THE LATEST BREAKING NEWS HERE -- SIGN UP FOR GOLOCAL FREE DAILY EBLASTTurn your attention then to the 25% increase in accidental drug overdose deaths in 2020. My city of Cranston has the second highest burden of opioid overdoses in the state, and despite yeoman's work by organizations like CODAC, who literally borrowed a Cranston Senior Center trans van so that they could deliver medication-based treatment during the height of the pandemic, we are not winning this battle. School-based education programs, like the CCAP-driven Substance Abuse Task Forces that bring in speakers like Chris Herren to influence teens, and industry-based wrap arounds like LIUNA's union-driven program to support those with pain medication addictions in the construction industry, are positive programs to put arms around different constituencies. Yet, it’s difficult to get adherence to treatment plans when the centers are three towns away, or don’t have the bandwidth to assist with the larger socioeconomic and medical problems driving their addictions. We need to do much more.
In the next five years, we should make significant public health infrastructure investments for specialty adult day care programs and step-down settings, addiction treatment centers that are hyperlocal and integrated with primary care practices for holistic care, and the proliferation of diverse medication-assisted treatment outreach programs. As we achieve success in these areas, you'll find a healthcare system that flows better, and one that provides more humane and cost-efficient care.
The status quo is not going to work anymore, and our neighbors are struggling. It's time to show strong leadership & seize the opportunity to give a figurative shot in the arm to our community-based mental health infrastructure.
Barbara Ann Fenton-Fung represents the 15th District in the House of Representatives.
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