Disclaimer, blah, blah...not real, not me, don't worry, etc. etc.
I've always said that governments MUST take care of the mentally ill, because they're unprofitable... so no for profit business would touch them.
I was saying it again recently in a conversation with a collegue who responded,"You're wrong." (I was, of course, aghast. Wrong?! is that possible?) "A private company is making money at it", he said, "and I'll tell you how they're doing it."
The Geo Group, Inc. has figured it out. They (the group)includes a construction company; they agree with the state to issue bonds which finance the building of a "tree design" hospital facility. Geo makes the standard bundle as a construction company. The deal with the state includes the return of the building to the state after 20 or 30 years(?)in exchange for which, Geo gets an incredible tax break from the state for all that time. The "tree" design of the facility allows for a central nurses station which oversees several "units" worth of patients...thus, many fewer staff can care for many more patients. The facility is expressly designed for its efficiency and ease of operation. The hospital has an agreement with the state to get payment on X number of beds, regardless of whether or not the beds are filled...Thus several financial elements are dealt with at once (low overhead, lower payroll, low taxes, guaranteed income) and the private company makes a profit. Since it is a private company, it is apparently not subject to various state level regulatory requirements involving disclosure...when I asked, "how're they doing?" my collegue said, "we don't know...they're private...they don't have to tell us." The State, for its part, is relieved of a bunch of expensive pension holding (not to mention blogging) employees, the headache of administering the thing, various legal liabilities and so forth and has a predictable expense each year.
So there you have it...how to make money off the chronically mentally ill....Here's Atlantic Shores website...looks like a great place...
Well. The government is still "paying for it", if I understand the deal...it's just that government pays a private company to provide the service in such a way that the company makes a profit...(we're back to outsourcing)....but government still pays...you and I still pay to have this social service provided...but a private company makes a profit providing it...there's a new layer there...some of the government money leaks out into the private sector...
This starts to look good when the government agency is run poorly, when its financial and managerial inefficiencies begin to reflect badly on the administration...when its become a headache instead of a jewel...government becomes willing to pay to just get the thing off its hands....but, surely, in a well ordered world, eliminating the profiting middle man would be cheaper.(?)
I'm curious about what the treatment is like there at Atlantic Shores...do the patients like it? And do they like it better? I'm curious about what the staff is like and how well they like their jobs....and about what the hospital's community placement options are...where do they send their patients when they leave?; is society getting a good deal here? How much profit is being made and who is enjoying it?
Why does the idea of a private company profiting from the treatment of the chronically mentally ill bother me? I kind of gives me the creeps, though.
Comments since last post on "Priorities, priorities, priorities"
15 comments:
I too would be interested to hear more about this facility from those that work within. I love small pictures, you can never really tell anything except that the flowers are nice. What do you think the focus is; mental health or substance abuse? Where do the real profits lie?
Privatization has been bandied about in this state as well. Perhaps the privateers have not seen a reasonable profit margin to pursue. Could a new company emerge that would reap reasonable profits as well as deliver quality care? Now there's a novel thought; quality care for the consumer at a reasonable cost to the taxpayer.
Can you see it?
Gadfly,
With minor inaccuracies you have got it. The funding of beds may be more complex than you state, but that is close to what we hear is going on at Atlantic Shores.
Additionally the state contract specifies that these hospitals pass muster on Joint Commission standards, and State standards. They must jump all the hurdles of quality of those organizations, go thru standard reviews, and be exemplars of rectitude in care of the mentally ill.
Areas of concern include overuse of "calming" medications...read chemical restraints. There are arguments which may be made for for amelioration of the intensity of emotions by use of prn meds as being therapeutic. (especially in lieu of seclusion or leather restraints). There is increased use of 1:1 and even 2:1 staffing of individuals in crisis.
There is a real willingness shown by the vender to flex staffing to provide additional coverage for very ill "person's served".
Contracting the service for a select population appears to be at least viable if not perfect. The state has shown a willingness to work with the vendor to ensure success of this venture.
Selective admissions can be tough for staff at the "state hospitals" who believe they take up slack for the "semi-privates" in handling some of the worst cases. This is being dealt with at the highest levels.
Over all it is a big discussion, but the point is that there is interest in, and money to be made in privatizing and giving good care furthers the interest of the vendor rather than confounds it.
Staff, by the way... like the vendors, although, naturally enough, not those who are close to retirement on a state pension. They are threatened by this new way of doing business, and so they talk it down.
It is easy to gloss over the down side of the old system too... neither is perfect.
Gadde Fly,
Coincidentally, the State of Colorado has just published the "JBC General Fund Decisions on FY 2005-06 Supplementals as a Result of Referendum C" (Colorado readers will know what that is, I think)
Here are the lines that apply to mental health:
1) Funding for
Clients in Community Displaced by the Closure of Ft. Logan Beds: $230,000
2)Mental Health for the Indigent $1,450,000.
3) Restore Funding for Short-Term Intensive Residental Remediation Treatment: $100,000
4) Eliminate Voc Rehab Wait List
5) Forensic Unit Buy Down: $20,000,000
Not sure if 3 and 4 are for MH services or DD ones. Anyhow, would love it if the Director would tell us how much of this is coming to Ft. Logan (if any) and how he plans to spend it...do we have any say in where the greatest needs are? And what's with the 20 million buy down for foresics unit? It that privatization at the other location?
I think its good to see where the money's going...
I think it's good to help decide where the money should go.
Gadfly,
Here's an interesting discussion about "privatization" of governmental functions. There is mention made of both South Florida State Hospital and South Florida Evaluation and Treatment Center.
http://www.reason.org/segal_fl_comp_sourcing.pdf
Your readers may be interested in this, or then again they may only mourn the glory of lost past days. My prediction is that the "gravy train" of state run hospitals will derail in the near term. They just are not competitive in modern terms. "Time keeps on slippin', slippin', slippin' into the future..." [please give credit mentally to whoever sang that, all I can say is I didn't think it up]
Just in case you were wondering about Geo... Look a little deeper into their website.
"The GEO Group, Inc. was initially founded as a division of The Wackenhut Corporation in 1984 under the name of Wackenhut Corrections (WCC). "
Thought you would like to know.
Hey, if we farm out the jails to the private firms and they make $$$$ on the deal I guess it shouldn't surprise us that mental health would be farmed out too.
FYI so you know who GEO is...
"On November 18, 2003, at a special meeting, WCC's shareholders approved a change in the corporate name of WCC from "Wackenhut Corrections Corporation" to "The GEO Group, Inc." The name change is required under the terms of a share purchase agreement signed by WCC on April 30, 2003 and Group 4 Falck. The name change became effective on November 25, 2003 upon the filing of an amendment to the company's Articles of Incorporation with the Secretary of State in the state of Florida where the company is incorporated.
Hmmm.....that would have been Steve Miller......my my that dates me.
Any viable options to improve the quality of care for the mentally ill should be welcomed; state run, privatized or whatever. As long it is ethical and effective. Maybe we should form a corporation?
Gadde......read further into the JBC documents and you will find your answers. The Ref C $$ we were encouraged to vote for, possibly in violation of state and federal laws but who really holds management accountable for their actions anymore, will go to the community to restore and/or improve programs. Just like we experienced with captitation and the Tri-West study. Except of course where are the programs?
The Institutes are recommended to receive very little increase, except of course for physician salaries (33% at this madhouse) and possibly pharmaceuticals. There is also language that indicates a push for increasing the revenue streams for the 2 but we shall see won't we? Especially since the Institute's revenue is also used elsewhwere within the general fund.
Other interesting observations from the documents are found in the reasons to fund or not fund the request for salary increases and alternatives to the request. Read them closely.
Most interesting are these statements found within the staff recommendations. "However, because having psychiatrists on staff at the mental health institutes is necessary, the lack thereof could threaten a unit's closure. This is a concern in Pueblo because of the competency evaluation backlog. This is also a concern in the metro area(Fort Logan)where the shortage of hospital beds is beginning to present itself as a crisis."
Yes, current physician salaries make it difficult to entice state service but perhaps questions should also be asked why physicians, and others, are leaving the madhouse. A rentention problem continues to exist. There are numerous studies, surveys, etc. that continue to demonstrate that other issues are just as, if not more, important than $$. Is it really just salaries or are there other more sinister reasons for the ongoing departures?
Bed crisis, wow! And we are repeatedly told that if we try to hold the CMHCs, or would that be the BHOs who control the Medicaid $$, accountable for their continuity of care that they will not admit here! Really and just where will they admit them if such a crisis looms large?
All this and equity too!
Can you see it? Can you feel it?
Shine the light!
The results of prison privatization were clearly demonstrated in the Crowley prison riots last year. Can you imagine what they could do with the madhouse? Some things should just not have a profit motive attached.
Ain't it funny.
Wakkenhut is the security for the light rail train.
Annony said, "Hey, if we farm out the jails to the private firms and they make $$$$ on the deal I guess it shouldn't surprise us that mental health would be farmed out too." HEY! Just like the rest of our nation has been farmed out. OH. NO. But there aren't any more real farmers, are there? Just corporate conglomerates that may not even live in this country and do not have any interest in community. Welcome to Walmart. Better known as Wally World. Hope you like it. It appears to be our future.
Let's weigh the issue. Chemical restraints? Let someone get the shit beat out of them? Chemical Restraints? Manic out of control? Chemical restraints? Let psychotic put self at risk when acting out on delusions/hallucinations? Chemical restraints? Let Borderline cut, choke, pull out hair or other self-injurious behavior. Come on people. SAFETY FIRST.
Why couldn't the treatment and care of people with mental illness be provided by private and public support? The tax payers are expected to provide public schools for the children of our society and so should we contribute to the treatment and care of people with mental illness. And the private organizations or for-profit businesses should be taxed according to the resources the use of our land ie, land, water, electricity, natural water, and waste management. Then there should be a more appropritate percentage of monies allotted to mental health treatment, health care, elder care, child care/ the same percentage as goes to the amount of money spent on paper, copying, and telephones in federal/state/city/county government. It isn't aabout we don't have enough money, it's about our elected officials who don't care about the people who live in this country. It's easy to care about WHITE, MALE, EDUCATED, WELL TO DO, CHRISTIANS WHO WANT TO DRIVE ON NICE HIGHWAYS IN THEIR RECREATIONAL VEHICLES TO THEIR OVER-WATERED GOLF COURSES. Again, the lack of funds being directed to the treatment of the mentally ill and the lack of competent, intelligent, ethical administrators is the reason there is such poor care for the mentally ill in the state system.
Yes!!! Well said! Thank you!
Everything points to an increased need to talk with legislators...or engage in voting drives, campaigns etc. and, man, that can't be fun.
...and I suppose that very reluctance to engage is why the government is in the mess its in now...
argh.
g.f.
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