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Dave Solomon's State House Dome: 'Back door' approach to shortage of mental health beds has some success

December 17. 2017 1:41AM

The backlog of mental-health patients in hospital emergency rooms awaiting admission to the state's psychiatric hospital may finally start to ease up, according to Lori Shibinette, the newly appointed CEO of New Hampshire Hospital.

If that happens, it won't be because the Legislature approved funding for 20 more mental-health beds. The Department of Health and Human Services months ago put out a request for bids from hospitals or health-care facilities to create those beds and got no response.

"We did not receive any bids for those services, and so we pulled the RFP back," says HHS Commissioner Jeffrey Meyers. "We have been having ongoing discussions with providers on what it would take for them to want to stand up (create) those beds."

Lack of workers is a problem, said Meyers, in addition to concerns about the need for new construction, how the new beds would fit into existing facilities and the rate of reimbursement.

Meyers said a typical pay rate for a hospital providing mental-health beds - a so-called Designated Receiving Facility - is about $7,000 per episode of care, which could last from one to 10 days.

That just hasn't been enough to whet the appetite of organizations with the resources to apply.

"The conversations are ongoing and we are optimistic that we are going to get those 20 beds," he said.

A new request for proposals will soon be issued, which most likely will offer higher reimbursement rates in the hope of drawing additional interest.

Shibinette, who took over at NHH in October, agrees that the new beds at the hospital are necessary but says too much attention has been paid to what she called "the front door" of the hospital, with patients awaiting admission, and not enough to "the back door," for patients awaiting discharge.

"One of the first things I had to do is get New Hampshire Hospital to define the problem," she said in a recent interview. "Today, we had 32 people waiting for beds, while I had 70 people waiting for discharge."

Discharging a patient at the hospital is a far cheaper and faster way to open up a bed than waiting for new ones to be created, as long as there is somewhere to send the discharged patients.

"That's where transitional housing or supportive residential care comes in," says Shibinette. "We need more of those types of beds in the community. So as we build our capacity in the community, you will see that our longer-term patients will start to discharge. That will open up capacity at the hospital to shrink our waiting list. That's our goal."

The good news is that DHHS has had far more success in getting transitional beds for discharged patients on line.

"We have lots of applications for transitional housing," says Shibinette.

The department has a contract for 14 new transitional beds with Harbor Homes of Nashua and soon will award a contract to another vendor for six more. The department will meet its legislative goal of 20 new transitional beds in 2017 and another 20 in 2018.

The lack of transitional options has meant a lot of people have stayed in New Hampshire Hospital who don't have to be there.

"We will be discharging 20 patients this year who have been in our building for months to years," said Shibinette. "We have some people leaving who have been in our building ready for discharge for more than a year because we didn't have transitional housing available."

Gov. Chris Sununu, while still anxious to see the new beds created for the front door, is excited about the success the state is having at the back door.

"We've been seeing people bid on certain things and not on others, and have had to change RFPs to get more bids," he recently told the Executive Council. "Now the pressing piece is transitional housing. That's where I believe the funding really needs to go. New Hampshire Hospital beds are being used to house people who are ready to leave, but we can't get them out the door."

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