Kansas Health Institute | Information For Policy Makers. Health for Kansans.

TOPEKA — The average stay in one of the state’s three hospitals for the mentally ill is between two and four weeks.

Typically, once patients are stabilized they are sent home where their community mental health center tries to provide treatment and keep them on their medications.

But that doesn’t always work.

Many former hospital patients — there isn’t an exact count — become homeless or commit crimes and are sent to a county jail or state prison.

Approximately 700 former hospital patients have been placed in what are called nursing facilities for mental health or NFMHs.

“They’re here because at this time they’re unable to live independently and safely and because they have nowhere else to go,” said Bonita Robertson Boydston, who runs Westview Nursing Center, a 46-bed NFMH in Peabody.

Most of the 11 NFMHs in Kansas are in buildings that were once nursing homes. All are operating at or near capacity. Together they have 716 beds.

“In the past two years, I think we’ve had maybe three openings,” Boydston said. “We have a waiting list because there’s a great need for what we do.”

But Boydston and other NFMH administrators say the state’s recent 10 percent cut in Medicaid payments has put their futures in doubt.

“The problem is we don’t have any other revenue source,” Boydston said. “So that 10 percent cut is 10 percent of my entire budget. It’s not 10 percent of part of my budget, it’s 10 percent of everything.”

Shirley Showalter has been the administrator at the 46-bed Applewood Rehabilitation NFMH in Chanute for 14 years.

“I’m getting ready to go to our state association’s winter conference in Topeka and I just got my hotel reservation. It’s $96 for one night,” Showalter said. “At the same time, I’m expected to provide round-the-clock skilled nursing, three meals a day and then meet the personal care needs of someone who has a severe and persistent mental illness — all for $77 a day. And now with a 10 percent cut, we’re expected to do it all for less than $70 a day.”

NFMHs Medicaid payments are administered by the Kansas Department of Social and Rehabilitation Services.

Earlier this month, SRS hosted an information-gathering meeting with representatives for all of the state’s NFMHs.

“We’re monitoring the situation,” said Rick Shults, director of mental health services at SRS. “We’re concerned.”

SRS expects to spend $15.8 million on the NFMHs in fiscal 2010, which ends June 30.

If an NFMH were to close, it is uncertain what would become of its residents. The state hospitals are at or over capacity. The census at Osawatomie State Hospital reached 200 on Monday. Its licensed capacity is for 176 patients.

“Here in Chanute — this is a rural community — we don’t have soup kitchens or boarding houses where our residents might be able to go,” Showalter said. “They could go back to the state hospitals, I guess, but they’re full. They can’t go to another NFMH because they’re full.”

“Some of them might have to go to a geriatric-type home — not because it would be appropriate, but because there’d be no other place to go,” Boydston said.

Some may be able to try their hand again in a less-restrictive community setting.

“I hope that’s what would happen,” Boydston said, “but I have to say the people we’re seeing are more and more ill because the community mental health centers aren’t in a position to provide all the services people need to sustain them in the community. The centers have been cut, too, you know.”

The NFMH administrators said their troubles are compounded by a tiered payment formula that reimburses more for a patient with complex medical needs; less for someone able to walk, feed and toilet themselves.

Most NFMH residents are in their 40s or 50s and are not considered medically fragile. Consequently, most NFMHs are paid less than $100 a day per resident.

At the same time, many MFMH residents — because of their illness — engage in anti-social behaviors that make their care difficult.

“It’s not a good situation,” said Kansas Health Care Association Executive Director Cindy Luxem. The association represents most of the state’s for-profit nursing facilities.

Each of the 11 NFMHs is a for-profit facility.