A consulting company has completed its review of the state hospitals for the mentally ill and developmentally disabled and Kansas officials are now moving forward with some of the resulting recommendations, including reducing the number of employees at Larned State Hospital and Kansas Neurological Institute in Topeka.
Shawn Sullivan, secretary of the Kansas Department for Aging and Disability Services, the agency that oversees the hospitals, said no layoffs would be required to complete the agency’s follow-up plan but that the equivalent of about 35 full-time jobs at KNI and 22 at Larned would be eliminated over the next two years as workers retire, resign or otherwise leave.
Sullivan said he intended to use the more than $3 million in expected savings over the next two years to cover recent pay raises given to some hospital workers, to offset anticipated cuts in federal aid for the facilities, hire more psychiatrists at Larned, and to help move developmentally disabled persons off the waiting list for home-based Medicaid services.
Sullivan said the consultants, The Buckley Group LLC, which is based in Englewood, Colo., concluded that 50 positions could be cut at Larned, saving the state an estimated $2.7 million, but that he decided fewer reductions would be more prudent.
No one throwing a parade
“I feel like what we’ve developed is a reasonable plan,” Sullivan said. “I think if we were to reduce by the full 50 employees and do what was recommended in the report it would lead to destabilizing the hospital and would run counter to a lot of the improvements we tried to make in the last 18 months and wouldn’t be helpful to the care and services we’re trying to provide.”
Buckley state hospital reports
KDADS Deputy Secretary Lea Stueve Taylor was at Larned last week for two days reviewing the consultant’s findings with hospital staff members and discussing the planned changes in operations at the facility.
“General reaction, from what I heard from my staff, was that no one was throwing us a parade,” Sullivan said of the response from Larned employees. “But there was a relief that there won’t be layoffs…and the savings will be used to reinvest back in the hospital.”
But Rebecca Proctor, interim executive director of the Kansas Organization of State Employees, a labor group with members at the hospital, said “forced overtime” remains a serious problem at Larned with many direct care workers clocking 15 to 30 hours of it per week.
‘No room for cuts’
“I can tell you that KOSE would oppose any of those reductions because we believe Larned is understaffed at the moment,” Proctor said. “When you’re working people that much overtime that tells me there is no room for cuts.”
The state’s Sexual Predator Treatment Program is housed at Larned and a September legislative audit that looked at security and staffing on the unit concluded that 55 of its 178 direct-care positions were vacant.
The audit also noted that staff on that unit alone had clocked more than 38,000 hours overtime in 2012, compared to 6,700 hours in 2010.
The sexual predator unit accounts for about 220 of the hospital’s 535 beds.
In fiscal year 2012, the hospital cost about $58 million to operate or about $320 a day per patient, according to the consultant’s report.
The consultant acknowledged the overtime problem for direct-care workers at the hospital but noted that therapy and social services at the facility were overstaffed compared to “industry benchmarks.”
Post Audit report on sex predator program
The consultant also reported that the employee absenteeism rate at Larned was relatively high, “around 5 percent” compared to the expected 1 percent.
“We believe it may be possible to reduce the frequency of unplanned absences through tighter standards of employee accountability and by expanding the pool of direct care staff. Increasing the pool of MHDDTs (mental health developmental disability technicians) and other direct care staff should also reduce the high rate of overtime,” the consultants wrote.
KDADS officials said their plan is to reduce positions in areas that the consultant concluded were overstaffed but increase direct-care staffing.
“With all due respect to KOSE, I do not know whether they have read and understood the Buckley report,” said Angela de Rocha, a KDADS spokesperson. “The audit recommends reducing staffing for certain job categories and increasing others. The purpose of this is to provide improved overall patient care. The audit does not recommend reducing any of the staff positions that are a challenge to fill and keep filled.”
Sullivan said the agency would be moving people from overstaffed functions, such as therapy, to fill vacancies in direct care over the next six months.
KDADS officials received the Buckley report on Kansas Neurological Institute in November. Sullivan said he met soon after with staff at the Topeka facility and with families of some of the patients to discuss the agency’s planned changes.
KHI News Service
Most KNI patients have severe developmental disabilities and typically are older. Many have lived at the hospital for years.
Sullivan said the agency plans to:
- Consolidate two residence buildings on the KNI campus, one in July 2014 and the second by July 2015.
- Combine the hospital’s medical unit and out-patient clinic by July 2014.
- Reduce operations at the hospital’s dental clinic from full-time to part-time by July 2014.
- Eliminate some administrative positions to reflect the hospital’s declining patient census.
All told, 35 jobs will be cut, Sullivan said. But there will be no layoffs. Instead, like at Larned, the reductions will made “through attrition,” as workers retire or otherwise leave KNI employment.
The consultant’s report on the state hospital for the mentally ill in Osawatomie was made public in early September and was featured in this report by KHI News Service.
Sullivan said a pilot program for implementing some of the recommended changes started there Nov. 1. The Osawatomie report called for different staffing structures and shifted responsibilities, but did not call for reductions on par with those recommended at Larned and KNI.
Altogether, the Buckley Group cited about $8.2 million in potential annual savings that could be realized at Larned, Osawatomie and KNI. The four reports cost the state about $200,000, according to KDADS officials.
The consultant’s report on Parsons State Hospital and Training Center, which has 188 beds and serves the developmentally disabled, is complete but won’t be made public until it has been given to hospital staff, according to KDADS officials.
Sullivan said the recommendations for Parsons “were minimal” because many of the changes that might have been suggested already had been implemented over the course of the past two years.
He said he anticipated savings of about $3 million from changes at KNI and Larned versus the $5.2 million recommended by Buckley but had not decided yet how much might be saved from changes at Osawatomie.
In any event, he said he hoped to plow those savings back into the hospitals or related programs rather than return dollars to the state general fund.
“I feel like I have a good enough relationships with the legislators on the appropriations committees that they will respect that we are trying to do this gradually and without going to them asking for more money,” he said.
In both the Larned and Osawatomie reports, the consultant noted that there were significant numbers of patients who probably didn’t need to be there but for the lack of community treatment options.
Sullivan said he thought the state lacked “intermediate” mental health care facilities focused on crisis stabilization and detoxification of drug and alcohol abusers.
“We have the community mental health centers at one end of the continuum and the state hospitals on the other end of the continuum, but we don’t have enough intermediate facilities,” he said.
Agency officials, he said, soon will announce their plans for the Rainbow Mental Health Facility in Kansas City, Kan., much of which has been mothballed the past two years after failing a fire marshal’s inspection.
Sullivan said the new Rainbow model would “be built around a drop-off, triage and assessment type of center” where people could be taken by law enforcement or mental health screeners.
He said those types of short-term services could reduce the number of patients sent to the state hospital in Osawatomie and Larned.
Kyle Kessler, executive director of the Association of Community Mental Health Centers of Kansas, said he agreed that more resources were needed.
“The association is in agreement with the need for more community resources, including crisis stabilization and detox services,” he said. “This could help alleviate the strain on the existing hospital resources so those individuals who need higher levels of care for longer durations are able to receive it.
“Adding crisis stabilization and detox services to the continuum of care currently offered could help individuals receive the most appropriate level of care in the most timely manner,” he said.
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