By Dave Ranney
KHI News Service
"He always says, "Try not to get hurt,"" she said. "He means it. He really hopes I can make it through the day without getting hurt."
Guilbeau, 43, is an aide on a 24-bed, all-female "thought disorder" unit at Osawatomie State Hospital. In the last four years, she"s been hit, kicked in the groin and bitten. She"s had her hair pulled, and she"s had burning hot coffee thrown on her.
"I still have a scar on my arm from the coffee," she said. "I was protecting an elderly patient from another patient. My patient didn"t get hurt. The time I got bit, we"d called a "code" on a patient who"d tried to hit another resident with a chair. When we had her down, she bit me."
Osawatomie State Hospital is one of three state-run facilities for adults with severe mental illnesses who are considered a danger to themselves or others. The 176-bed hospital with an annual budget of $25 million has an average daily census of 168 patients from 46 counties in eastern and central Kansas. Half the patients" stays are for nine days or less.
Most of the patients on Guilbeau"s unit have been diagnosed with bipolar disorder, schizophrenia or major depression.
"If you"re going to work here, you have to understand that the patients are here because they"re sick, and they"re going to do things that don"t make sense to you but make sense to them," she said. "Most of my patients think we"re experimenting on them, that we"re poisoning them. They don"t think they"re sick, they think it"s somebody else"s fault that they"re here."
As an aide, Guilbeau earns $12.35 an hour, though she takes home considerably less. "My husband is self-employed so our health insurance comes out of my paycheck," she said. "We have two kids, so there"s not much left."
Guilbeau knows mental illness. Her mother was a patient at Osawatomie State Hospital in the late 1960s and early 1970s.
"It was terribly difficult on my family," she said. "I remember I had to go live with my sister because my mother couldn"t take care of me."
Guilbeau remembers her mother telling "horrendous stories" about what went on at the hospital.
"That"s one of the reasons I wanted to work here, I wanted to see if they were true," she said. "Now that I"ve been here and worked with people like my mother, I realize just how sick and how scared she was. It"s not as bad as my mother said it was. People were just doing their jobs, trying to keep her safe."
Staffing and safety concerns
"We"re understaffed," she said. "We have two aides for 24 patients. We should have three for 20 patients. The other day, we had 25 patients we were one over census when the other aide had to take four patients off the unit for the some lab work. That left me with 21 patients, and it was on a Tuesday, the day I have to change sheets and disinfect all the mattresses."
With some regularity, Guilbeau said, aides are expected to work double shifts.
"We have people who want to work double shifts. They want the money," Guilbeau said. "But I don"t unless they make me. I can be on my toes for eight and half hours but after that, I"m done. It"s not good for me or my patients for me to be here 12 or 16 hours in a day and I have a family waiting for me at home.
"But if they tell me I have to, I will," she added. "I don"t want to get written up for insubordination."
State officials are aware of the shortfalls in staffing and attempting to address them.
"We"re trying to reduce the double shifts," said Department of Social and Rehabilitation Services Secretary Don Jordan.
"We added 14 or 15 positions earlier this year because the census was running higher," Jordan said.
The positions addressed some of the concerns raised in a 2006 federal audit that cited the hospital for "significant deficiencies in active treatment." The audit, conducted by the Centers for Medicare and Medicaid Services, found that patients often weren"t engaged in beneficial activities. Follow-up surveys by CMS found that the deficiencies were corrected late last year.
Budget increase requested
Jordan was superintendent at Osawatomie State Hospital from 2002 to 2005. He"s requested an additional $900,000 in Fiscal Year 2009 to further increase the size of the staff, which now stands at about 425.
"We"d like to add another person per unit per shift," Jordon said, stressing that despite the shortfalls, all three state facilities for the mentally ill Osawatomie and Larned state hospitals and the 50-bed Rainbow Mental Health Facility in Kansas City are fully accredited.
"I think we"re doing a good job," Jordan said. "But I also think we can"t sit back and expect the situation to take care of itself. We need to make sure the resources are in place to stay on top of things."
"I"ve begged my legislators for more staff," Guilbeau said, "and that staff needs to get all the way down to where the patients are and not be in an office somewhere."
Noting that her unit had three aides over the Thanksgiving weekend, Guilbeau said adding staff will allow her to provide better patient care.
"I felt like I was in heaven. I finally had enough time to give baths and actually spend time with my patients. We did some decorating for Christmas," she said. "I went home thinking I"d done a good job."
-Dave Ranney is a staff writer for KHI News Service, which specializes in coverage of health issues facing Kansans. He can be reached at firstname.lastname@example.org or at 785-233-5443, ext. 128.