For decades the United States of America has made a concerted effort to help the mentally ill and those with developmental limitations to thrive in their communities, in less restrictive settings as opposed to institutional environments. The days of the “large building housing those special people” were positively impacted by a change in how we approached treatment and integration into society for those with cognitive limitations.
State Mental Health Codes emerged and evolved and those who were recipients of mental health services obtained new protections known as Recipient Rights. Special training came about governing the handling of psychotropic medications and person-centeredness with the goal of assisting direct care staff (typically not clinical professionals) to render, safe, person-centered care.
All of this spells good things for many who are the most vulnerable among us. Pull forward a few years. As dollars used to reimburse group living providers who served the mentally ill dried up- including those in the adult foster care system in states like Michigan – the previous profitability associated with the business waned. In some cases daily per diems paid for residential services dropped by as much as 70% after what was labeled “re-assessments” by community mental health agencies. In other instances there has been a greater push to transition these populations into more independent living environments, i.e. SIL or Semi-Independent Living Homes.
Many providers made a mad exodus to other business models or sought to serve differing populations where the reimbursement was not tied to mental health dollars.
Some of these homes sought to serve the medically fragile elderly – some with mental illness and some without it – but it would appear the published expectations of many state governments and publicly provided tools to help ensure provider preparedness has not kept up with the exodus. So we have tons of direct care workers in group living serving residents with:
- Pressure wounds
- Peg tubes, and
- Foley catheters
among other things but who have no clinical training to help the resident manage a daily routine focused on wellness. In one case the publishers of this Blog are aware of a direct care worker in Oakland County, Michigan who asked a resident’s family “whats a nebulizer?” after a resident who had been living there for three, (3) weeks expressed difficulty breathing. The nebulizer was in her bedroom closet and even the owners of the home were not familiar with it. All they knew is the driver brought it when the new resident was admitted from a nursing home.
Is a national training and preparedness standard for workers in community based care the answer? Perhaps. Whatever the final solution it has to be one that recognizes that many who need assistance to make it through every day do not need to live in nursing homes but still need care and attention from the most qualified people. This means people trained to manage more than that which is expected of a physically high-functioning population with varying levels of mental illness. The public must demand it!
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