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Hagedorn Closing Raises Concerns About Future of Elderly Patients

The burden for accepting patients who have been hospitalized remains with family members.

New Jersey is on track to close the Hagedorn Psychiatric Hospital on June 30, the subject of a hearing Thursday in Trenton where mental health advocates, legislators and opponents of the shutdown seemed to agree on one point: New Jersey should commit more money to support Hagedorn's elderly patients as they move out of the hospital and into the homes of relatives, residential facilities in the community, and other psychiatric hospitals.

Phillip Lubitz, associate director of the New Jersey chapter of the National Alliance on Mental Illness, told the Senate health committee hearing that there has been no reduction in the number of people in state and county mental hospitals over the past 19 months.

"This comes at a time when you have been putting in significant resources to build additional community capacity," he said. "One interpretation might be that we have squeezed out all the efficiencies we're going to squeeze out and unless we continue to put about $5 million in new resources into building capacity every year, we are going to face overcrowding."

The state's goal was to provide housing for the mentally ill in the community, with supportive services to enable them to live in that housing. "A great deal of funding has gone to approving housing. But looking at the data it remains clear that the primary burden for accepting patients who have been hospitalized remains with the family members," Lubitz said. "The largest group of people continue to be discharged to families and over this period there has been no additional supports provided for these families to care for these patients."

The closure of Hagedorn, located in Glen Gardner in Hunterdon County, was announced by Gov. Chris Christie last June following years of planning and discussion, including the convening of a task force that reported on February 1, 2011, it "was not able to reach consensus whether Hagedorn should close or not." Closing the hospital, which has seen a decline in patients -- from 285 a year ago to 164 -- was budgeted to save about $9 million in the current fiscal year.

Jennifer Velez, commissioner of the state Department of Human Services, said in a statement Thursday that her department "is on course with its closure of Hagedorn, following the plan we released and publicly posted over a year ago."

This includes "the safe and appropriate discharge or transfer of our consumers," she said. Patients clinically determined to be ready for discharge prior to the closure of Hagedorn will be discharged into an appropriate community placement. Those who are assessed as needing longer inpatient treatment or who refuse discharge will be transferred to other state psychiatric hospitals. "The trending reduction in census provides ample capacity among the remaining hospitals for these admissions."

But Ronald E. Schroeder, clinical psychologist at Hagedorn, told the committee the hospital should not be closed. "The community and other psychiatric hospitals cannot handle the fragile elderly with severe and persistent mental illness. Closing Hagedorn will hurt the most vulnerable citizens of New Jersey," he said.

Carolyn Beauchamp, president of the Mental Health Association in New Jersey, said her organization supports the closing "with the understanding that resources saved from such a closure will be diverted to enhance the community system of care."

In fiscal year 2013, Beauchamp urged the state to reinvest the $44 million saved through a total shutdown of Hagedorn "back into the community mental health system where it is sorely needed."

In her statement, Velez noted that the state's decision to close Hagedorn is consistent with the 1999 Olmstead decision of the U.S. Supreme Court, "which mandated that individuals with mental illness receive treatment in the least restrictive and most integrated setting as clinically appropriate."

Closing Hagedorn, "advances this state's commitment to reducing reliance on institutional services and expanding the community-based mental health system," Velez said. In 2011, DHS developed 171 supportive placements for patients discharged from NJ hospitals, and to expand and support community capacity, DHS developed 72 beds for individuals who are at risk of being hospitalized, homeless, or at risk of being homeless and diagnosed with a mental illness. "As we continue the process of closing the hospital, patient care and safety remains our primary objective. We understand full well our responsibility to ensure the appropriate level of care and supports for consumers served in the community," Velez said.

Health committee chair Sen. Loretta Weinberg (D-Bergen) said she decided to hold a hearing on Hagedorn to focus more attention on the need for increased support of patients who are moved out of institutions.

When psychiatric patients leave mental hospitals, the money that had been spent on their care should follow them into the community and fund the support services they need -- but that doesn't happen, Weinberg said. The philosophy of the Olmstead decision, to support the dignity and autonomy of the mentally ill, "is very desirable, but it is up to the state to implement it, and we have not done a great job."

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