Please be advised that use the term “LTCF” in place of “Skilled Nursing Facility”.
I believe we should expand the criteria for nursing home level of care (long-term care facilities – “LTCFs”) to those with mental illness, who are too symptomatic to live in a community group home and/or supportive housing living arrangement, regardless of whether or not they have medical problems and/or self-care deficits. Oftentimes, people with severe mental illnesses are housed in State Hospitals or keep returning to Emergency Rooms or correctional facilities through the revolving doors, seeking treatment of a longer duration than is available in regular short term psychiatric facilities.
With many States privatizing their State Hospitals, it is safe to predict that at least some of these individuals will be left to fend for themselves in a dangerous world. Many hospitals will discharge individuals to a homeless shelter. This is not ideal whatsoever. Homelessness is a big problem for those with mental illness and having a continuum of housing options, including more restrictive options, such as LTCFs, would be a better solution.
In LTCFs, there is the infrastructure to have various rehab programs, run by a full treatment team, including nurses, direct care staff, medical security officers, psychiatrists, psychologists, behavior analysts, medical doctors, family specialists, social workers, counselors, dieticians, and peer support specialists. In other settings, these programs and the full treatment team may not be readily available.
Letting people go around hurting themselves and/or others without professional intervention in a safe setting is a violation of everyone’s right to a safe environment. In LTCFs, there is more external control for those with a high suicide and/or violence risk and who lack internal impulse control. In a group home or supported housing, you can just walk out and hurt someone. In an LTCF, the doors are usually locked, and you need supervision to leave. Also, LTCFs may have the full repertoire of restraints and seclusion, including physical holds, seclusion, mechanical restraints, and chemical restraints. Having a setting with a full repertoire of restraints and seclusion is ideal for those who continue to need these interventions for dangerous behavior. Calling 911 or 988 will not suffice as individuals may be arrested or brought to the Emergency Room, which results in very expensive jail and hospital admissions. We need a “safety net” treatment setting for those who cannot live in a community setting; yet, do not need a hospital (such as those with chronic mental illness, rather than a single acute episode).
LTCFs may become an option for those on Forensic Status (i.e., with criminal charges), when the individual is found Not Guilty by Reason of Insanity or Incompetent to Stand Trial. In this case, we need special highly secure forensic LTCF units, with video surveillance monitoring, security control centers, secure rooms/cells, electronically controlled doors, more security officers on staff, etc. These are mental health-equipped units, possibly funded and staffed by the local sheriff’s office, similar to the Bergen Regional Medical Center Forensic Unit in Paramus New Jersey.
They would need to reconfigure units in current facilities into specialized units (without building new buildings) in LTCFs for those with mental illness with admissions to these units stipulated by the results of an individual’s Pre Admission Screening and Resident Review (PASRR). We need to add a category to the PASRR for special services within a nursing facility, not just the option of psychiatric hospitals or community services. This should allow more robust individuals with or without medical problems and/or self-care deficits to be admitted to an LTCF when they need custodial care beyond what a group home can provide.
As suggested, some people will always require custodial care in a congregate care setting. LTCFs will help fill this gap in care for those with the most severe, disabling, and debilitating mental health conditions. Medicaid should fund LTCFs, through LTSS monies, to care for those with mental illness, so they can be discharged from hospitals to a safe setting, that has the resources to treat their mental illness, rather than homeless shelters.
Also, the State should modify its civil commitment laws to allow individuals to be committed to LTCFs, such that individuals cannot leave when they are not capable of self-preserving in the community independently without supervision.
As for me and many others, people linger in hospitals for extended periods waiting for an appropriate placement that never comes. Our system just doesn’t have the infrastructure to maintain people with mental illness in LTCFs. There needs to be an in-between step between hospitals, group homes, and supported housing. Doctors like to play it safe and avoid discharging these individuals because there is just nowhere better for them to go. An LTCF would have been an excellent alternative for people like me. Group homes and supported housing do not cut it for many people with the most severe mental illness.
We have almost 90 pages of LTCFs in New Jersey. Why can’t some of them pitch in to help those with developmental disabilities and mental illness?
