By Molly Altorfer
CEDAR RAPIDS — Starting Oct. 1, about 75 adults with mental illness who received transitional and residential services from the Abbe Center for Community Care, Inc. will be forced to receive their mental health services elsewhere.
Additionally, 80 part-time, full-time and on-call Abbe Center employees – many of whom have been with the agency since its start in 1987 – will be searching for new jobs.
The impending Sept. 30 closure of the Abbe Center follows closely on the heels of the shuttering of Anamosa’s Fairview Care Center on Feb. 1. Fairview Care Center, a residential care facility for those with mental illness and developmental disabilities, was operated by Community Care Inc., a DeWitt-based non-profit.
The shuttering of these two facilities signifies a growing change in the way that mental health services for adults will be offered and funded in the state of Iowa. Similar changes are also taking place in the availability of mental health services for children, too.
Dan Strellner, Abbe Center’s president, notes the shift in the delivery of adult mental health services and points to the transition from a county-based to a regional-based care system as the reason.
“The future role of licensed residential care facilities in the state is uncertain, and funding for mental health services is in flux until the redesign to a regional system is completed,” he said.
The Abbe Center faced a mammoth budget shortfall when the agency learned it would face a 60 percent, or $1.4 million, reduction in county fees for service support in fiscal year 2013. With an annual budget of $4.5 million, the reduction in county funding was crippling.
Transition to a regional system
The funding reduction, says Linn County Supervisor Linda Langston, is something that many residential care facilities (RCFs) faced in 2013 as a result of the redesign leading to a regional system.
“Largely the state’s takeover of Medicaid-based services put all counties in the position of having to work creatively to move people to funding streams that did not impact RCFs,” she said. “This was true all over the state. Abbe Center was only one of several RCFs that have been seriously impacted in the state.”
As part of the state’s mandated redesign of mental health services, individual counties are required to enter into a region; Linn County has joined eight other contiguous counties as a region.
“The legislature is attempting to standardize mental health services across the state,” said Linn County Supervisor Ben Rogers. “In standardizing services, service-rich counties like Linn County have had to reduce services to meet the standard.”
Mr. Rogers noted that Linn County has long been known as a “magnet” for providing an “array of robust services.”
The Abbe Center board and staff had actively prepared for budget shortfalls as a part of the impending redesign. Mr. Strellner noted that “good faith and exhaustive efforts” were made to enact budget savings strategies, including staffing reductions based on reduced census numbers and cost savings measures in the areas of information systems, transportation and travel expenses.
The Abbe Center facility, 1860 County Home Road, was also rented from Linn County. Mr. Rogers said Linn County supervisors and Mr. Strellner had worked together throughout the process, with the Linn County Supervisors approving rent reductions and ultimately scaling back the facility’s rental fee to $1 per year in an effort to free up funding for other core Abbe Center services.
In the end, it wasn’t enough.
The final decision to close the Abbe Center’s doors took place over the last few months.
“The revenue enhancements weren’t working to our satisfaction and the board of directors determined it was not financially feasible to continue operations,” Mr. Strellner said.
“Dan [Strellner] tried to find every efficiency possible,” Mr. Rogers said.
The future of RCFs
Mr. Strellner believes that the future of the mental health care system for adults in Iowa “may not be determined until the regional system is in place,” by July 1, 2014. That same feeling is shared by Ms. Langston and Mr. Rogers.
“We are going from an imperfect system of mental health care to an unknown,” Mr. Rogers conceded.
Despite the Abbe Center’s closing, Mr. Strellner still believes that the licensed residential care facility model is necessary.
“Licensed residential care facilities provide a level of service needed in the continuum of care for adults with mental health issues,” he said.
It has been suggested that current residents at the Abbe Center may easily transition to group homes or other non-institutionalized care settings. Mr. Strellner urged caution with this option.
“The houses we develop in neighborhoods are good options for clients who are stable,” he said. “They may not be appropriate for individuals needing a higher level of care.”
Such individuals may include those who are actively psychotic, severely depressed or physically aggressive. Mr. Strellner noted that the Abbe Center was available to provide many residents a “period of stabilization” required after a mental health crisis, an option that is not necessarily feasible in a group home or neighborhood setting.
“The nature of residential care facilities has been changing across the state and nation,” Mr. Rogers said, and “best practice is leading to fewer RCFs and more group settings.”
As Mr. Strellner points out, however, group or community settings are not suitable for all individuals with mental health diagnoses.
“There will always be a certain percentage of people with severe mental illness,” Mr. Rogers said. “So the need for residential care facilities will exist, but it will be on a smaller scale than facilities like the Abbe Center.”
Ms. Langston also acknowledges the changing nature of care offered by RCFs in Iowa.
“Along with federal guidelines and state guidelines, there are likely to be far fewer residential care facilities that look like Abbe,” she said. “It will be important to make sure we have enough appropriately staffed and maintained facilities in the areas where there is the most need.”
Until that time, residential care facilities offering adult mental health services in “service-rich counties” like Linn County may continue to see funding whittled away in advance of the regional redesign implementation.
George Estle, CEO of Tanager Place in Cedar Rapids, which offers mental health treatment, prevention and research for children, expresses concern for the dwindling residential care facilities available for adults and how that may impact children currently receiving mental health treatment as they enter into adulthood.
“Often children in need of ongoing mental health care must continue to receive services once they reach adulthood,” Mr. Estle said. “If the adult mental health service system continues to shrink, it will inevitably have an effect on service funding and availability for children.”
Tanager Place is one such agency that continues to “anticipate that public policymakers will continue their efforts to reduce residential care.”
Mr. Estle noted that while Tanager Place has not increased the number of its beds in recent years, it has diversified and specialized some of those beds to work with specific populations.
“We have added community-based services, outpatient services through the Tanager Place Clinic, and care coordination and support through the new Pediatric Integrated Health program,” he said. “The demand for our outpatient services continues to far exceed our capacity, from both staff and physical space perspectives.”
Ms. Langston has identified several concerns as the state nears the redesign implementation date.
“The challenge of system redesign was that there was not enough serious planning and collaboration in regards to capacity, need and use of RCFs,” Ms. Langston said. “System redesign such as the state has taken on will likely take several years to accomplish.”
Mr. Estle agrees with Mr. Strellner, Ms. Langston and Mr. Rogers that the future of the mental health care system is unknown.
“The future role of licensed residential care facilities is very uncertain and funding for mental health services will continue to be an issue – both for adults and for children,” says Estle. “Whether the redesign of administrative structure regionally or statewide is a positive development remains to be seen.”
Mr. Estle noted that Tanager Place’s philosophy on mental health services for children is driven by two primary principles: that care should be locally designed and responsive, and that services should be consumer driven.
“Without consumer choice, quality and innovation will not occur,” he said.
Ms. Langston urged patience and collaboration as the mandated redesign continues.
“We hope that the state will continue to see counties as partners in redesign and make every effort to provide citizens with the best possible care,” she said. “County mental health providers remain committed to such collaborative efforts. We hope the state does as well.”
In the meantime, Mr. Strellner and the Abbe Center team are working to place the 75 adult residents in other appropriate living situations before Sept. 30.
“We are focusing on transitioning our residents to the best possible environment,” Mr. Strellner said.
Additionally, for the 80 Abbe Center employees, Mr. Strellner is “working to help the staff determine and pursue their options” for other employment, possibly within other agencies under the Abbe, Inc. umbrella.