Detox patients often sit in emergency departments for hours, or even days, before a spot opens up at a detoxification facility. With the county’s detox center shuttered, the nearest places that will take those patients are now miles away, in Moorhead, Nevis or St. Cloud, where space is limited and there’s usually a wait. Transporting patients to these faraway facilities is also an issue.
In a letter sent to the county board of commissioners at the end of March, Perham Health CEO, Chuck Hofius, and Joshua Chapman, chief of the medical staff, laid out the hospital’s struggles, explaining “how difficult it has been since the (county) program closed,” and noting that it’s “extremely difficult and sometimes impossible” to find alternate solutions for detox patients.
“There are times when no alternative arises, so when the person is safe to leave, they go right back to the same environment and it is not uncommon for us to see them again days later,” the letter states. “The scope and frequency of substance use/abuse is only increasing. At this time, patients are simply not getting their needs met safely.”
The situation is the same at Lake Region Healthcare in Fergus Falls, where CEO Larry Schulz said detox patients have been in the emergency department for up to 72 hours while awaiting placement elsewhere. The hospitals keep these patients safe and medically stable, he explained, but they don’t provide detoxification services.
“It’s become more difficult to find placement,” Schulz said of not having a local detox center, “and I think the sooner we can get these patients into the services that they need, the better.”
Lake Region sees about a dozen detox patients a month, according to Schulz; Hofius said Perham Health sees 6 to 8.
Prior to January, detox services were provided in Otter Tail County by Productive Alternatives, which ran a 10-bed facility in Fergus Falls and contracted its services out to the county. It also provided patients with transportation.
But, after nearly a decade of running the facility, and facing financial and staffing issues, Productive Alternatives decided it was time to let it go.
The immediate question for county leaders was, inevitably, ‘What do we do now?’
That’s a question that still needs a definitive answer.
Deb Sjostrom, the director of human services for Otter Tail County, said administrative staff from several county departments, including public health, probation, law enforcement and others, have been meeting to talk about how they can best meet the needs of people requiring detox services.
“We do acknowledge that there is an issue and that we need to find a way to manage it for people who need detox,” she said.
So far, there have been two possible solutions discussed—one that would meet short-term and mid-term needs, and another that would offer a long-term solution.
In the short-to-mid-term, Sjostrom said, Otter Tail County could work cooperatively with Clay County, which runs the detox center in Moorhead, where some of Otter Tail’s patients are already being sent. If the counties were to partner, Otter Tail could actually ‘buy’ a certain number of beds at that facility, keeping those spots open for Otter Tail County patients.
That’s one idea, but it hasn’t gotten off the ground yet.
“We’re in the discussion stages of that,” Sjostrom said. “Nothing has been finalized.”
The longer-range solution, she continued, determines what could be done within Otter Tail County, to continue to provide detox services locally. There are a lot of factors to consider: Where would the facility be located? Who would run it? How would it be funded?
Those and plenty of other questions would need to be answered before any sort of long-term plan could be put in place—and those answers will likely be shaped by decisions made at the state legislature.
“The next legislative session, in 2017, we expect to see some chemical dependency reform,” said Sjostrom. “So we’re looking at how we’re going to deliver detox services within any new state directives about those services.”
John Dinsmore, director of Otter Tail County’s Community Services Division, explained that detox programs in Minnesota are evolving from a “social detox model” to a “healthcare model” otherwise known as withdrawal management services.
The new model acknowledges the complexities of detoxification, he said; it recognizes that many detox patients today also have medical issues related to the use of multiple kinds of drugs.
“The process of detoxifying is a risky one at times, and it’s also much more of a health matter and health concern (than it used to be),” he said, “and so you need to have health professionals monitoring it. Many are seeing that as the next phase of detoxification services.”
Within the next two years, Dinsmore said, the state would like to get approval from the federal government to make detox services reimbursable through Medicaid.
If that happens, healthcare centers would have more funding to deal with detoxification, and that could open a window to more direct hospital involvement.
Otter Tail County’s long-range plans for detox are taking this possibility into account. County leaders are including local healthcare centers in their discussions now, to see how they might be willing to help in the future. Perham Health, Lake Region Healthcare and Lakeland Mental Health have all been invited to a meeting with county leaders in early May, to discuss the possibilities.
Otter Tail County is not the only county in Minnesota without a detox program, it’s just the most recent one to go without. Dinsmore said the number of programs in the state has decreased from 30 a decade ago to 21 today, usually for the same reasons the Otter Tail center closed—money and staffing issues.
“When you think about health care services on a continuum, this is not one of those services that people jump up and want to provide,” said Dinsmore. “Most people can detoxify in 7 to 10 days, but the services they need in that time are very complicated.”
Until a better solution is set in stone, Otter Tail County hospitals will continue to feel the strain, and the situation will likely take some time to figure out.
According to Sjostrom, “this isn’t an answer that we’re going to have up and running in a month or two.”
No comments:
Post a Comment