The shortage of beds for older adults with behavioral health needs has reached a crisis point, forcing some adults to be housed for months in hospitals or remain with family members ill equipped to provide care, according to advocates for the poor and elderly.
In one case, an 83-year-old woman’s grandchildren who could no longer care for her delivered her to the Springs Rescue Mission homeless shelter.
“The kids just dropped her off in our parking lot, and our teams worked to figure out how to take care of her,” says Travis Williams, the Rescue Mission’s chief development officer.
El Paso County has no beds available for seniors experiencing behavioral issues who can’t afford to pay for nursing home care. The problem was made more acute over the last 18 months with the closure of the Union Printers Home in March 2020 and Laurel Manor in November 2020.
“At any given time in our region, that number is zero availability,” says Melissa Marts, program development administrator at the Area Agency on Aging office in Colorado Springs. “There’s never a place for them to go. Even facilities in Denver are full.”
That means many seniors find themselves languishing in the homeless shelter, in a home setting where family members are unable to care for them, in hospital beds designed for more acute care, or even in jail.
But help could be coming via the Biden administration’s American Rescue Plan Act, which afforded Colorado $450 million to deal with behavioral health needs that cover the spectrum from workforce shortages to outpatient services.
It’s unclear whether the money will be used to build new facilities or reserve existing beds for those who qualify for Medicaid, the state and federal low-income health care program, Marts says.
But a coalition of partners has been meeting to formulate a recommendation to the 16-member Behavioral Health Transformational Task Force composed of legislators, including Rep. Mary Bradfield of El Paso County.
That task force is due to report to Gov. Jared Polis and the General Assembly by November on how to use federal coronavirus recovery money.
Marts is a member of the Pikes Peak Ethics and Long-Term Care Behavioral Health Committee that consists of 75 to 100 people representing dozens of partners searching for the best ways to fill gaps of care for those with mental-health needs.
Those partners range from local governments to hospitals, from private providers such as nursing homes, to local law enforcement and the Department of Human Services.
Marts says she knows of at least 16 documented cases of older adults being placed in hospitals for six months or longer in the last two years. She says one hospital system housed 24 older adults at a time.
Hospitals aren’t wild about that, she says, because the individuals occupy beds not designed for long-term care, and the reimbursement from Medicaid is less than full cost of having a hospital bed occupied by a regular patient.
“They [those needing care] are in a very restricted environment in a hospital, and they’re stuck,” Marts says, “whereas if they were to go to a nursing home facility, they would have things open to them.” Those things include social interaction with other residents and individualized treatment by staff.
Adult Protective Services, a division of the Department of Human Services, has identified up to 20 people with “significant abuse and neglect with no place to house them,” Marts wrote in a May 14 letter to Jarett Hughes, Polis’ senior policy adviser on aging, in a plea to consider funding more beds across the state.
Solutions range from constructing new facilities to establishing five-person houses, she says in the letter.
The problem goes beyond just having too few Medicaid beds for those with behavioral problems. “We have no Medicaid beds, no Medicaid beds for those with behavioral health issues,” she tells the Indy.
Peak View Behavioral Health often accepted elderly clients needing full assessments, but the facility closed the psychiatric wing when COVID-19 set in, she says.
“Peak View says they haven’t had to turn anybody down for short-term inpatient treatment, but they can’t keep them permanently there,” Marts says.
The committee, Marts says, wants to team up with other entities to request funding to support behavioral health Medicaid beds for older adults. What that looks like isn’t yet clear, she says, but some money could be used to help provide special training to staff, as well as expanding facility services or partnering with existing nursing homes.
“Getting that training and getting it paid for is a challenge,” she says.
Marts’ chief interest is older adults, a vulnerable and often forgotten population, especially if they have no assets and no close family to care for them or see that they find appropriate care.
“They end up on the street, in hospitals, overmedicated, not medicated at all — all kinds of injustices that are the result of not having the behavioral health Medicaid beds available. If they can’t private pay, people with dementia aren’t being served. We can’t ignore that,” she says.
“If someone sees an older person living on the street and wonders why they’re still there, this is why,” she adds.
Williams with Springs Rescue Mission knows all about this issue. For the fiscal year ending June 30, the Rescue Mission accepted 101 people from hospitals and non-psychiatric medical facilities and seven from long-term care and nursing home facilities.
“Often, the Springs Rescue Mission is the last resort or the hopeful resort for many,” Williams says. “It is not uncommon for folks to be referred to the Rescue Mission from emergency rooms, and our staff has to figure out how and who we can accommodate. It does put a strain on us. We do our best to accommodate, but we are not a medical facility.”
Besides accommodating three to five people per night who rely on oxygen tanks, the mission serves people with severe mental illness, some who’ve lived there for four to five years, because, as Williams says, “There’s nowhere else for them to go.”
Of the 2,596 clients served in the last fiscal year, 540, or 21 percent, were older than 55.
“Our team is doing a resilient and powerful job of trying to meet individual needs,” he says. “I see the pain and suffering of the folks we serve, and it does break all of our team’s hearts.”
Williams adds that some mental health issues arise from the stress of being homeless and aren’t necessarily chronic.
But he credits Springs Rescue Mission and an array of community partners with making headway toward helping those in need find housing and mental health care.
Five years ago, Springs Rescue Mission helped move 18 people into supportive and permanent housing supplied by SRM and others in a year. “Now we’re seeing 15 to 20 [find housing] every month. We are seeing some of the collaborative work is paying off,” Williams says.
Katie Blickenderfer, interim chief clinical officer with Diversus Health, a mental health provider here, called the matter of finding permanent placements for older adults “a complicated, multi-systemic issue that cannot be addressed by any one entity within the El Paso County region.”
While Diversus primarily provides outpatient behavioral health services, it also runs a 24/7 walk-in crisis center and an acute treatment unit that Blickenderfer says is “very short-term” for managing acute risk to self or others.
“The long-term housing needs of older adults remains unsolved and is a systemic issue that needs to be solved by the larger community and likely changes at the state level that creates additional opportunities for affordable, safe housing options for these individuals,” she says.
Blickenderfer adds, “Diversus Health would like to be part of the solution by ensuring these individuals have access to behavioral health services and we are accepting referrals for new clients needing psychiatry, counseling, addictions or crisis services.”
Rep. Bradfield says in an email she wants the task force to steer resources to counties with no behavioral health services. She also wants to see coordination of services to minimize duplication.
“Addressing the lack of basic necessities that are part of the treatment plan is important such as the beds and housing for people who can not be with family,” she says.
The task force must issue a report with recommendations to the General Assembly and the governor regarding policies to create “transformational” change in the area of behavioral health with the ARPA money. It’s not clear where the state will go from there.
As for that 83-year-old woman dropped off at Springs Rescue Mission?
She’s no longer there after the staff helped connect her with another family member, spokesperson Cameron Moix says via email.
“Sad stuff,” he says, “but there are silver linings as well.”