Many Abbe Center residents moving to smaller group homes

The topic was “encouragement.”

“How do you get through hard times?” Jeannie Sampica asked about a dozen people gathered around her one recent afternoon.

“Listen to music,” suggested one middle-aged man. “Watching TV.”

“Being around friends,” offered a woman in her 60s.

“I think about where I'll go,” said another man. “Leaving my new address for my doctor.”

“Are you having pretty positive thoughts about your moving?” asked Sampica. “That's good.”

Thoughts of moving have led to anxiety at the Abbe Center for Community Care in Marion, where Sampica, 55, of Coggon, works as an activities assistant. Many of the 125 Linn County residents, many with profound psychiatric disorders, may be leaving soon due to budget troubles.

“It's all about shifting the cost to Medicaid,” said Dan Strellner, president of Abbe Services, the non-profit that operates the center under contract to the county. “We can understand that, but we don't agree with it.”

The center's daily rates for basic residential care facility (RCF) - $119.32 - and for people with mental illness (RCF/PMI) - $148.97 - are posted near the front door. Of that, the state pays $28. The balance for each resident comes from several sources - mostly Social Security but also private insurance and whatever savings, trusts or other resources the resident or their family may have.

Linn County covers what's left. And that's where the numbers have gone off-kilter.

With unanticipated changes in state aid and Medicaid payments leaving a $5.3 million shortfall in the budget for mental health and developmental disability (MHDD) services, county supervisors last week approved a plan to shift 90 or more of the Abbe Center's 125 residents to smaller three- or four-bedroom neighborhood group homes, where Medicaid will pay for most of their costs.

Moving clients from Abbe to group homes will save the county a little more than $400,000 in the present fiscal year. Medicaid covers 62 percent of the residents' group home cost, according to Mechelle Dhondt, the county's director of MHDD services.

There's nothing new about residents leaving the center at 1860 County Home Rd., Marion. The daily patient count remains fairly stable at around 125, but the average day sees one resident coming or going, said facility manager Craig Bradke.

Bradke said most residents are in transition from an acute-care psychiatric facility, such as the one at St. Luke's Hospital, to a group home.

“We start preparing someone for discharge the first week they get here,” said Bradke. As for the county's basic plan, “we don't have any problem with that because that's where we discharge people to.”

Speed worries

It's the pace of the transition that worries.

“We're struggling to figure out how best to maintain the continuum of service,” Strellner said. “We're just concerned about moving folks before they're ready.”

On Thursday, 51 Abbe residents were receiving mental health services, 74 were receiving residential care facility services. The average stay for a resident with mental illness resident is 194 days and 469 for residential care facility. Linn County was responsible for 75 of the residents - the rest came from as far away as western Iowa.

Building trust

“It took about a year for some to build that trust,” said Candence Long of Cedar Rapids, a licensed practical nurse at Abbe Center. “They'd ask smart questions: ‘Are you qualified?'”

Strellner said Abbe requires at least a two-year degree of its 87 care workers - there are eight administrative staff - “and more likely we're hiring people with four-year degrees” in a social work or human services field.

A primary-care physician holds office hours at the center three days a week, with specialized medical and psychiatric care available as needed.

Long is skeptical that some Abbe residents will get the supervision or monitoring they need in less intensive surroundings. She mentions a resident who deals with frustration with a sudden explosive outburst, another who routinely mentions killing herself over minor daily aggravations.

When such an incident occurs, Long said, a staff member checks on the resident at least every 15 minutes through the day and night.

“We certainly don't hold people back from moving to other places if they want to,” said Long, 46. “But what would the qualifications be for these people to (work) in these (other) places?”

County home successor

Abbe pays Linn County $284,000 rent for the center.

Abbe, a non-profit formed in 1949 and named for an early settler, took over operation of the county-owned care facility in 1987 as society moved away from the traditional “county home” institutional model for the developmentally disabled and mentally ill. The move has continued toward small-group homes and support services for the more independent who can live on their own.

Resident fees generated $6,155,266 at Abbe in the fiscal year ending June 2010, according to the center's most recent tax return posted at the charity watchdog site Guidestar. The center reported $6,059,970 in expenses.

Steve Miller, a county, state, and national board member for the National Alliance on Mental Illness, said the local chapter is generally satisfied with Abbe's work.

“There may be some people at Abbe who may be able to go into a group home with some supervision, but there are some who can't,” said Miller, of Cedar Rapids. “There are people out there (for whom) it's the right place.”

“From my perspective, the move of people from the Abbe institutional setting to community providers is not a negative thing,” Dhondt wrote in an email. “The mental health system is moving away from large congregate settings to smaller homes in the community. Residential care facilities have closed in other counties.”

Strellner and his staff are planning ways to meet the county's changes. Among them are providing group-home services for some residents at the center, and opening some group homes of its own.

Whatever steps are taken, the center will remain for those who need it, including a few who've been there since the facility opened, Strellner said.

“We're not going out of business,” he said. “We're not going anywhere.”

Related articles:

Future of Abbe Center deemed 'tenuous at best' (thegazette.com)

Linn supervisors approve first round of MHDD cuts (thegazette.com)