The Abbe Center for Community Care located on County Home Road in Marion. (The Gazette,file)

The Abbe Center for Community Care, for 40 years the provider of Linn County’s most intensive care for people with mental illness or developmental disability, may be nearing the end of its useful life – at least in its present form.

“We’ve got a large building that is probably too large,” said Dan Strellner, president of Abbe Services, the non-profit that operates the center under contract to the county. “We’re trying to right-size.”

Earlier this month, county supervisors voted to commission a study of the center’s future under the state’s reorganization of services for Iowans with mental health and developmental disability (MHDD) issues. That’s complicated by the fact that no one knows just what the new MHDD system will look like or how it will function.

“We want to get an architect to assess the building’s viability,” said Supervisor Linda Langston, D-Cedar Rapids. “Is it worth it to invest anything in this building?”

Langston said all options are open, including demolition all or part of the 128,000-square-foot facility, opened in the early 1970s. Total demolition would be accompanied by plans for a smaller replacement, Langston said.

Supervisors also reduced the rent Abbe pays for the center at 1860 County Home Rd., Marion, from $284,000 to $1 for the year ending next June 30, with a corresponding cut in maintenance.

The changes began last year as the county scrambled to cut costs in response to an unexpected $5.3 million MHDD deficit. Two weeks ago Abbe had 88 residents where 125 lived a year ago.

Licensed for up to 280, the center reached its maximum population of 218 in 1999, Strellner said.

The decline since then reflects long-term national changes, and some factors unique to Iowa.

“We’ve been decreasing the facility naturally for some time,” Strellner said. “Mostly because there are more opportunities in the community for people to live, and because we’ve adopted some treatment-oriented methods that enable people to live in the community.”

Moving MHDD patients from large residential facilities into smaller neighborhood group homes has occurred across the country over the past few decades. The smaller homes’ advantages, including a less institutional atmosphere often closer to family members, make them the preferred setting for Medicaid, which pays a higher share of their residents’ costs.

Abbe’s changes include a corresponding reduction in staff, down 24 full-time workers from last year’s 87. Strellner said some of the workers have followed residents, providing care and supervision in group homes.

Abbe has opened three group homes in Manchester and two in Marion, each with four or five residents. There’s also a 14-unit complex in Cedar Rapids, where Abbe will open two smaller homes next month, Strellner said.

Medicaid’s preference for small-group homes leaves counties and states to fund most of the costs of residential facilities. Strellner wants to make sure the pressure to control costs doesn’t force patients into more independent settings before they’re ready.

“Previously, the reason people moved was purely clinical,” he said. “Now, it can be for financial needs.”

Iowa counties and their non-profit contractors are also trying to keep up with the state’s reorganization of MHDD services. In response to legislation passed earlier this year, counties are planning new regional service-delivery agencies to provide uniform services while controlling administrative costs.

County supervisors and MHDD administrators from seven northeast Iowa counties – Linn, Benton, Delaware, Dubuque, Iowa,  Jones,  and Johnson – have begun meeting to decide whether to form such a region. Part of that includes figuring out how their own residential facilities would fit into such an arrangement.

“That will be something we have to talk about within the region,” said Benton County Social Services Director Mary Williams. “We’re waiting for rules from the state.”

It’s common for residential facilities to serve patients from other counties – Strellner said 45 of Abbe Center’s 88 residents are from Linn County – as families seek care in counties offering specialized services or higher levels of care. With uniform services a state priority, that may change.

“They recognize the service system delivery model is going to be different,” said Kristen Artley, Johnson County’s director of mental health and disability services. The county contracts with Chatham Oaks in Iowa City for residential services, and “their board of directors is reviewing options,” said Artley.

Artley said the University of Iowa contributes to Chatham Oaks’ patient census. Many patients transition through Chatham Oaks after more intensive treatment at the university’s hospital and clinics.

On Oct. 25, Hillcrest Family Services took title of its namesake facility from Dubuque County. Hillcrest, on the west end of Dubuque, held 48 patients last week, said chief operating officer Julie Heiderscheit.

“We’re focusing on providing the best level of care for the clients, maximizing their skills so they can get back into the community,” Heiderscheit said. “Our feeling is there’s always going to be a need for some type of residential facility.”

Strellner agrees.

“Where do residential treatment facilities like ours fit?” he said. “That’s the question we’re trying to find the answer to.”