Funding pressures force Linn County mental health facility to close

Caregivers debate if new services will emerge to fill need

Rick Smith
Published: August 29 2013 | 5:30 am - Updated: 28 March 2014 | 7:41 pm in
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LINN COUNTY — Linda McKinney thought she had found a safe haven two years ago after losing her job, her condominium and nearly her life to depression.

Now the ground under the 61-year-old is shifting again.

In late July, the staff of the non-profit Abbe Center for Community Care brought together McKinney and the 75 or so other residents of the Linn County-owned, Abbe-operated residential care facility to announce that they would shut down the place and close the doors on Sept. 30.

“All the wind went out of everybody,” McKinney says.

A month later, the emptying is underway.

The close down, in truth, is a last step, however rushed because of funding issues, and it is part of a downsizing that started at the sprawling facility in the late 1990s before accelerating in the face of money issues two years ago.

At present, the Abbe staff is being forced to hustle to find new placements and new homes for the 65 who still remain at the facility on County Home Road, just off Highway 13. Some will go to the 60-or-so resident residential care facilities in Iowa City and Delhi, which are affiliates of Abbe Inc., though these two facilities are not licensed as the Linn County facility is to also provide more intensive mental health care.

Bigger picture

In the bigger picture, though, Mechelle Dhondt, director of Mental Health and Developmental Disability Services in Linn County, Kristen Artley, her counterpart in Johnson County, and Renee Schulte, a state consultant to the Iowa Department of Human Services, all argue that Iowa has had too many people in residential care facilities as has the new, nine-county East Central Region for MHDD services of Linn, Johnson, Dubuque, Delaware, Buchanan, Jones, Benton, Iowa and Bremer counties, they say.

Dan Strellner, president of Abbe Inc., disagrees, bluntly saying, “That hasn’t been assessed.”

Schulte, a former state legislator from Cedar Rapids, concedes that there is a need for new data, which she says is being collected as part of the state’s new regionalization of MHDD services.

The closing of the Linn County facility won’t go unnoticed, and Dhondt, Artley and Schulte say new kinds and levels of residential mental health care in Eastern Iowa are being discussed in earnest and need to emerge. Those would provide the intensive level of residential care for the mentally ill that has been one part of the services offered by the Abbe-managed facility in Linn County.

Dhondt and Artley talk about the creation of small, “subacute” facilities, which Dhondt says would help someone coming out of a hospital psychiatric ward for six to 10 weeks so that they can make the transition to a less-intense level of care.

Crisis centers

Dhondt and Artley also talk about the creation of community crisis centers, which would house people for a short time after a hospital stay and help them secure housing and other community support. Such a center with 16 or fewer beds is open now in Black Hawk County, and Dhondt says Linn County has set aside $80,000 in county funds to create a pilot crisis center here.

At the same time, too, one Abbe Inc.’s affiliates is quickly moving to open three more group homes of three to five residents with mental illness, which will be staffed 24 hours a day. There are eight now in operation in the Cedar Rapids area.

Dhondt and Artley both say they have talked to Abbe Inc. and its affiliates about opening a small, “subacute” facility, but Artley notes that such facilities and crisis centers still need guidelines and regulations provided by the state of Iowa as well as a source of revenue to operate them.

“There are so many unknowns at this point, and folks are doing the best they can to survive in this climate of service system change,” Artley says.

It has come to the end for Abbe’s large Linn County residential care facility, says Abbe’s Strellner, because government funding forces at the federal, state and county levels have decided that it is time for most large residential care facilities to go the way of the old Iowa county homes that places like the Abbe-run Linn County residential program replaced almost 40 years ago.

Strellner and Craig Bradke, Abbe’s administrator at the Linn County facility, report that Linn County opened what is now called the Abbe Center for Community Care in 1976 to replace the county home on the property. In 1987, when Abbe took over the facility’s management for the county, the facility had 212 residents, nearly all from Linn County.

Abbe numbers

As recently as two years ago, the Abbe-managed Linn County facility’s population had declined to 137 residents, with a larger number in the mix from counties in Iowa where residential care facilities had closed, Dhondt said.

Two years ago, too, Linn County had a $5.4 million deficit in its $35 million annual county budget for all of its mental health and developmental disability services, a budget with federal, state and county funds each contributing about a third, Dhondt said.

Counties, said Abbe’s Strellner, began to realize that federal Medicaid dollars available to states could help pay for much of the residential care for those with mental illness, but the Medicaid program comes with a catch: It does not allow its dollars to be spent at facilities with more than 16 beds.

As a result, Dhondt and Strellner say that counties had an incentive to look for options other than large residential care facilities like the Abbe Center for Community Care to provide residential services for the mentally ill.

Of the 65 residents still remaining at the Linn County facility for the last month of its operation, about half are from Linn County. Of the 65, Abbe’s Bradke says about 17 are “very, very difficult to place” because of the acuity of their mental illness and “to a great extent” their history of dealing with the mental illness. Others are difficult to place, he says, because of a combination of acute mental illness and physical problems. Many residents have had substance abuse problems along with mental illness, he said.

In her view, state consultant Schulte says Linn County’s budget deficit for mental health and developmental disabilities two years ago prompted the county to start shifting services away from the large Abbe facility to other “more cost-effective” facilities in the community. And as a result, the large Abbe facility became even less efficient to operate as its population declined, she said.

Transitional services

Even so, Dhondt, Artley and Abbe’s Strellner and Bradke agree that there is a need to provide some kind of “step-down” residential care for those leaving local hospital psychiatric wards as they make a transition back home.

Strellner and Bradke point to this number: In the nine-county East Central Region for MHDD services, “only” nine beds will remain that are licensed as residential care facility beds that provide more intensive help with people with mental illness once the Abbe’s facility in Linn County closes on Sept. 30. Those nine beds are in Dubuque. Nineteen of the Linn County facility’s last 65 residents are now in that more-intensive level of care, Strellner reports.

A month after the revelation that the Abbe-run Linn County facility that Linda McKinney has come to call home is closing, McKinney is optimistic that the Abbe staff members will help find her another place she can call home.

“If I know where I’m going, I’m OK. It’s the not knowing,” she says.

McKinney, who is single, worked most of her life, but she says losing her job in 2009 really hit her hard. At one point, she says she couldn’t make simple decisions like choosing what kind of can of soup to buy at the grocery store. Twice, she says, she tried to commit suicide.

Her two years at the Abbe Center for Community Care have provided her with a supportive community that she says she now realizes is important for her well-being.

“I need somebody around,” McKinney says. “I can never, never be alone again. I know that for a fact.”

Linn County’s Dhondt says most who are leaving the closing facility will be like most who left in 1990s when developmentally disabled residents went into community group homes and like most who have left in the last two years for other places as the facility has continued to downsize.

“The fear is real, and it is there,” Dhondt says of those who previously have left the facility. “… But once they make the move, it’s been incredibly good.”

ABBE CENTER AT A GLANCE

Abbe Center for Community Care, on County Home Road at Highway 13, opened in 1976 to replace the Linn County Home. The non-profit organization, Abbe Inc., took over the management of the Linn County facility in 1987.

The Abbe Center”s board of directors now has decided to close the large facility because counties are not using it as much and it is no longer cost-effective to operate. It will close Sept. 30.

In 1987, the facility had 212 residents, nearly all from Linn County. By the late 1990s, the portion of the population with intellectual and developmental disabilities was moved into community group homes, and the facility’s primary clientele since has been those with mental illness.

Two years ago, the center’s population stood at 137, and it currently is at 65. Half of the residents are from Linn County.

The facility is licensed by the state of Iowa to provide two levels of care. Those receiving more intensive care have stayed an average of 92 days at a cost of $154 a day per resident; the average stay for those in less intensive care has been 190 days at a cost of $112 a day per resident. State supplemental assistance often pays $29.30 a day of the cost. Some residents receive Social Security income, part of which goes to the cost of their stay. However, revenue from local property taxes paid to counties pays much of the cost.

Most of the residents suffer from mental illness, and some also have substance abuse problems and/or physical ailments.

The Linn County facility has 80 full-time, part-time and on-call employees. All will lose their jobs, but some are being hired elsewhere in the mental health field.

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