Dementia patients fill Western State's wards

Western State Hospital may be best known for treating people with mental illnesses such as schizophrenia. In recent years, however, it's become a sort of last stop for people with advanced dementia.

They, like Johanna Pratt, arrive at the hospital ostensibly for short-term stays, yet they get stuck there because there is no place else for them to go.

But now the price for keeping the dementia patients at Western State has gotten a lot higher. In August, the federal government stopped paying for their long-term care on the psychiatric ward. Just as the state is facing a huge budget shortfall, Western State has to come up with an additional $4 million a year to continue housing these patients.

A growing need

Caring for the occasional advanced-dementia patient has been part of Western State's job for decades, said Richard Kellogg, director of the state Mental Health Division.

Increasingly, though, dementia patients have filled entire wards. When Medicaid and Medicare funding was cut, Western State had about 60 such patients. The growth, explained Doug Porter, assistant secretary for the Health and Recovery Services Administration, coincides with the aging of the baby boomers.

Most of the dementia patients are on Medicare or Medicaid, so the federal government covered about half the cost of their psychiatric hospitalization. Those programs are administered by the Centers for Medicare and Medicaid Services (CMS).

"Previously, if there were two or three (advanced dementia) patients on a ward, it was no big deal," Porter said. "CMS is now taking a hard line."

While the state disagrees with the funding cutoff, Kellogg said he can't argue with the reasoning.

Legally, there is considerable case law — as well as constitutional protections — saying that people can't be held in psychiatric hospitals unless there's evidence that they are being treated and that the treatment can improve their condition.

The problem is that people with advanced dementia often are unable to participate in treatment. If they are able, they can't benefit from it because they simply can't recall things from one day to the next.

The hospital can't discharge them because many facilities won't accept them.

Most arrive at Western State after living in nursing homes or assisted-living facilities. Often, Kellogg said, they have "significant" behavior problems, including assaulting caregivers or acting out sexually.

Safety issues in care

If their behavior escalates to a point that the nursing home is unable to safely care for them, they can be civilly committed to Western State. In these cases, the hospital still can get federal money to deal with immediate issues, such as medication adjustments. But after that, the feds won't pay.

State officials are working on possible solutions that might involve increased rates for nursing homes willing to accept these patients.