Windham County Delegation Statement on Retreat

The Windham County Delegation has been aware of ongoing financial challenges being experienced by the Brattleboro Retreat related to multi-year, inadequate medicaid reimbursements, unexpected census declines, and the increasing cost of contract RNs and MDs due to national and state-wide workforce shortages.

The Brattleboro Retreat is a 150 year old private mental healthcare institution providing quality, compassionate healthcare to the most vulnerable Vermonters.

As we see play out every day across the country and our state, adequate funding for public healthcare remains an unsolved challenge.

Since Tropical Storm Irene, the Retreat has served as a contracted arm of the Agency of Human Services in the provision of state mental healthcare services. This means the Retreat has repeatedly been faced with decision making that requires it prioritize the public good over profit.

Today over 50% of all of Vermont’s inpatient psychiatric treatment beds, 100% of Vermont’s child/teen treatment beds and 150 HUB suboxone treatment slots are a part of the Retreat’s operations.

The Windham County delegation is proud our region is home to such compassionate care for so many vulnerable Vermonters. We support the decisions the Retreat has made to answer the Agency of Human Services repeated requests to expand its state beds and services in order to help the State of Vermont provide mental healthcare to Vermonters in the most acute need.

To say we are disappointed by Secretary Smith’s public statement issued today is an understatement. We have no doubt that the State of Vermont will continue to work, responsibly, in partnership with the Retreat to continue to provide care for all patients. We will work diligently with the Scott Administration and the Retreat to ensure that is the case.

Representative Mollie Burke

Brattleboro

Representative Emilie Kornheiser

Brattleboro

Representative Tristan Toleno

Brattleboro

Representative Laura Sibilia
Dover

Representative Nader Hashim

Dummerston

Comments | 5

  • my 1.5 cents

    “multi-year, inadequate medicaid reimbursements, unexpected census declines, and the increasing cost of contract RNs and MDs due to national and state-wide workforce shortages.”

    The first one, ‘multi-year, inadequate medicaid reimbursements,’ seems to mean a money shortage.

    The second, ‘unexpected census declines,’ makes little sense to me. Vermont has long talked of a changing population and census declines. More specifically to the Retreat, the need for mental health care seems to be increasing, not decreasing. One would think there would be no shortage of potential patients. I’ve heard rumors that the Retreat turns some patients away. Perhaps the problem is there is a shortage of patients able to afford to pay properly. Money again?

    The third, ‘ increasing cost of contract RNs and MDs due to national and state-wide workforce shortages,’ is again a money issue. This might be turned into an opportunity if the Retreat added a teaching and accreditation program to train mental health RNs – creating income and RNs.

    Money is linked to all three reasons. As the delegation notes, it has forced decisions favoring profits over public good.

    Two options suggested by the state are to close or to sell.

    It is quite a collection of spaces to sell. There’s a gym, a stage, kitchens, bedrooms, tunnels and more. (Will the Tower be part of the sale?)

    Closing would certainly change the dynamic of Brattleboro. It would end the mental health era here. A lot of good people would lose their jobs, and might move away. It would free up a lot of downtown property and buildings for new purposes. A developer might swoop. Eco-elder housing? Multi-use retail residential living?

    Selling it to a bigger hedge fund/health care system might keep the jobs going and the services available. A bigger owner would probably be interested in slashing costs somehow. They might also be interested in building new facilities that are more efficient and might not be nostalgic about the current campus look and feel.

    Have the employees considered making an offer? I would bet that if the people working there owned it, it could be rejuvenated in the spirit of the public good rather than profits. Is there a cooperative model that could apply? Maybe the state could help locals finance it.

    I suppose another sale possibility might be to an entity in need of a campus. Would a college want it? This type of sale would mean a change-over in jobs, from one profession to another, plus all the staff and maintenance that goes along with it.

    Much to ponder…

    • Retreat Issues

      It is sad to hear such a sanitized response from the legislative delegation. It looks like they have not made an effort to look at how the Retreat is being run. It is always considered sacred territory and even local legislators tread lightly when it comes to issues of questionable management practices. From what I have been able to learn, issues the Retreat is facing go beyond the Medicaid reimbursement.

  • More retreating

    I heard the discussion on VPR today about the Retreat, featuring their president/CEO. Closing seems to be off the table for now, as is selling.

    The new approach is a four step plan of consultants, evaluations, oversight, and an attempt to streamline admissions.

    To me, it seems like they’ll end up reorganizing staff and services, and probably look at streamlining other costs.

    There was talk of saving special programs, and a need to rework admissions, but I didn’t hear much about the current turning away of patients. There were a few call ins/ commentators who questioned whether there was a mental health system here worth saving, describing frustrations with getting in and then back out of care.

    I hear a Retreat staff person call in to say he felt patients shouldn’t be able to refuse medication. His boss disagreed.

  • A former Retreat nurse: Her viewpoint

    My sister just recently left the Retreat to work elsewhere, and sent the following to several local news outlets. It was published in the Reformer and the Commons.

    http://www.commonsnews.org/site/sitenext/story.php?articleno=31700

    The news of the Retreat’s financial situation is deeply concerning, but not a surprise to those of us who work (or worked) there. I was a nurse there for 10 years before I felt compelled to resign due to changes to the patient care environment enacted by the current administration. I was relieved when (Vermont) Secretary (of Human Services) Smith finally called them out and brought some of the troubles into the light. But some issues still remain in the shadows.

    (Retreat president and CEO) Dr. Josephson cites low census as one of the primary issues causing financial difficulties. As Secretary Smith pointed out, this is specific to the Retreat. I can tell you from personal experience that census is down because patients do not want to go to the Retreat. In my last year at the Retreat I heard more and more patients saying, “When I was in the emergency room I begged them to send me anywhere but here; they sent me here anyway.” Not all of them get sent there anyway; more and more are successfully going elsewhere. Now that I am working at another psych facility, I hear more of the same, but the patients are relieved to have not gone to the Retreat.

    The reasons for this are changes to the patient environment which I feel are getting perilously close to inhumane. The bathrooms are all locked and patients must ask a staff person to open the door so that they can use one. Access to food has been restricted as much as possible. On some floors that means a patient must ask a staff person for a simple drink of water. Shower curtains were removed from all the bathrooms that had them and no other form of privacy was offered in their place. As one patient noted, “This is worse than jail.” There is no excuse for this form of treatment and it is not “industry standard” as (Chief Nursing Officer) Meghan Baston likes to state.

    Dr. Josephson points to the nursing shortage as the reason for needing to hire contract or “travel” nurses. The lack of staff at the Retreat is a direct result of this administration. Many staff who had been there for decades appeared to be targeted and were disciplined for minor or imaginary infractions until they gave in and quit. The overall attitude of this administration towards all direct patient care staff, be they doctors, social workers, nurses, or other support staff appears to be one of disdain and disrespect or outright aggression. Staff are leaving in droves. This past year about 150 direct care staff left the Retreat. The number of contract workers has steadily increased, each of which costs 2 to 3 times as much as a regular staff worker.

    I hope an investigation will be carried out. As part of it I hope that the few remaining staff will be asked for their opinions. I hope that patients and patient advocates will asked their opinions. The administration and the board of the Retreat are clearly incompetent and the top heavy, overpaid administration there needs a major overhaul if the Retreat is to be saved.

    Eileen J. Glover, RN

    Brattleboro, Jan. 9

    • Thanks!

      That sounds a bit more realistic to me. There is no shortage of people who need help, and lots of people who want to help them, but something gets in the way. Hmm…

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