AUBURN - With its new mental health care unit, Auburn Memorial Hospital adds another chapter to its turnaround story.

Next month, AMH will hold an open house to showcase its updated and relocated 14-bed inpatient facility, which was previously housed in a separate building at 146 North St. The upgrade is the latest in a string of service improvements and program expansions at the hospital, which include revamped maternity and orthopedic services, along with a new ear, nose and throat department.

But while the hospital is excited about its modern Center for Behavioral Health, the new unit comes with continued concerns from some residents in the community about the quality of mental health care the hospital has provided in the past and what Cayuga County residents can expect for the future.

The new unit, which cost $1 million, was funded by the state and by local foundations, said Chief Operating Officer Rosalyn McCormick.

One major change the hospital is working toward is getting permission from the state Office of Mental Health to provide geropsychiatric care within the inpatient unit, she said. Geropsychiatry refers to a behavioral health care in which clinical staff with special training can diagnose and treat mental health disorders that occur in adults 55 and older while caring for the coexisting medical illnesses of the patient.

However, some advocates for recipients of mental health care as well as mental health care consumers within Cayuga County are worried that the lucrative reimbursements from geropsychiatric care may get priority.

“I'm concerned about that (unit) just being for adults and geriatric issues rather than young adults and middle-aged people with mental illness needs,” said Marion Cool, who serves on the mental health subcommittee of the Cayuga County Community Services Board, which is charged by state law with formulating mental health care planning for the county. She was not speaking behalf on behalf of the board.

The concerns also stem from a recent history of state

violations cited against the hospital's mental health care unit, as well as what some advocates and clients feel is a lack of communication from the hospital.

Another phase

of the turnaround

Besides being able to provide more specialized care to people 55 and older, the hospital is looking for a way to make money on a unit that has been draining its finances for the past five years.

The average daily census from August 2006 to August 2008 was 6.7 filled beds, McCormick said. The geropsychiatric track will hopefully help fill beds as well as net the hospital more government health insurance reimbursement.

“Our intention is to fill our beds. ... We need to make money to keep the unit going. Our intention is to fill our beds with whatever patient we get, as long as they're an adult patient. Whether they're over 55 or under 55, that's our goal,” McCormick said. “The hospital looks at opportunities to make money. This is one way to at least make some money to sustain the services.”

The hospital has lost nearly $1 million in recent years because the beds are not being filled, said John Baran, chief financial officer.

Rebekah Gagne, a member of the mental health subcommittee and a recipient of mental health services in Cayuga County, understands the hospital's need for filling the beds. She is not as concerned with the hospital providing geropsychiatric care as much as the reimbursement system that's classifying geropsychiatric care as a service for people 55 and older, she said.

“That's a pretty low number and that can classify a lot of people. When I hear geriatrics, I think like 70, 80 and above. The general concept of geriatrics is not 55. So, I don't see that the care will change but I think the priority would change at the hospital level, not at the community level,” she said.

Because dementia is classified as a mental illness, Gagne, who was not speaking on behalf of the subcommittee, believes the hospital would admit a person 55 or older into the inpatient facility under the geropsychiatric track, once the state approves it.

“I just have a hard time seeing how they can do that,” she said. “If the person is in a decent nursing home, they should be able to take care of somebody with dementia. No matter where you put somebody who has dementia, the only thing you can do is give them meds.”

Geriatric care should not be for someone 55 and older, said Arleen Egry, who is also a consumer of mental health services in Cayuga County. Egry, who used to chair the mental health subcommittee as well as serve on the Community Services Board, is 57 and does not see herself as a geriatric. She does not believe she would do well in a setting with someone who has dementia. However, she believes people with dementia should receive services because the inpatient unit needs to cover all aspects of psychiatric care.

Although Egry is not opposed to the hospital providing geropsychiatric care in the new unit, she is worried about the hospital marketing it to places outside of Cayuga County.

“There's a big need in Cayuga County,” Egry said. “Are they in it for the money or are they in it to help people, individuals, serve themselves?”

But McCormick said the hospital's plan to get state approval for a geriatric track will not have a negative impact on the rest of the services provided in the Center for Behavioral Health.

“I think it's going to improve the care of the patients in Cayuga County because those who are over 55 are going to get the specialized care they need with their medical concerns as well, and the other patients who are under 55 are going to be getting the care they need also,” she said.

Dealing with past performance issues

In addition to getting the new unit ready and trying to get authorization for the geropsychiatric track, the hospital is addressing violations cited by the state Office of Mental Health in the recent past.

During an inspection conducted in March, the facility was cited for not admitting more than 120 patients who were referred to the unit by other health-care professionals between June 2007 and March 2008.

According to the state report, 41 referrals were refused admissions, 41 referrals did not contain documentation regarding disposition and 40 referrals documented dispositions of the recipient being placed in another facility.

That track record is fueling some of the concerns advocates and consumers have about local residents getting access to care in the future, especially if beds are being marketed outside the area for potential geropsychiatric patients.

The hospital was also cited in the same report for numerous violations pertaining to the building conditions of the mental health unit.

McCormick acknowledged the hospital had a shortage of staff that resulted in some problems, but it has since addressed the issue.

“I think we are looking at that process... we did have a shortage of psychiatrists which now, we have been able to recruit,” she said.

A psychiatrist is the one who determines if a patient should be admitted to the unit and those who were present during the period violations were issued are no longer at the hospital.

Auburn Memorial Hospital also recently hired a new chief medical officer, Dr. James Blute, who oversees quality control.

“Whatever was happening before isn't happening now,” McCormick said.

Relocating the inpatient facility will address the environmental and physical concerns, said Katharine O'Connell, interim director of the county Community Services Board.

“The good news in the community is that there's a brand, spanking-new inpatient unit that is absolutely in compliance with regulations,” she said.

“They've followed all the safety measures that are important and required in an inpatient unit,” O'Connell added. “I think for the community, it's actually a good thing that there's a brand-new, current, compliant and contemporary inpatient unit. ... I think that's a good thing and the hospital should be applauded.”

Another concern cited by the state has been the hospital's coordination with outpatient providers, especially concerning patients discharged from the AMH inpatient unit.

As for those patient care procedures and handling of cases, O'Connell said she started to discuss these issues with the hospital fairly recently and hopes they will be addressed fairly quickly.

“There are lot of systems issues in terms of mental health delivery in the community and the hospital's inpatient as well as the hospital's emergency room are part of the system of care,” she said. “There are issues that all of us need to address, our response when people are discharged as well as the way people are discharged, and the way people are admitted or not.”

Seeking an active voice in the process

A major worry for Egry was her feeling that she was being excluded from the planning of the hospital's new unit, she said.

Egry said she raised this question during October's Mental Health Subcommittee meeting. McCormick, who was present at the meeting, indicated that advocates for consumers were consulted.

But that answer is not good enough for Egry.

“Nobody needs to speak for us. I mean, sorry, just because we have mental illnesses doesn't mean that we can't speak for ourselves,” she said.

She said something as simple as the color of the walls could make a difference to mental health care clients, so it makes sense to ask for their opinions.

“It's very important because it shouldn't look like a hospital setting,” she said. “They want the community to support them yet they don't want the community's input.”

She believes the open house event will show off the bells and whistles of the facility, which is not where the focus should be, she said.

“To me, it's about the care that you give the individuals while there. It's like it's going to be a showcase. That really bothers me,” Egry said.

However, Auburn Memorial Hospital said it is also working on improving services within its inpatient facility.

It has hired Behavioral Health Concepts, a consulting firm helping AMH develop policies and procedures for the new unit.

Last week, the hospital also hired Lisa McCarthy as a community liaison manager to educate and inform the community about services provided by the Center for Behavioral Health.

And while Auburn Memorial Hospital is not legally obligated to follow suggestions made by members of the Community Services Board or the Mental Health Subcommittee, McCormick said those who have concerns are encouraged to reach out to the hospital.

But until the unit opens, Egry said, it will be difficult to know exactly what changes need to be made.

At that point, it will be crucial for the hospital to listen to what consumers are saying, Egry said.

Overall, O'Connell is optimistic that with time, the various issues surrounding the inpatient facility can be resolved and that mental health care in Cayuga County will be seeing substantial improvement.

“There's a lot of history here,” O'Connell said.

She also said it's important not to dwell to much on the past problems.

“I don't want to go backwards,” she said. “My inclination and my style is to work forward and if there are issues tomorrow or the next day, I think it's incumbent on all of us to make sure then that the system is as seamless as possible and that the highest quality (exists), in terms of its response to mental health needs of the community.”

Staff writer Gitana Mirochnik can be reached at 253-5311 ext. 237 or gitana.mirochnik@lee.net