Retirement Housing Proposal
11/21/2008

Intent:

The purpose of Retirement Housing (RH) is four-fold.  1)  To provide Treatment Saturated-Seriously and Persistently Mentally Ill (TS-SPMI) residents a dignified and appropriate living experience.  2) To make available RTF and RTH beds that are presently unavailable due to being occupied by Treatment Saturated SPMI residents.  3)  To provide appropriate cost effective housing and treatment for SPMI residents of Oregon.  4)  To make the residential treatment system active and healthy.

Rationalization:

The quality of life for the TS resident is poor, at best, in a treatment facility.  This resident has to tolerate the repeated requirements of attending groups, therapy sessions and house activities that no longer have any benefit.  They also have to experience the transitory nature of the other residents and the    unstable/unpredictable behaviors that the new residents may bring with them.  Residential treatment facilities/homes are designed, both clinically and structurally, to meet the needs of a treatment receptive resident expected to move to a lower level of care within 1 to 2 years, not as a permanent residence.

We have identified approximately 35.7% of EOHSC’s residential treatment beds as being occupied by TS-SPMI residents.   35.7% represents 35 residential treatment beds in our region – making available 35 beds would significantly reduce congestion at the hospital level of care and bring those beds back into an active roll in the treatment continuum.

By moving these TS-SPMI residents to RH would reduce their average Service Payment and Treatment cost approximately 33.3% this reduced cost is achieved by eliminating treatment, lowering of staffing ratios and reducing non-required services.

The TS-SPMI resident is identified by a resident who has achieved therapeutically a point of diminishing returns and is no longer receptive to treatment due to their baseline functioning level.  The individual who has experienced a major portion of their life living in residential treatment settings and has been exposed to a multitude of treatment modalities and no longer responds to treatment has achieved a “saturation point” of treatment.  This individual can no longer expect any benefits from continued treatment.

This individual has also achieved his/her least restrictive living environment at the level of an RTF/RTH. Also the TS-SMPI resident will continue to require a monitored living environment for the rest of their life and does not have any community support systems that would be able to provide the needed level of care.  A minimum age limit, 50 years old for example, could be one aspect of identification, but with the understanding that there will be “special circumstances” that will warrant a waiver for younger residents.

Design:

The RH will be designed with the knowledge that the individuals that will be living in it will be there for a lifetime.  This would include small apartment style units with kitchenettes that could house one or two residents (similar to an assisted living model).  24-hr staffing would be provided for monitoring and safety reasons.  Meal preparation, medication management, ADL assistance, transportation and recreational activities would be offered.

Summary:

For the SPMI resident that is no longer receptive to treatment living in a structured residential treatment setting is very uncomfortable and anxiety producing.  It is not reasonable for us to expect this resident to live out the remainder of their life in that environment.

The proposed housing would offer an environment for these residents to live with dignity and comfort.  It would “free up” the level of care continuum and increase efficiency throughout all aspects of the residential treatment services in Oregon.  The cost savings would be significant.

By developing this proposed housing AMHD would significantly reduce the hospital over-crowding and the severe acute care issues by having the residential treatment system active and healthy.