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Fri September 27, 2013
Budget cuts, uncertainty force residential care facility to close
One week before the Abbe Center’s scheduled closing, Brandie Anderson came to pack up a van with her mother’s belongings, destined for the nearby Penn Center.
“It was just nice to know she was here, I think this was the safest place for her. My mom just wasn’t a number or a resident, she was a person here,” Anderson said.
On Monday, one of Iowa’s largest residential care facilities for people with mental illness will shut its doors for good. The Abbe Center for Community Care in Linn County had the capacity to house 216 people at a time, and was in operation for 37 years.
After announcing the center’s closure on July 31, Abbe staff had two months to find placements for their residents in facilities around the state. Anderson says her mother will be separated from the friends she made during her time here.
“They had their own community here,” Anderson said.
UNCERTAINTY OF STATEWIDE CHANGES
Mental health services are undergoing a major restructuring in Iowa, and officials at Abbe say it’s played a partial role in the Center’s sudden closure.
“I don’t think that people realized that by redesigning the mental system, that facilities like this would close,” said Dan Strellner, president of the Abbe Inc. network. He said that as mental health services transition to a regional model, it’s not yet clear how that will work for facilities like the Abbe Center.
“There’s still a lot of uncertainty over what regions are going to pay for and what they’re not,” Strellner said. “We used all reserves over 18 to 24 months to continue operations, thinking regionalization would help determine where RCF’s (Residential Care Facilities) fit.”
Strellner says the Abbe Center had hoped to slowly downsize to fit the state’s new funding model. But they didn’t have the funds for that after Governor Terry Branstad’s veto of $13 million for county based mental health services.
Mechelle Dhondt, Director of Linn County’s Mental Health and Developmental Disability Services (MHDD), disagrees.
“Redesign is being blamed for a lot of things, but redesign has barely started. Redesign can’t be blamed for much of anything because they haven’t been running long enough to be responsible,” Dhondt said.
A SHRINKING RESIDENT POPULATION
Abbe’s financial difficulties began two years ago, when budget woes forced Linn County to begin to refer fewer patients to their facility.
In Iowa, Medicaid does not reimburse the cost of care if a mental health patient is sent to a residential care facility with more than sixteen beds—a provision intended to discourage placing the mentally ill in large institutions. Linn County used to cover the cost of referring patients to Abbe, until the County faced a 5.3 million dollar budget shortfall for mental health spending in 2011. Strellner says Abbe’s population dropped dramatically.
“Those referrals went down from one a month, from 15. Which means a much smaller daily census, and a loss financially that we just couldn’t recover from,” he said.
The county’s MHDD office makes those referrals. Director Mechelle Dhondt says moving to a model that includes smaller, community based homes is better for patients in the long run.
“A lot of it is the fear of moving in the first place. Once someone has moved, doesn’t take long at all for adjustment to occur. “When they actually make that move, it has been such a success,” Dhondt said.
ABBE STAFF SAY GOODBYE
One of the first things one walks through at the Abbe Center is the indoor garden—a high-ceilinged atrium full of potted plants, ferns, and flowers.
They’ve been tended by Wilbur Collins for more than a decade. The week before the center’s closing, he began the painful process of clearing them out. But he was happy to give a tour.
“We never spent actually spent a lot of money,” Collins said. “We got cuttings, and once I got a geranium or some plant that had some size on it I’d get cuttings and start more of ‘em.”
He points out hanging baskets of pink flowers—bougainvilleas.
“I think I gave five dollars apiece for them at Walmart, years ago,” Collins said. “But I knew what they were and what they could do.”
Down the hall, in an office filled with moving boxes, the Abbe Center’s Activity Coordinator, Rich Keenan, looks through old photographs. They were taken during his 32 years working here—camping trips, outings, holiday celebrations.
“You have these moments where suddenly the closing hits you,” Keenan said.
The Abbe Center was more than a career for Keenan; it was a family. He met his wife here, a nurse who coordinated intakes.
“We really worked to have a quality program here,” Keenan said, referring to the calendar of activities he kept jam-packed throughout the years. “Hopefully we were kind of a model of treatment to other people.”
Keenan says in the past two months, he’s spent a lot of time reassuring clients that they’ll be cared for in their new residences. At the same time, he and the other staff have been looking for work.
“There’s not a lot out there. I’m actually thinking about switching gears,” Keenan said. “I have to reassure myself I’ll be ok, too.”