Minnesota Department of Human Services (DHS) Commissioner Emily Johnson Piper is calling for changes at Anoka-Metro Regional Treatment Center. After an April 26 visit, she said the center needs more beds for Minnesotans waiting for treatment. It also needs security improvements and more nursing staff. To make those changes the center needs financial help from the 2016 Minnesota Legislature.
Piper’s visit was meant to highlight problems and encourage action by state lawmakers, in the form of a $30.3 million package of facility improvements. She participated in a roundtable discussion with representatives from Minnesota Hospital Association, legislators, community partners, advocates and patients. She also met privately with employees to hear their concerns.
“Addressing patient care and employee safety at Anoka-Metro Regional Treatment Center has been my focus from Day One,” Piper said. “I want legislators to understand how critical the needs are as they consider this year’s budget proposals in the final weeks of session. We absolutely must repair this part of the safety net so people can get the care they need.”
Anoka-Metro Regional Treatment Center provides inpatient psychiatric care for people going through severe mental health crises. Employees, mental health advocates and family members of patients contend that Anoka-Metro lacks needed staff and facility resources to handle patients whose behavior has grown increasingly volatile. These patients exhibit behaviors that endanger them, other patients and employees. Injuries to staff and patients, high employee turnover, and increased overtime pay are among issues cited at Anoka-Metro.
Anoka-Metro patients sometimes wait for a long time for community placements to open for them. The longer they stay at the facility, the longer patients in hospitals and other settings must wait for beds at Anoka-Metro. Counties bear the $1,309-per-day cost for each patient who no longer requires hospital care. Piper said the DHS is close to finalizing a systems improvement agreement with federal regulators. The agreement is likely to allow the state to continue billing for services that qualify for Medicare or Medicaid reimbursement.
Some of the problems at Anoka-Metro, and other state facilities stem from a 2013 law meant to alleviate the problems of people with mental illness staying in county jails. This law is known as the 48-rule. If a judge determines that a jail inmate is mentally ill, state law requires that the person shall be placed in a psychiatric bed. Advocates contend the law has pushed Anoka-Metro and other facilities to the breaking point.
Gov. Mark Dayton has asked legislators to approve a $177.3 million package of improvements for state hospitals and mental health facilities, including $30.3 million for Anoka-Metro Regional Treatment Center and community behavioral health hospitals statewide and $55 million to stabilize direct care and treatment services across Minnesota.
Part of his proposal is to create a secure, standalone Competency Restoration Program to treat people accused of crimes who are found incompetent to stand trial. Moving these patients out of Anoka-
Metro would free approximately 20 beds. The recommendation also includes bonding for improvements to the Anoka-Metro hospital, including cameras, personal duress alarms and new and renovated courtyards to provide calm, secure spaces.
Anoka-Metro has been riddled with problems in recent years, including complaints of safety and patient care lapses. The same day as Piper’s visit, the federal Centers for Medicare and Medicaid Services (CMS) and the state announced that they had reached an agreement to continue working together. Anoka-Metro could have lost millions of dollars in federal government insurance dollars for the 110-bed hospital, had an agreement not been reached.
Federal oversight of the hospital will continue through May 2018. State officials must develop a detailed plan to address problems. An independent consultant will conduct a comprehensive analysis of Anoka-Metro operations.
CMS officials visited Anoka-Metro in 2015 and warned state officials that if problems weren’t rectified, the state couldn’t bill the federal government for services. CMS raised concerns about the need to treat complex conditions and tailor treatment for individual patients. Red flags were also raised about staff training, use of restraints and other practices.
DHS has made progress in hiring staff at Anoka-Metro Regional Treatment Center, according to Piper. A job fair in Anoka-Metro in February attracted more than 300 applicants, filling more than 50 positions.
Mandated overtime and employee injuries are down so far this year compared with 2015.