Inebriate Care Helps Saves Money

April 30, 2004
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GRAND RAPIDS — Over the past 19 months the Public Inebriate Shelter at Mel Trotter Ministries has not only provided humane care for public inebriates in the core city, but has saved the community nearly $2 million in traditional emergency room costs.

Since its inception Aug. 21, 2002, the program has been providing inebriates with a safe environment for recovery, along with medical supervision, meals, clothing and substance abuse treatment referrals.

The shelter ministers to the “hardest cases” — the intoxicated individuals that pass out on the street and are vulnerable to predators or at risk of being injured or of dying from exposure. Those individuals typically don’t belong in a hospital and don’t belong in a detox facility because they don’t want treatment. They just need a safe place to sleep it off.

Previously, ambulance or police personnel took those individuals to a hospital emergency room for tests and observation, where inebriates stayed until they sobered up. Hospitals have had to absorb those costs, and ambulance services have ended up writing off a large share of the costs, as well, because most often the individuals don’t have insurance.

Ambulance attendants or police officers are now able to pick up those individuals, drop them off at the inebriate shelter and be on their way, said William Merchut, assistant executive director of Mel Trotter.

Between August 2002 and this past April, the program recorded more than 1,300 visits, some of which were repeat visits, Merchut said. He estimates the inebriate shelter cares for about four people a day on average and that the average visit lasts about eight hours.

“We figure that if it’s an overnight stay, the emergency room cost for that diagnostic group would be about $1,808 per visit,” he said. “If it were an outpatient stay of less than eight hours, it would be $387. We are staying at about $289 per visit.

“For an inpatient, overnight stay we’re saving $1,979,000. If all of the services were outpatient, we’re saving the community $127,600.”

The inebriate shelter is manned around the clock by at least one of the mission’s medical personnel — a registered nurse, a paramedic or emergency medical technician.

Initially there was some difficulty maintaining 24-hour-a-day staffing, Merchut noted, but that issue has since been worked out.

It costs the mission approximately $240,000 annually to run the program, Merchut noted. This year the program is being funded with donations from Kent County Community Mental Health, Saint Mary’s Mercy Medical Center, Spectrum Health, the Downtown Improvement District and a few private donors.

Though several public agencies support the inebriate shelter via their involvement, they don’t offer monetary support.

“We’re really looking for additional people to come on board because a large part of that expense we can’t cover under our budget,” Merchut said.

As far as the community in general, the inebriate shelter cuts down on a lot of ambulance expenses and hospital stays, a cost that comes out of everybody’s pocket in the long run, said Officer Amanda Linklater of the Grand Rapids Police Department (GRPD).

“As far as the police department, it’s given us an option other than the hospital, which was the only option we had for a long time. We don’t have to wait for an ambulance to take them to the hospital or wait around at the hospital to make sure they’re OK, so it has freed up our time somewhat.”

Brian Buller, M.D., former director of the ER and vice chief of staff at Saint Mary’s, said the program has had an impact on the emergency room and the patients themselves.

“We literally have space issues when we have a lot of people that are intoxicated. We sometimes have to just leave them in the hallways and here they are, intoxicated in full view of the public.

“If these people could see what they’re like when they’re intoxicated, it would be very embarrassing to them.”

Inebriates are there just to sober up and their behavior in the ER is often disruptive and, as far as Buller is concerned, often disrespectful to other patients who are there for treatment.

“The program at Mel Trotter is definitely much more appropriate,” he said. “Alcoholism is a terrible disease and it needs to be recognized. If we can accept that, we know there are programs that will help not only with detoxification but also with recovery.”

Dale McNinch, M.D., attending ER physician at Spectrum Health’s Butterworth campus and volunteer medical director for the inebriate shelter, said the program is a positive reflection on the Grand Rapids community.

“I think it’s tremendous that we’ve been able to change the way inebriates are treated and taken care of,” he said.

Twenty-five years ago public inebriates were jailed. Then a law was passed and they had to be sent to the hospital, he explained. As he sees it, the program serves a very key network between GRPD, EMS and the hospitals in the area.

“I am just amazed at the teamwork between the different agencies in town, and I think it’s a real tribute to Grand Rapids. Their teamwork has allowed this to happen. I think the impact has been great and will continue to be even greater in the future. What we need is continued support from the community to provide funding assistance.”

Word about the shelter has gotten around on the street.

Merchut said when some of the men on the street “see one of their own down,” they will pick them up and bring them to the shelter themselves.

“We have everyday citizens who see somebody down or passed out in a doorway and they bring them here, too.”

Treatment isn’t forced on individuals, but they are made aware that it’s available for the asking.

Only a handful of public inebriates have actually chosen to go into treatment, said Sandra Enders, development assistant for Mel Trotter.

“But when they come here, at the very least they end up leaving here clean, fed, with clean clothing and a little more dignity than they would have had if they had slept in a doorway.”

Every person brought to the shelter is offered the opportunity to enter a substance abuse program, said Executive Director Thomas Meyers.

“While we wish more people would make that choice, we’re going to keep offering it every time they come in.”     

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