Demand up for inpatient psychiatric services

October 20, 2008
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Three local hospitals are moving ahead with bids to add capacity for inpatient psychiatric services, while one community hospital has left that line of business behind.

Allegan General Hospital announced last month that it would no longer maintain its nine-bed psychiatric unit as of Oct. 1. The 25-bed hospital also is in the process of closing its obstetrics department, sending Allegan mothers to Grand Rapids, Holland or Kalamazoo. Last year, Allegan General had 205 baby deliveries.

Plans to expand adult inpatient services at Pine Rest Christian Mental Health Services in Cutlerville, provided under the auspices of Saint Mary's Health Care, gained approval in September from the local health care planning agency Alliance for Health.

Forest View Psychiatric Hospital submitted two requests. One, like the Saint Mary's-Pine Rest bid, seeks additional beds under regulations aimed at facilities experiencing high occupancy rates. The other request is for two additional beds under general rules.

At both Pine Rest and Forest View, new wings would be constructed to accommodate the new beds.

Holland Hospital is seeking four additional psychiatric beds under high occupancy rules and already has space for them in the newly renovated sixth floor, which will be unveiled at a 4-7 p.m. Oct. 21 open house for the public.

The loss of the Allegan General beds bolsters the proposals from Holland Hospital and Forest View, said Alliance for Health President Lody Zwarensteyn. He said the flurry of expansion requests from psychiatric facilities appears to be based on demand.

Changes to Certificate of Need regulations earlier this year introduced the opportunity for organizations to add psychiatric beds based on high occupancy, in addition to the bed need designated for each of eight health service areas in the state. High occupancy is defined as 85 percent occupancy over a two-year period.

Holland Hospital is leaving behind space on the second floor for a unit specially designed for psychiatric services, said Dr. James Dumerhauf, a psychiatrist and medical director for the unit. The unit has plumbing and windows designed to prevent tampering, occupational therapy rooms and classrooms, and offers an area for sensory integration treatment, which is used to calm agitated patients.

"Care has changed, and some of the things that we're doing recognize that we're a multi-disciplined specialty," Dumerhauf said.

Back in the 1990s, the Holland psychiatric unit had 20 beds, but that was reduced over time, Dumerhauf said. Now the Ottawa County population has grown, he said.

"Over time, at least in the five or six years that I've worked on the inpatient side, we've had difficulty with there being times where we're at capacity, there are patients in our emergency room who need inpatient care, and we're having to transfer them out of town," Dumerhauf said. "That creates burden on them; it creates a burden on their family."

Family involvement has become more important as lengths of stay have become shorter and more recovery time is spent back at home, he said. Patients who previously have used Allegan General's services now are likely to be split between Grand Rapids, Holland and Kalamazoo, as each are about equidistant to Allegan, he added.

The average length of stay is six days, said Sherry Oegema, administrative director for behavior health services. "Usually people are at risk for harming themselves or someone else due to a psychiatric illness, or someone might be psychotic and not able to adequately care for themselves," she explained.

As an acute care hospital, Holland Hospital's psychiatric unit can handle patients who may arrive with a physical illness as well, Oegema added.

"We've turned away a lot of patients, or we have placed them in other hospitals. About 23 percent of the people we see in our emergency room who need a psychiatric bed, we are placing somewhere else. We've really had problems keeping up with demand."

Dumerhauf added that having a space designed for psychiatric care will be an improvement, from security and confidentiality measures to pleasant colors to abundant natural light, which can be important for those whose illness has interrupted their sleeping patterns.

Allegan General CEO Jerry Barbini said two staff members were laid off with the closure of the psychiatric unit, which he said was losing money for the hospital. Typical occupancy was five. He said 45 percent of psychiatric inpatients came from outside the hospital's primary and secondary service areas, which cover a population of about 45,000 in the surrounding area.

As a federally designated Critical Access Hospital, the hospital will lose use of those nine beds. But Barbini said Allegan General plans to utilize the space to remodel and offer all private beds.

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