Home eludes patient - Raleigh News & Observer

Ruth Sheehan, Staff Writer

Phil Wiggins should have been kicked out of his group home in Zebulon a month ago today.
The holdup is that the county cannot find him a place to go.

Wiggins, 62 and schizophrenic, spent 44 years in state psychiatric hospitals until last spring when, under the aegis of mental health reform, he was released into community-based care.

I've been following his journey for nearly a year and a half now. His progress has brought great hope. But there have been setbacks, too. He is on his fifth community-based social worker already. He seems so mild-mannered, but he's tricky and quick -- and more trouble than most folks getting paid $10 an hour want to mess with.

Last month, he tried to set a fire outside the group home with baking soda, cologne and matches pilfered from another resident's room. That's when the eviction notice came to his sister, Louise Jordan, who lives in Raleigh.
Since then, the county has tried, without success, to find another suitable home for Wiggins. Jordan has visited three possibilities.

One, near Hedingham, left her sobbing. The second, on the south side of Raleigh, was neat enough, but it catered to patients who were high-enough functioning that they could cook for themselves.

The third is very nice, located in a typical North Raleigh neighborhood with a park up the street.

But there, as at the second home, the clients are higher-functioning than Wiggins. Several have jobs at sheltered workshops. A couple have notes from their doctors allowing them to stay in the home for up to three hours without supervision.

These are what the advocates refer to as "cream puffs," residents who need assistance but can manage basic self-care fairly well on their own.

Wiggins is no cream puff.

He will wear the same dirty clothing day after day if allowed.

He needs help with personal hygiene.

His pockets need to be searched every time he enters the house.

And then there is his fascination with fire and chemicals. A few weeks ago, the house attendant in Zebulon discovered that Wiggins had poured sugar and vanilla flavoring into one of his drawers with plans to set the mixture on fire.

Now the county is trying to find a day program that will allow Wiggins to attend, so that a personal social worker can be with him from late afternoon until late evening, after he goes to bed. The county needs to find him another worker for the weekends.

And the group home in Zebulon has had to hire an extra person to be on hand, and awake, during the night.

Wiggins wanders, after all. He goes through other residents' belongings. He stashes items that might be interesting to light on fire.

Essentially, Wiggins needs one-on-one care, 24 hours a day. But the community isn't quite ready to provide it.

So much for the supposed economies of community-based care; so much for market forces providing all the care that's needed for the mentally ill in our state.

Mental health reform sounds so simple; real life is far more complicated.

Ruth Sheehan can be reached at 829-4828 or rsheehan@newsobserver.com. Read more!

After Dix, who'll pay for care? - Raliegh N&O

After Dix, who'll pay for care?

Ryan Teague Beckwith, Staff Writer

When Hurricane Fran destroyed Joe Donovan's home in 1996, it sparked a depression that a year later left him considering suicide.

He checked in to the Dorothea Dix mental hospital for two weeks, a stay he says saved his life. Because he was uninsured and admitted to a state-run hospital, North Carolina taxpayers footed the bill.

When Dix closes in early 2008, Wake County will have to open its own short-term mental health center, which it hopes will be run by a local general hospital -- Rex Healthcare, Duke Health Raleigh or WakeMed. So far, none has stepped forward because no one has answered the key question: Who will pay for patients like Joe Donovan?

The hospitals want the county to guarantee that it will cover the cost of treating uninsured patients before they agree to run a center. County officials have said the hospitals can finance a center without their help.

The result is a logjam that has lasted more than a year, frustrating mental health advocates and delaying the eventual opening of a treatment center.
"A lot of the things that people are jumping on now should have been straightened out two or three years ago," said Donovan, who is now an advocate in Raleigh. "The fact that everyone is saying it's not their job is disappointing."

No one knows exactly how many people with mental illnesses are uninsured in Wake County or what it would cost to treat them. But the estimates are high enough to worry hospital administrators.

They anticipate that about 30 percent of patients at the 60-bed treatment center would not have insurance. The county's figures -- which the hospitals think are low -- project an annual operating loss of $1.1 million.

"It's tough to [break even] when a third of your patients have absolutely no means to pay," said Stan Taylor, vice president of corporate planning for WakeMed.

The bottom line depends on the rest of the patients.

The facility would also treat people on the federal Medicaid program, as well as those with private insurance. To break even, the hospital would need to make enough from those patients to cover the cost of treating the uninsured, or else receive outside funding.

Deputy County Manager Joe Durham said the county may have underestimated some of the costs and the hospitals' ability to pay them. Not all of the assumptions were "totally accurate," he said.

Past facilities

In years past, Wake hospitals have had short-term treatment centers.

WakeMed ran a 28-bed psychiatric unit called Ashby Hall in the 1970s. Raleigh Community Hospital -- now Duke Health Raleigh -- closed its 19-bed unit in 2003 to concentrate on more profitable care in surgery, cancer and heart disease.

That left two psychiatric units in Wake County. One is Holly Hill, a private mental hospital that does not accept charity cases. The other is Dorothea Dix.

When Joe Donovan decided to get help in 1997, he could not go to Holly Hill. Donovan, a self-employed computer consultant, did not have health insurance or the cash to pay a bill that could have been thousands of dollars.

He ended up at Dorothea Dix, which is designed to serve seriously troubled patients who need long-term care but has also accepted short-term patients. Others in his situation have ended up traveling to Rocky Mount and Greensboro for treatment.

Though he was happy with his care, Donovan did not think Dix was the best place for him.

"It was designed for people to go and spend the rest of their lives, and that's not the modern world," he said. "It really seemed out of place for what I needed."

He thinks the current proposal -- a local treatment center connected to a regular hospital -- would be ideal. But even he says he's not sure who should pay for it.

County allocations

Wake County officials point out that they are already paying for the treatment center.

They have set aside $10 million in their own budget and raised $5 million from the local alcohol board toward the $30 million construction cost. They plan to raise the rest from state and private sources.

But WakeMed -- which county commissioners favor to run the treatment center -- said that it already loses money on charity medical care.

In the fiscal year that ended Oct. 1, the hospital reported $119 million in charges for uninsured patients who had no means to pay, making it one of the top three spenders on indigent care in the state.

Still, it made a profit of about $54 million.

Hospital officials say they do not want to take on more obligation for covering the cost of the uninsured, especially when the treatment center's finances are still uncertain. They say the center would attract even more patients in the future, adding to the strain.

Marc Fenton, a health care consultant hired by the county to study the treatment center, said that was a fair complaint.

"The one thing we know about health care is that supply creates demand," he said. "If you have a supply of a good service, people will come to it, and we have never factored that into any of our projections."

Donovan is frustrated that disputes over financing the short-term treatment center are overshadowing the serious problems of the people it would help.

"If I didn't go, I would have been dead within a week," he said.

Staff writer Ryan Teague Beckwith can be reached at 836-4944 or rbeckwit@newsobserver.com. Read more!