The cash-strapped Brattleboro Retreat and the state have agreed on a plan to move the mental health facility toward financial sustainability — starting with an infusion of $10.2 million.
The payment, which has yet to be approved by the Legislature, is part of a sustainability plan floated by the Agency of Human Services and Retreat officials.
The report outlines a nine-step plan for putting the Retreat on solid financial footing, including filling open beds, reorganizing and cutting staff positions, changing the payment structure, making renovations and using more telemedicine.
The goal of the restructuring is to make Vermont’s largest mental health facility less dependent on tax dollars over the long haul.
Department of Mental Health Commissioner Sarah Squirrell said the plan gives the state reassurance of “commitment and accountability,” and ensures the stabilization of “an essential health care provider.”
Lawmakers aren’t convinced. Members of the Joint Fiscal Committee Monday questioned how much funding would be necessary in the long run and whether the changes would lead to better patient care.
“I’m trying to get a read on, are we going to be back here three months from now?” Sen. Jane Kitchel, D-Caledonia, said in an interview. “We put in some additional money and now [the Retreat is] back” asking for more.
“In my view, it’s fair to say we don’t have a lot of choices,” said Rep. Bill Lippert, D-Hinesburg.
“The state may have to take further steps other than pumping money into the Retreat.”
For nearly a decade, the state has relied on the Retreat to take the most severely ill patients.The facility contains half the state’s total inpatient mental health capacity, including all of Vermont’s 30 beds for children and teens, as well as the units for involuntarily admitted patients.
That dependance has meant the state has been quick to come to its financial assistance. In January, the Legislature approved $2 million when president and CEO Louis Josephson threatened closure. In March, the state provided $7.3 million in loans and grants as the number of patients dropped from 105 to about 65 due to Covid-19. The state Agency of Human Services also provided nearly $9 million in rate increases last year.
“If we were to lose this capacity of the Retreat, it would pull the rug out from underneath our system of care, because we don’t have additional capacity elsewhere,” Squirrell said.
As a condition of the $7.3 million payment, AHS Secretary Mike Smith convened a team of government and Retreat officials to develop a viable fiscal plan. The Retreat hired a consultant to analyze possible outcomes and the group met weekly throughout April and May.
At one point, Smith said he would consider a court-ordered government receivership or another entity taking over the Retreat. But after two months of deliberations, the task force agreed to less sweeping changes.
The Retreat will focus on increasing patient numbers to pre-Covid levels within the next 12 months, according to the report. Stalled construction of a 12-bed unit will be completed by early winter. The Retreat will move an adolescent residential program into a remodeled inpatient unit by next month, according to Retreat spokesperson Jeff Kelliher.
The state and the Retreat will also consider funding changes for patients from the Department of Mental Health and renegotiating rates for patients from New Hampshire and Massachusetts.
Administrators will review staffing and organizational structure and work with the union to adjust “work rules and requirements,” according to the plan.
The department will also create contingency plans in the event the Retreat’s finances don’t recover or if the facility doesn’t meet agreed upon objectives.
Kelliher, the spokesperson, said the facility’s administrators don’t expect to ask for more money — but they don’t know for sure. “While we do not anticipate requesting additional funds at this time, we are unsure how long the Covid-19 crisis will be with us and what the extended impact of the pandemic might be,” Kelliher wrote in an emailed response to questions.
The $10.2 million for the Retreat money would come from $1.25 billion in coronavirus relief funds. Gov. Phil Scott has proposed that $375 million go toward the health care system; $42 million has already been spent, according Deputy Finance Commissioner Sarah Clark.
Meanwhile, turnover at the Retreat has accelerated and tensions between employees and management have flared. More than 322 staff have left within the last 17 months, according to data from the nurses union. Staff say the shortages have made the Retreat unsafe for staff and patients. After union president Sy Creamer was fired last week, the union planned protests.
Rep. Anne Donahue, R-Northfield, a mental health advocate, says the plan is fundamentally flawed because it does not include improvements to patient care. “It is almost exclusively a financial document,” she said. “It doesn’t really address any of the much deeper, underlying policy questions such as whether in the long-term the Retreat is an appropriate model of inpatient care and whether it’s capable of providing quality care.”
Those changes may have to wait until after the pandemic, Donahue acknowledged.
According to Lippert, the Vermont House is considering legislation that would make the Retreat subject to more state oversight; it would give the Department of Mental Health more power to oversee patient quality, and require the facility submit finances to the Green Mountain Care Board, which approves hospital budgets.
“Families and patients need to be confident that they’re receiving quality care,” said Lippert.
Lawmakers said they wanted to hear more before they approve $10.2 million in funds to keep the facility afloat. They’ll hear testimony from Squirrell this week and plan to vote Friday.
