Virginia’s eight state-run mental health hospitals are operating at near-peak capacity, while operating at just 60 to 75 percent staffing levels, according to a presentation Virginia Department of Behavioral Health and Developmental Services Commissioner Alison Land gave legislators on Tuesday.
“We’ve been working on this issue for years and years before I came, and the picture just keeps looking bleaker, and not better, I have to say,” Land said.
“The adult state hospital census is dangerously high,” one page of Land’s presentation states.
According to Land, at one point during Fiscal Year 2021, Piedmont Geriatric Hospital reached 112 percent of capacity. Other facilities are also operating at above 90 percent capacity.
“When a hospital is full, it means that there are no beds left at all,” Land said. “So, staff may find space for patients in a day room, or in a hallway on a cot, on a mattress on the floor, but there’s no privacy, there’s a lack of adequate staff to maintain constant observation, and it makes patients vulnerable to victimization and there’s a lack of recovery-oriented treatment.”
Land noted that six of the eight adult hospitals temporarily closed admissions due to COVID-19 outbreaks as recommended by the Virginia Department of Health. The other two had the ability to maintain operations without full closure during their outbreaks. Land said 1,700 patients and staff in the eight facilities had recovered from COVID-19 since March 2020.
Another problem facing the facilities is staffing shortages, Land said. She said all healthcare providers are facing staffing shortages. In state facilities, that’s exacerbated by the high risks state behavioral health facility staff face, combined with non-competitive wages offered staff.
“We’re not only challenged in our facilities by the difficult job descriptions, the high-risk job descriptions, but also that direct-care compensation falls well below market value and so it’s just not competitive. So we’re looking at options including raising salaries to the market rate and other ways to attract and retain employees.”
She said adding security staff and improving safety was also key for employee retention. During a question-and-answer period, Senator Creigh Deeds (D-Bath) said at some facilities in the past, police frequently responded to facilities for patient-on-patient assaults, or patient-on-staff assaults.
“This is dangerous, hard work,” Deeds said.
“Staffing shortages really are critical at this point, but we’re not alone. Healthcare employers everywhere are feeling the effects of exhausted staff who are leaving their employment following over 12 months of pandemic-related stress,” Land said in her presentation. “We have over 1,000 state facilities direct-care vacancies, and we’ve had that since March of 2020, and it’s actually been growing.”
Fully staffed, the facilities have 5,500 positions. Land said funding is another problem, since they’re only funded by the state to operate at 90 percent capacity.
“At the same time, again, we’re operating at very close to or over 100 percent of capacity of bed utilization, and we’re only funded to operate at 90 percent staffing, but with our current vacancies, we really are operating at 60 to 75 percent staffing,” she said.
She also described ongoing and new contracts the department is developing with other providers to help reduce the number of patients in the state-run facilities.
The capacity problems and temporary admissions closures also burdens law enforcement, Land said.
“Admission delays due to COVID–19 are requiring law enforcement to stay with some patients for several hours or days before a bed becomes available,” Land’s presentation states.
Land told the legislators, “It does take time to ensure that every discharge is safe before we can free a bed for new admission. And state hospital staff are working closely with community partners all the time to free up a bed, and it’s really no small task to make sure that they have everything they need so that they’re safe when they go into the community and don’t bounce right back.”
“We’re really just down to talking to you and letting you know that as you can see from the slides, we haven’t slowed down at all during the pandemic. Quite the opposite, we’re still right up there at 100 percent [capacity] or more,” Land said. “We’re really trying to do everything we can in our power to solve these difficult challenges, and were grateful for the resources that we have received, and hopeful for more resources to address these challenges.”
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