Guilford County weighs cost of rehab: Member quoted
Tuesday, July 29, 2014
Posted by: Valerie Arendt
Jack Register currently serves as the NASW-NC Board of Directors Secretary
News and Record (Greensboro, NC)
Guilford County residents who seek treatment for their substance addiction might have to spend less time in rehab as the county looks for ways to curb spending.
But some experts said they worry that cutting a stay short enough to make it eligible for federal reimbursements won’t rehabilitate anyone.
The county spends about $2.4 million each year operating the Guilford County Substance Abuse Treatment Center on Wendover Avenue. No other money supports the center, which treated 556 patients from July 2012 to June 2013. Those adults — the center only treats Guilford County residents — stay from 30 to 90 days.
The Guilford County Board of Commissioners is reviewing whether to seek Medicaid reimbursement to help with the cost of rehab, which would limit stays to 14 days under Medicaid rules. In addition, the center couldn’t treat more than 16 people at a time; it currently treats three times as many.
A 14-day stay is enough to detox and determine a best course of treatment, but that’s all, said Jack Register, a clinical addiction specialist and undergraduate director of social work at UNCG.
“County funding is critical,” said Anthony Ward, the chief operating officer of Sandhills Center, a regional treatment center. “Evidence suggests that short-term programs can get someone started into treatment, but long-term treatment is more effective.”
Demand is there
County commissioners opened the center off Wendover Avenue in 2006, in part to deal with a crack cocaine problem throughout the county.
“Particularly around that 2005-ish mark, there was a sense of need in the community for long-term treatment, something that would go beyond (detox),” Ward said.
Then known as the Guilford Center, the facility merged last year with the Sandhills Center, a collective mental-health agency composed of the much-smaller counties of Harnett, Hoke, Anson, Lee, Montgomery, Randolph, Moore and Richmond. Sandhills covers Guilford County’s mental health and substance abuse needs and contracts with Daymark Recovery Services to handle the daily operations of Guilford’s site.
The center can handle 56 beds and houses low-income, uninsured adults with substance abuse problems for anywhere from 30 to 90 days.
Because it accepts adult men and women, it aids a group of people that often aren’t eligible for Medicaid: single, able-bodied men. Medicaid generally covers low-income children and their parents, the elderly, people with disabilities and the poor.
The center has served about 500 patients in each of the past three fiscal years, according to data from Ward.
The beds are full about 70 percent of the year, according to Michelle Ivey, the clinical operations director of the Wendover site.
So the demand is there.
But longer-term rehabilitation can be expensive.
That’s why some commissioners are examining the balance between extended services and taxpayer dollars.
The board has been in cost-cutting mode since 2012, when Republicans won a majority on the board for the first time in 14 years and began a push to control county spending.
Earlier this year, the center came up in budget discussions as an area that could save the county money by taking advantage of Medicaid funding.
“The early discussion, at least in my mind, revolves around the distinction between a 30-day treatment program and a 14-day program,” Commissioner Jeff Phillips said. “That’s where I’d like to have some focused discussion around. If we were to find out that there is not a tremendous amount of long-term recovery as a result of a 30- to 90-day treatment program, then we might consider making a transition to a 14-day, where we can get most of that treatment reimbursed, thereby saving a significant amount of dollars.”
Most substance abuse literature says the best practice in residential programs is for patients to stay between 60 and 90 days, Register said.
“The problem in public policy, in my opinion, is that we tend to seek a one-size-fits-all solution when addiction is not a one-size-fits-all illness,” he said. “There’s not really one measuring stick to hold up. It’s really got to be based on populations.”
But one thing’s clear, he said: 14 days isn’t enough time to treat anyone with a clinical addiction.
And commissioners, who are grappling with what is the best use of county money, are asking how to measure success.
So the question becomes, how should efficacy be measured in a substance abuse center? Sobriety after a year? Five years? What if someone relapses after 10 years sober, does that mean that person’s treatment was ineffective?
When asked what would measure success, Commissioner Hank Henning said he doesn’t have any judgments until he sees more information from Sandhills.
“A lot of this is a learning process for us,” Henning said. “We need to look very closely at how we’re spending on nonmandated services. It doesn’t mean we have to cut or anything, we just need to do our due diligence.”
If the county decides to change funding for the center, there’s no indication of when the changes would be implemented.
But even if the center shortened stays, that wouldn’t make it eligible for Medicaid reimbursement. It treats too many people at one time.
The 16-bed limit comes from policies developed in the 1970s to keep people with addictions in their own communities, Register said. For now, the commissioners have asked Sandhills to present them with more information.
Statistics show a link between addiction and crime, and some commissioners point to that data as a reason the county should support rehab programs.
In 2004 — the most recent national data available — 17 percent of all state prisoners nationwide said they committed their current offense to obtain money for drugs, according to data from the U.S. Bureau of Justice Statistics.
“We can either service the people who have substance abuse issues, or we can pay for them on Sycamore Street, in jail,” Commissioner Ray Trapp said. “One way or the other, we’re going to pay for it.”
State data show that 62 percent of the people screened in North Carolina prisons required substance abuse treatment in the 2011-12 fiscal year.
For inmates who completed treatment, the return-to-prison rates were lower, according to the N.C. Department of Public Safety’s annual legislative report for that year.
Commissioner Kay Cashion, who serves on the Sandhills board, said every taxpayer-funded operation deserves evaluation — but she was surprised to hear the attitudes of some of her fellow commissioners about the Wendover center. She said there’s an obvious need for treatment lasting longer than two weeks.
“This is not some extra, frivolous thing,” Cashion said. “This is a medical need, and somebody ought to be addressing it. And I suspect, when everything is said and done, this is the least costly way to handle it.”
Register said society doesn’t have a “therapeutic culture” when it comes to addictions but rather a “punishment culture.”
“There are plenty of folks in this state who would love to see the counties get out of the business of doing any addiction care whatsoever,” he said.
“And that sends me into orbit.”