The closure of the James B. Craig Nursing Center, located on the campus of Central State Hospital (CSH), has been delayed two months to Aug. 31.
Regional Hospital Administrator Dan Howell said the new date is “firm.”
“We bumped it back to ensure the safe and effective transition of individuals still up at the Craig Building,” he said Tuesday.
Howell said, if for some reason all of the 70 remaining Craig residents don’t move to a “community setting” by late August, they will head to Atlanta’s Georgia Regional Hospital or Augusta’s Gracewood East Central Regional Hospital.
“Our hope is to transition as many people as possible by Aug. 31 to minimize the move to Augusta or Georgia Regional,” the CSH administrator said. “Inevitably, people will end up moving to both locations.”
The only state-run nursing home
The Craig Center is home to individuals with developmental disabilities and behavioral health issues, and is Georgia’s only state-run nursing home facility. The home housed more than 200 people at the start of downsizing nearly two years ago.
Craig was originally planned for funding termination effective Dec. 31, 2013, but the date continues creeping back.
Closure of the Craig Center was advertised under a DBHDD shift from an institutional-based system of health care delivery to a community-based system of care. This deinstitutionalization satisfies requirements imposed by a 2010 settlement agreement with the U.S. Department of Justice requiring the state to move all individuals with developmental disabilities out of state institutions and into communities, where they have the opportunity to live in their own homes with access to high quality health care, according to the DBHDD website.
Craig’s 70 residents represent 37 Georgia counties. Howell said nearly 180 staff members remain also.
These individuals’ diagnoses and/or medical requirements include tube fed or oxygen, mentally or severely retarded, dementia, schizophrenia and court ordered “mentally” ill prisoners to name a few. The majority of Craig residents have spent more than 20 years at the facility. One resident is 96 years old.
State Rep. Rusty Kidd (I-Milledgeville) pleaded his Craig Center case during the recent Georgia legislative session. Kidd said the state of Georgia has abandoned its “fragile citizens.”
“They are having a hard time trying to place these people. There are nursing homes that don’t want some of these patients,” Kidd said. “Where are you going to put them?”
The local legislator said the DBHDD is doing the best it can to follow the federal settlement but he believes Craig should stay open to serve the remaining population.
“The state is running short on treatment of the mentally ill,” he said. “As long as we have a facility in my opinion, it would be smart to utilize it. You have a place that’s been working. The need is there.”
Independent review identifies statewide transition issues
A report released March 23 by independent reviewer Elizabeth Jones said that Georgia isn’t providing proper supervision of individuals with developmental disabilities moved to community group homes.
The Georgia Department of Behavioral Health and Developmental Disabilities (DBHDD) halted hospital discharges of people with developmental disabilities into community settings until improvements are made, thus the Craig delay.
Jones’ report said DBHDD recognized the “vulnerability of its placement protocols and decisions” by choosing to reinstate the suspension in early January 2014.
“The Department’s efforts to strengthen the transition process have identified the clear need to obtain a more complete understanding of those still placed in state hospitals,” the report said.
Jones and clinical consultants evaluated 60 community placements through February.
The review states though DBHDD has shown “good faith, energy and diligence” in addressing its obligations “the systemic problems and weaknesses are known” making the state “not yet in compliance.”
For example, DBHDD recently removed developmentally disabled individuals from three provider agencies due to unacceptable care and oversight, according to the review’s evaluation period. Also during the 2014 Fiscal Year, two individuals died shortly after transitions from Southwestern State Hospital to the community setting.
The state department commissioned “Columbus Community Services Consultant Report” found that Individual Service Plans (ISP) didn’t recognize that “individuals generally react differently in dissimilar environments.”
Generally, ISPs were not implemented in a timely and appropriate manner during the review’s evaluation period.
Jones suggested better support of the developmentally disabled through the following:
• design and implementation of intensive support coordination for medically fragile individuals;
• recruitment and retention of provider agencies with the requisite expertise;
• sustained development of sufficiently rigorous monitoring and oversight strategies;
In response to Jones’s findings, DBHDD agreed write a plan by June 30 that would bring the coordination of the DOJ settlement agreement and publish that course of action by July 21 on the state agency’s website.
“The more time we have to transition people the safer and more orderly we can be,” the CSH administrator said.
Moving on at Craig
Howell said community transitions from Craig have done “well to the best of (his) knowledge.”
The regional administrator has participated in several other hospital closures. Howell said the Craig Center staff has gone “above and beyond the call of duty caring for these individuals.”
“I think the state and DBHDD has been strategic and very mindful of making sure that people are in the best place possible,” he said.
Howell and administrators try to help the remaining Craig Center employees find other jobs within the state system. A GED work release program has improved the workforce as well.
“You treat people the way you would want to be treated. At the end of the day I think we’ve attempted to do the right thing for our staff,” Howell said.
Mike Couch, executive director of the Central State Hospital Local Redevelopment Authority, said the board is pleased to see the Craig Center remain open for now.
“We know what that facility has meant to the community both in employees and good patient care. The longer they stay the better it is for the community,” Couch said Tuesday. “It’s a unique situation and a decision that rests with DBHDD in Atlanta.”
Couch said Howell continues showing “good stewardship of Milledgeville.”
“Dan will do the right thing,” the CSHLRA director said.