ABLEnews Extra

                    "Haven of Rest"

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Some patients at the county-owned East Valley Pavilion crouch in the
halls with blank looks on their faces. Others paint pictures of trees
and blue sky. At times, a few become so agitated the staff must use
physical constraints.
   
This 85-bed locked facility in East San Jose is a home for the
severely mentally ill, patients who have been deemed to need 24-hour
supervision. But now, a complicated funding snafu has brought county
officials to the brink of closing it.
   
If East Valley Pavilion is shut down, some of its patients could be
moved as far away as the state hospital in Napa. Others would go to
private institutions. And a few would have to return home. All this
has patients, their families and East Valley's staff concerned.
   
"I am nervous about being out in the community," wrote James, a
patient, in a note he handed to a reporter. "East Valley Pavilion is
the only hospital which I feel safe in. It is a haven of health,
safety and rest for my tired soul."
   
But there may be no other choice. The county expects it will soon lose
$5.6 million in state and federal funding for the facility--an
amount that covered most of its $8.7 million annual cost.
   
Already facing an expected $30 million gap between countywide spending
and revenues, officials say they can't afford to operate the pavilion
alone. Without the state and federal funding, East Valley costs county
taxpayers more than $150,000 a week.
   
   `Need a locked facility'
   
"Our biggest concern is what to do with the clients," said Bob
Martinez, the county's mental health director. "You can't ignore
these patients. They need a locked facility. We can't discharge them
into the streets. We just can't."
   
One option is to close East Valley and move the patients to smaller
private facilities that would care for them for a fee. Another is to
hire a private provider to take over East Valley.
   
But the union that represents most of the East Valley's 100-member
staff of nursing attendants, cooks, janitors and others is adamantly
opposed to those plans.
   
Employees want the county to continue operating the facility. They say
they can make the program run more efficiently. And, they say, some of
the patients at East Valley are too sick to be handled by private
providers.
   
   Alternative flawed
   
"Private facilities will kick them out because they're too abusive or
confrontational," said Harry Adams, a representative from Service
Employees International Union Local 715. Once the patients are on the
street, Adams said, the county and city governments may spend even
more on additional police calls, arrests and emergency psychiatric
treatment.
   
Whatever the county decides to do with the pavilion, it probably will
have to move 15 or more of the most severely mentally ill patients to
Napa State Hospital, some 90 miles away. That part of the plan has
families of patients particularly worried.
   
"Visits are important not only for family, but the client," said one
man who recently had a son at East Valley. The man, who declined to be
named, said his son, a doctoral student in mathematics, would run and
hide from the voices he heard in his head. The father said he didn't
know where his son, who can now stay at home with the help of
medication, would have stayed without the county program.
   
"Something is different here," he said. "The staff treats clients
empathetically."
   
   Uncertain funding
   
The funding for East Valley, which the county bought in 1986, has long
been uncertain.
   
From the first, the county has referred to East Valley as a qualified
skilled nursing facility. Such facilities are eligible for federal
funding of $209 for each patient day.
   
But because East Valley's patients are mentally ill, the pavilion
didn't fit federal definitions, which stipulate that skilled nursing
facilities are those whose patients have physical ailments. So, with
the assent of the state, the county classified the pavilion as part of
Valley Medical Center for funding purposes.
   
In 1988, federal officials rejected that arrangement. The county
quickly appealed, and continued to receive the $209 until late last
year, when the appeal was denied. East Valley is more properly an
"institute for mental disease," federal officials said, and should
receive funding at a rate of $98 per patient day.
   
   Catch-22 situation
   
Then a second problem arose. Because the state gives out funding for
mental disease programs based on the number of qualified beds each
county had in 1992, East Valley didn't qualify there either. In 1992,
East Valley was still a skilled nursing facility pending results of
the appeal.
   
Now, county officials don't know whether they can get any outside
funding for East Valley at all.
   
On a tour through East Valley on Thursday, many patients said they
wanted the program to continue. With its clean but
institutional-dreary halls and rooms crammed with three twin beds
each, the building is not one where most people would want to stay.
But for most patients, it's home for months, if not years.
   
"It's a pretty nice place," said one woman as she sat coloring with
magic markers.
   
[Public Mental Hospital at Risk, Melody Petersen, San Jose Mercury
News, April 3, 1995]

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