CRANSTON, R.I. (WJAR) — Eleanor Slater Hospital is home to some of the most frail and vulnerable Rhode Islanders. Many patients there spend their days on ventilators with around-the-clock care from doctors and nurses, who relatives say have become 'like family.'
"It brings comfort," said Brenda Guerra, whose brother Alexis is currently in a coma at Eleanor Slater Hospital. "It brings comfort that we know he's being so well taken care of."
But now, Guerra said she and her family are starting to worry about the future of her brother's care, as the Department of Behavioral Healthcare Developmental Disabilities and Hospitals explores ways to restructure the hospital, which would close buildings and move patients to other facilities, possibly those within the community.
"We want people to flourish, we want people to do better, we want people to be well," said BHDDH Director Kathryn Power. "But in reality, living in an institution for the rest of their lives is not necessarily the only choice."
But the union that represents more than half of the staff at Eleanor Slater said the move could be damaging to patients and employees.
"We feel this is an attempt to try and discharge as many patients as possible and that not enough thought is going into the readiness of these patients," said Nicole Barnard, Attorney for Rhode Island Council 94.
"THE ELEANOR SLATER HOSPITAL OF THE FUTURE"
"This hospital is operating under an old model," Power told NBC 10 News in an interview Thursday.
As a long-term care hospital, some patients have lived at Eleanor Slater for more than years, others just several months or weeks. It's a model that Power said is changing, with numbers continuing to decrease.
"They're keeping people at home and they're keeping people in hospice if they need crisis care," she told NBC 10 News. "So, the use of this facility has changed. We discovered that we were not delivering a hospital level of care. We were delivering a nursing home level of care and that caused questions."
Questions that are now being answered by the tune of a $1.3 million consultant, who was brought on to examine restructuring plans. Power said the agency looked at a variety of options, including privatizing the facility. She believes the option presented to a House Finance Subcommittee on Tuesday is the best solution, which she called "the Eleanor Slater Hospital of the Future."
Under the proposed plan, the Benton Facility in Cranston, where forensic patients are treated, would remain. The Adolph Meyer building, which was built in 1908 and serves a mix of 35 medical and psychiatric patients, would close.
"That's the most-immediate movement we know we can do," Power said. "Those patients would be moved to the Regan Building in Cranston, the Zambarano Unit in Burrillville or possibly a transitional facility. Over time, Regan would close and all individuals there would be moved to Zambarano and/or community placements."
"The value that we are trying to stress here for the hospital is that individuals should be in the least-restricted care environment," she added.
In total, Power said the entire plan is complete in a three-year window and would end with keeping only the Benton Facility and Zambarano Unit open. In the first year alone, she estimates the transitions would save the state about $20 million.
THE PUSH BACK
"When you have people who are vulnerable, you don't just kick them out," Barnard told NBC 10 Thursday.
Kwame Larbi, president of Local 1350, which represents more than half of the roughly 750 employees at Eleanor Slater, said the changes could be "damaging" to patients and staff.
"Our patients are the most difficult patients in the state that no nursing facility can take care of," he said.
Larbi has worked at Eleanor Slater for 31 years. He said his patients have become like family to him.
"We are so used to the patients, they're part of our families," he said. "And they have nowhere to go. We provide excellent care for our patients and we want those patients to stay in Cranston."
Guerra said her family is able to FaceTime with her brother once a week and believes he's in good hands.
"It's like he's with family," she told NBC 10. "Seriously. I am so happy and so relieved. I see how much they care for him and how well they take care of him. I couldn't be any happier. I know he's in the right place."
Guerra said she worries about the possibility of her brother being moved, especially with the level of care he needs on a daily basis.
"Have a heart," she said. "These are people we are talking about. Whether they can live 'viable lives' like doctors like to use that term. My brother is here, he is fighting, he is breathing and he's not six-feet under. He's a human being. And he is there."
Barnard said there are little to no other facilities in the state that provide such level of care, particularly to the patients on ventilators.
"Those skills are hard learned," she said. "And our members on average have about 20-years of experience doing this work. There's only one nursing home in Rhode Island, I believe in Coventry, that has any ventilator care because it's very specific, it's very specialized."
In a letter to lawmakers, the governor's sister, Rhode Island College professor Marianne Raimondo, expressed similar concerns.
"Having been a hospice social worker in my past career, I have observed the quality of care provided by the hospital to Rhode Islanders on ventilators. I have heard many physicians involved in critical care medicine praise the care patients receive at the hospital. To my knowledge, there is no other facility in the state that is equipped to care for these patients which require not only specialized equipment but staff who are competent and well trained in ventilator care."
The union strongly opposes the closing of Regan, and has suggested renovating Regan and Mathias, two of the younger buildings on the Cranston campus.
When asked how to make families feel comfortable with the transition, Power said no one will be 'forced to move,' adding "we're not going to move people willy-nilly."
"It's a delicate balance," said Rep. Scott Slater, D-Providence.
In June, state lawmakers were forced to scrounge up $65 million to fill a gaping hole in the Eleanor Slater budget and keep the hospital running. Power said that came about due to billing and compliance issues, because the hospital had more psychiatric patients than medical patients, making them ineligible for the reimbursement of Medicaid.
After coming back into compliance, Power said they discovered forensic patients were no longer eligible for federal reimbursement.
"Automatically, a large number of patients we thought were reimbursable were not," she told NBC 10.
After that, she said state officials expressed the need for a more "sustainable model."
Slater said it costs about $530,000 per patient per year and believes the hospital needs to look at more cost-saving measures.
"I don't think status quo is something that we can do right now," Slater told NBC 10. "I'm not exactly sure if the plan we have from the consultants is exactly the way we need to go."
Slater said he received letters from concerned family members and staff, but also feels the obligation to protect taxpayer dollars in finding a solution.
"I think we need to find some kind of cost-savings in there and that's not signing off on the plan that we have, but I definitely think we can find some efficiencies and consolidations," he said.
Guerra said she hopes all parties involved keep the patients and staff at the forefront.
"I understand the world runs on money and I just don't understand how, when it comes to people's lives, you can put a price tag on that," she said. "I mean, these are human beings we are talking about, and they can be greatly affected, if not pass away, by being moved to a location where they will not be properly cared for."