Kansas mental health hospitals, strained for years, could reach turning point in 2020

At one state-operated mental health hospital in Kansas, nearly two out of five jobs sit empty. To make up for the staff shortage, roughly $170,000 in overtime is paid out every two weeks.

Another facility has had to limit admissions for more than four years, forcing people in crisis to wait for care.

Kansas’s state hospital system has been beleaguered for years, unable to fully recover from setbacks and solve long-term problems, such as recruiting and retaining workers. The near-continual crisis has cost millions and placed additional stress on the state’s mental healthcare services, which are already stretched too thin.

But a turning point may be coming.

Gov. Laura Kelly last week approved pay raises for more than 325 employees at Larned State Hospital who deal directly with patients, including including nurses, mental health technicians and security officers. Some positions at the western Kansas facility are receiving increases of approximately 2.5 percent, but others could be as high as 20 percent.

Next month the Kansas Department for Aging and Disability Services, or KDADS, which oversees state hospitals, will give lawmakers a plan to lift a four-year-old cap on admissions at Osawatomie State Hospital.

Larned and Osawatomie provide the backbone of the state hospital system, treating hundreds of patients at any given time with mental health problems while two other facilities (Kansas Neurological Institute and Parsons State Hospital and Training Center) serve those with intellectual and developmental disabilities. With annual budgets collectively exceeding $100 million, Larned and Osawatomie provide crucial care for the severely mentally ill – accepting court-ordered admissions and others with acute issues.

Many of the problems plaguing the system are concentrated in these two hospitals. But as Kansas anticipates a budget surplus approaching $1 billion in the fiscal year that begins July 1, they could be poised to receive additional funding after lean times in the recent past.

“They were horrendously underfunded because we just didn’t have the tax revenue to do any of the things we needed to do,” said Sarah LaFrenz, president of the Kansas Organization of State Employees. “So consistently, the workers were being made to do more with less.”

Larned worker shortage

Larned State Hospital should have 67 licensed practical nurses and 14 doctors. But, according to numbers from earlier this fall, just 20 nurses and seven physicians were working. More than half of the registered nurse positions were empty.

Its overall average employee vacancy rate stood at 38.4 percent in late October, according to data KDADS gave to lawmakers in last month. For some position types, rates exceeded 70 percent.

The open positions require large amounts of overtime to cover. According to KDADS, workers at Larned typically log between 6,300 and 7,100 hours of overtime every two weeks, costing about $175,000 per pay period.

On an annual basis, those levels of overtime would cost more than $4.5 million.

Recruiting and retention issues are not new to the hospital, which sits just outside Larned, a city of about 4,000 near Great Bend. The nearest large urban center – Wichita – is 120 miles away and the government-run facility must compete with private sector work that pays more.

Rep. Will Carpenter, an El Dorado Republican who chairs the House Social Services Budget Committee, said great quality of life exists in Kansas’ small rural communities. But getting people to move there is hard.

“It’s just the way of the world,” Carpenter said. “Nowadays, it’s just very difficult to attract someone to Larned, Kansas.”

The pay increases announced this week are intended to help combat staffing and retention challenges, KDADS said. Licensed practical nurses and mental health technicians will both receive two-step pay grade increases. LaFrenz said that’s an approximately 5 percent bump.

KDADS spokeswoman Cara Sloan-Ramos said it’s difficult to say exactly how much more workers will make because each receives different pay based on experience, credentials and other factors. But echoing LaFrenz, she indicated some positions will receive raises of about 5 percent but others -- such as security officers -- will see hikes as high as 20 percent.

LPNs at Larned can make between $18.70 and $25.05 an hour depending on experience and qualifications, according to a state jobs site. A third-shift security officer starts at $14.66, the site says.

The large raise for security officers will make their pay more competitive with Kansas Department of Corrections positions. Larned is also home to a state correctional mental health facility and the state hospital has lost some employees to the prison.

“We operate in a very unique situation in western Kansas, where the number of workforce applicants is smaller than other areas in the state and we compete with other state agencies for those qualified applicants,” Larned State Hospital Superintendent Lesia Dipman said in a statement.

KDADS is using one-time funds to pay for the raises, which will cost about $1.5 million, during the current fiscal year, which runs through June. Lawmakers will need to provide funding to maintain the higher pay levels.

Kelly will unveil her budget proposal in January. It will almost certainly contain funding to make the pay raises permanent. In a statement, she spoke of a “moral obligation” to adequately support programs that help Kansans in need.

“It’s no secret our state hospitals have been severely underfunded, understaffed and overstressed. We are working to fix this, day by day,” Kelly said.

Osawatomie admissions still limited

Osawatomie State Hospital is licensed to house approximately 200 patients but has limited admissions to less than 170 since 2015. The policy has essentially kept the institution operating on a one-in-one-out system for more than four years.

Officials imposed the cap amid safety concerns by federal authorities, especially over whether the facility was designed and furnished to minimize the risk of hangings. Inspectors also expressed worries over the high numbers of patients at the hospital. At one point, some patients were being triple-bunked to a room.

Amid the concerns, the Centers for Medicare and Medicaid Services decertified the entire hospital, a move that cost about $1 million a month in federal funds. In 2017, CMS recertified 60 beds, allowing the facility to again receive partial federal funding.

KDADS is telling lawmakers it will release its plan then to end the years-old admissions moratorium at the facility.

“They’ve either got to go in and do some major remodeling on Osawatomie so they can open up more (federally-funded) beds, because their hands are tied right now – or implode it and rebuild,” Rep. Brenda Landwehr, a Wichita Republican, said. “That’s where they’re at.”

In 2017, KDADS estimated the cost of building a new hospital at between $100 million to $170 million.

The moratorium has effectively dragged down the rest of the state’s mental healthcare system, making it more difficult for individuals with the most severe problems to get help . A mental health task force created by the Legislature said in a January report that the limit on admissions at Osawatomie had increased pressure on hospital emergency departments and jails.

In practice, it has led to waits in emergency rooms until hospital beds open up.

In fiscal year 2018, the average wait time for state hospital admission was about 41 hours, according to information KDADS gave to lawmakers in February. On average, seven people were on a wait list each day.

The task force recommended that Kansas add more than 200 regional or state hospital beds within the next five years. The panel estimated the additional beds could cost up to $55 million a year.

Amy Campbell, a coordinator for the Kansas Mental Health Coalition who sat on the task force, hopes KDADS’ plan to end the moratorium hews closely to its recommendations.

“I see it as a pivotal year because here we are, it’s been too many years,” Campbell said. “The decision making has been deferred over and over and over again.”