March letter<\/a> to the California Health and Human Services Agency, CHA predicted that more than 760 mental health workers would be laid off to make room in the budget to hire nurses.<\/p>\nBehavioral health specialists \u2014 workers who perform tasks such as distributing meals, helping patients with requests, and doing rounds \u2014 are \u201ccentral to the safety of the environment,\u201d said John Meier, CEO of Aurora Charter Oak Hospital in Covina. \u201cThey spend the most time with each patient each day.\u201d<\/p>\n
Some get waivers<\/p>\n
The California Department of Public Health has approved rule waivers for more than 20 hospitals, according to the CHA. Among them is Aurora Charter Oak, which has until Aug. 1 to comply. Hospital administrators there are using those extra two months to continue recruiting, hiring and training the approximately 85 new nurses needed to adhere to the new ratios.<\/p>\n
Meier said the new ratios mandate a \u201cstark operational change.\u201d<\/p>\n
\u201cThis is a regulation that sort of forces an overhaul,\u201d Meier said. \u201cI don\u2019t know if the system requires an overhaul.\u201d<\/p>\n
Barlow said the main concern with the waivers is the next six months. \u201cThe waivers will expire, and I think we are all very nervous about what will happen,\u201d she said. It\u2019s unclear whether the California Department of Public Health will grant extensions. \u201cThey need them to continue to work on hiring and avoid losing more beds,\u201d she said.<\/p>\n
Hiring nurses<\/p>\n
Al Senella, CEO and president of the Tarzana Treatment Centers, said the facility had to hire about eight new nurses to meet the new staffing ratios, plus cover associated costs with advertising and recruiting for these roles. That\u2019s \u201chundreds of thousands of dollars in additional payroll expenses that you don\u2019t have budgeted,\u201d he said.<\/p>\n
Tarzana Treatment Centers is in compliance, but if any nurses go on leave or resign, the hospital would be in trouble, he worried. \u201cSuddenly, boom, you\u2019re out of compliance,\u201d he said. He believes that with these new requirements, psychiatric hospitals are \u201cset up to fail.\u201d<\/p>\n
Glendora Hospital hired 28 additional nurses, and College Hospital Cerritos hired 70. In a joint statement, the hospitals said that because \u201cthe market for nurses is very tight,\u201d they were \u201cproactive and got an early start in anticipation of the ratios.\u201d<\/p>\n
For Dixon, these new ratios have been a largely positive shift. Before they were enacted, it was difficult for nurses to take breaks, she said. If someone went on break, she said, other nurses would be responsible for that nurse\u2019s patients. \u201cAt the end of the day, ratios are about giving every patient the attention and care that they need exactly when they need it.\u201d<\/p>\n
But Dixon acknowledged that the rollout of these new ratios has not been seamless. New hires are still going through training and orientation, which has \u201ccaused a lot of gaps\u201d and miscommunications that can be dangerous, she acknowledged.<\/p>\n
Staffing ratios apply to the night shift as well, Barlow said, which has been the \u201cbiggest problem\u201d for many hospitals. Previously, nighttime checks were typically performed by other staff. It\u2019s difficult to find nurses willing to do night shifts, even with increased pay, Barlow said.<\/p>\n
Barlow said some hospitals have experienced resignations in the wake of these new rules. \u201cWe\u2019re also hearing quite a bit of dissatisfaction among nurses themselves,\u201d she said. Nurses are being asked to do tasks that now-displaced workers used to take care of. \u201cThat\u2019s really not what a nurse went through extensive medical training to perform,\u201d she said.<\/p>\n
Nursing ratios are forcing hospitals to make \u201chard decisions,\u201d Meier agreed. \u201cBehavioral health care already operates with razor-thin margins, and adding an unfunded mandate to the tune of millions of dollars a year is something that really worries me,\u201d he said. He fears for the \u201cfinancial viability\u201d of behavioral health care without some kind of funding or relief.<\/p>\n
For some hospitals, it\u2019s been business-as-usual since the new regulation took effect. A representative from the Motion Picture & Television Fund, which operates a 12-bed geriatric psychiatric hospital in Woodland Hills for members of the entertainment industry and their families, said it \u201cis managing the changes without any bed reductions or service changes.\u201d<\/p>\n
Similarly, a spokesperson from the UCLA Resnick Neuropsychiatric Hospital said the facility \u201chas for years followed more stringent ratios that previously applied only to general acute care hospitals.\u201d<\/p>\n
\u2018One-size-fits-all\u2019 requirements<\/p>\n
Another concern, Senella said, is that the new \u201cone-size-fits-all\u201d requirements ignore the needs of individual hospitals.<\/p>\n
Tarzana Treatment Centers is a 60-bed facility that specializes in treating substance abuse disorders. \u201cWe\u2019re doing largely medical withdrawal management,\u201d Senella said.<\/p>\n
Unlike other hospitals that do involuntary holds, patients at the Tarzana Treatment Centers are there voluntarily, which is a \u201ccompletely different\u201d kind of care from what\u2019s provided in general acute hospitals, where patients are at a higher risk of harming themselves or others, he said. \u201cThe process didn\u2019t take us into account.\u201d<\/p>\n
Bed closures<\/p>\n
So far, Senella said he\u2019s managed to avoid layoffs and bed closures, but the threat looms. According to the California Hospital Association, psychiatric hospitals statewide have closed at least 67 beds even though nursing staffs have been increased.<\/p>\n
So far, Aurora Charter Oak Hospital has not had to close any of its 134 beds yet either. Because the financial penalties are so steep, \u201cbeing out of compliance is not an option,\u201d said CEO Meier, but bed closures are not off the table. The hospital, which operates 30 beds for patients younger than 18, has been hit especially hard by the more stringent requirements for adolescent patients, he said. It\u2019s one of only a handful of hospitals in the state that offer services for minors.<\/p>\n
When beds close, the demand for service doesn\u2019t disappear, Meier pointed out. Patients receive delayed treatment and often spend more time in emergency waiting rooms. \u201cThose patients have to go somewhere, and it creates a big increased responsibility on law enforcement,\u201d he said. The closure of inpatient beds \u201cforces more of their immediate intervention.\u201d<\/p>\n
Dixon said concerns about bed closures are overblown, and that if hospitals had to close beds, it would be temporary. \u201cIt\u2019s not about closing access,\u201d she said. \u201cIt\u2019s about making sure the beds that exist are actually safe for the patients to be in.\u201d<\/p>\n
If beds do close, this can create treatment delays, Barlow said. In the Central Valley, she said she\u2019d heard from hospitals where patients were \u201cwaiting days to be admitted.\u201d Under federal law, Barlow said emergency departments and psychiatric hospitals cannot turn anyone away \u2014 they must at least screen anyone who shows up.<\/p>\n
Senella also complained that it\u2019s been difficult to find nurses with experience in mental health and substance abuse treatment, which means new hires require significant training.<\/p>\n
Meier agreed that more training is needed, saying hospitals are hiring many recent nursing school grads. \u201cWhich is great,\u201d he said. \u201cBut someone who is fresh out of nursing school, they may require more training than someone who has worked in a psych facility for 10 years.<\/p>\n
\u201cWe are not going to hastily accelerate our training and orientation process simply to meet the ratios,\u201d he added.<\/p>\n
The Tarzana facility also has relied on on-call and traveling nurses, which Senella said they pay a \u201cpremium\u201d to have fill in. This is all compounded by the nationwide nursing shortage<\/a>, he said. \u201cThat is a major impediment to compliance,\u201d Senella said. \u201cIt\u2019s been a factor for years, it\u2019s worse now than ever, and no recognition of that at all in this process.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"Southern California psychiatric hospitals are scrambling to hire nurses to meet new state nurse-to-patient ratios that hospital representatives…\n","protected":false},"author":2,"featured_media":772954,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[59],"tags":[2356,4887,97,252,253,9447,13489,259,3,6011,329835,452],"class_list":["post-772953","post","type-post","status-publish","format-standard","has-post-thumbnail","category-health-care","tag-california","tag-california-news","tag-health","tag-health-care","tag-healthcare","tag-hospitals","tag-los-angeles-county","tag-mental-health","tag-news","tag-orange-county","tag-socal-watchdog","tag-top-stories"],"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts\/772953","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/comments?post=772953"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts\/772953\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/media\/772954"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/media?parent=772953"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/categories?post=772953"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/tags?post=772953"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}