beds (all for male patients). Regional Hospital Planning Board information system shows a 1965 occupancy rate exceeding 90%

B. Organization

St. Vincent Charity Hospital, operated by the Sisters of Charity of St. Augustine, has a well established Advisory Board and Medical Staff structure. The alcoholic unit is the responsibility of St. Vincent Charity Hospital, but the program is structured and conducted by Alcoholic Anonymous. Clinically, the alcoholic unit is considered under the Department of Medicine.

C. Community & Professional Support

"Friends of Rosary Hall", a group of Alocholic Anonymous Fellowship Members and other community leaders, have embarked upon a program to provide all of the $200,000 estimated cost as required to remodel and equip the space. This was the only condition placed on the availability of the space by the Sisters. The "Friends", as a Fellowship, cannot officially sponsor or sanction hospital facilities. However, through this mechanism approximately $100,000 has been obtained before St. Vincent Charity Hospital (or on behalf of or by the "Friends of Rosary Hall") formally sought official endorsement of this isolated, special purpose unit through the established channels with the Regional Hospital Planning Board, Capital Accounts Committee of the Welfare Federation, The Cleveland Chamber of Commerce, or Mental Health Planning Committee of the Welfare Federation.

III. SITE AND ENVIRONMENT

Located at 2222 Central Avenue in the central west portion of the City of Cleveland, St. Vincent Charity Hospital is situated within the St. Vincent urban renewal area. Due to renewal activities, land uses have altered around the hospital within the past few years. Currently the hospital is surrounded by lowcost housing, some commercial and service buildings, open space, and parking areas. St. Vincent Charity Hospital is engulfed by an expanding freeway system and other limited access roads that provide adequate accessability to points throughout Cuyahoga County. This transportation network further accelerates accessability to low-income areas served in the vicinity and to downtown locations. Public transportation is provided by the Cleveland Transit System.

Provisions for utilities-Electricity, Water, Sewage, Storm Drainage, have proved adequate for this site in the past.

In addition, St. Vincent Charity Hospital is effectively served in fire protection by the City of Cleveland.

Abundant parking accommodations are available through municipal parking

lots.

Nuisances, such as noise, dirt, or other environmental factors prevail to varied degrees, but not in crisis proportions at this time.

Population characteristics surrounding St. Vincent Charity Hospital show a population low in educational attainment and high in its unemployment rates. This is a predominantly Negro population, and is generally considered to be blue-collar workers. People are generally in a low income bracket, and many receive some form of government or communtiy aid.

IV. PLANNING CONSIDERATIONS

A. Architectural and Functional Programs

1. Architectural Program

a. Space Allocations-St. Vincent Charity Hospital proposes to renovate a second floor wing of the older hospital building into a 30 bed alcoholic unit. Like the current 15 bed unit, this expanded area (Rosary Hall) will be separated as much as possible from the general hospital area in order to obtain maximum benefits from group therapy.

It is estimated that the proposed alcoholic unit will include approximately 12,000 square feet of space. Estimated space allocations are:

Category

Patient Room Areas__.

Recreation Areas..

Utility and Corridor_

Patient Care Areas--‒‒

Total

Number of Sq. Ft.

3, 300 2,600 4, 400 1,700

12,000

b. Bed Allocations-Plans indicate 30 inpatient beds for Rosary Hall. 22 of these beds are for male patients and 8 are for female patients. In the current unit of 15 beds there are no bed allocations for female patients. It is anticipated there will be only 2 private rooms and 1 four-bed ward. Other divisions are 3 two-bed wards, and 6 three-bed wards. 2 of the two-bed wards are set aside for new patients.

c. Building Layout-Schematic drawings are not yet available. However, a preliminary layout of the area has been made and is attached. This layout depicts an entire wing of the second floor of the older hospital. The widest portion, the east end of the second floor wing, currently houses Rosary Hall.

In addition to the increase of 15 beds, the hospital's plans indicate space increments in dining room, meeting room, and kitchen facilities. Additional office space will be provided for admissions, counseling, examination and rehabilitation. Provisions will also be made for a chapel, a new library, a women's lounge and library, and a combination snack-recreation room.

2. Functional Program

a. St. Vincent Charity Hospital has provided alcoholic rehabilitation care since 1953. Through 1965 over 11,000 patients had been cared for in this program. The number of patients served in any one year have fluctuated from a high of 1,048 in 1957 to a low of 636 in 1965.

Regional Hospital Planning Board information system data reveals the following operational activities for three representative years:

In addition, St. Vincent Charity Hospital has operated a psychiatric unit since 1956. This unit currently total 34 beds, and in 1965 served 281 patients for 10,537 patient days for an occupancy rate of 84.9% and an average stay of 37.5 days.

b. The current program at Rosary Hall aims to restore the alcoholic to physical, mental, and moral health. The treatment is based on the recognition that alcoholism is a physical disease which has deleterious effects on mind, morals, and social attitudes. The program is in accordance with the philosophy and way of life described in the Twelve Steps and Twelve Traditions of Alcoholic Anonymous.

Rosary Hall is an integral part of the hospital, and has all the facilities of the hospital at its disposal. However, Rosary Hall is separate in its administrative functions. For instance, meals are served in a dining room and patients have access to a library and meeting room. Also, there is a separate chapel and administration office.

A Sister Director is appointed by the Sisters of Charity of St. Augustine to supervise the alcoholic unit. A Medical Director for Rosary Hall is appointed by the Hospital Director of Medicine. With this permanent appointed physician is a resident M.D. on call to assist in continuity of clinical care. Also, a psychiatrist is available once a week to consult with patients (only with their consent). Remaining staff includes-Graduate Nurses, AA Member, Volunteers, Nurses Aids, Secretary, with exception of non-pay volunteers, all of the staff are on the payroll of the hospital.

This program, structured and conducted by AA. but the responsibility of St. Vincent Charity Hospital, accepts patients strictly on a voluntary basis. Patients are admitted only under sponsorship of an active AA member. Rosary Hall's program is based on a stay of ten days (extended from six days in July 1965.)

Programmed for gradual withdrawal from alcohol for the first three days, the daily therapy is then added to the medical schedule. This continues in three general phases:

1) Group Meetings based on the Twelve Steps of AA, either with a speaker or discussion leader-a priest or AA Member.

2) Private discussion with counselors and visiting AA, and

3) Personal meditation and reading by the patient

Upon rehabilitation and then discharge, the sponsor assumes responsibility for the return to the community. No follow-up program, or referral to patient's physician, is conducted by Rosary Hall. In addition, no patient having once been discharged from Rosary Hall is permitted to return as a patient unless special circumstances seem to merit an exception to the rule.

In relation to payment for care at Rosary Hall, the patient is required, upon admittance, to complete a "reservation data" form. Here the patient indicates the nature of his insurance, i.e., Blue Cross or other (if so, what kind). If no insurance coverage exists, a deposit of $200.00 is required. Hospital authorities indicate that Blue Cross is the primary payor.

Additional plans for the future programming and staffing to handle the extended load are limited. Staffing hopes includes a full time doctor for better treatment and care of patients, and for research purposes. Plans also are to improve and increase the staff to include trained counsellors, psychologists, and social workers. Current hopes are limited to obtaining one worker experienced in AA and professionally trained. Rosary Hall also plans to establish communication channels with local community service agencies. Other indications are to establish an outpatient program to add follow-up assistance for problem drinkers. c. Financial Information:

1. Cost of Renovation.-The estimated cost of renovation is $200,000. This includes cost of remodeling and equipment. The total project cost per bed will approximate $6,700. Project cost per square foot will approximate $17.

2. Sources of Capital Funds.-St. Vincent Charity Hospital expects to finance the renovation project through the efforts of the "Friends of Rosary Hall". This group, composed of former patients and other individuals in the community interested in the alcoholic problem, hopes to raise the entire $200,000 from individual members of AA. their friends and relatives, industrial organizations, foundations, and others who are sympathetic with, and aware of, the alcoholic problem. One-half ($100,000) of the contributions are expected from individuals. Both individual and corporate solicitations have already started. The reported amount collected to date approximates $100,000. The Hospital Administration has a separate account for funds received for this project, isolated for this specific purpose. Contributions are being made to "Sisters of Charity-Rosary Hall Fund" in this crash program of less than sixty days duration.

V. DETERMINING BED NEED

In relation to all four types of services provided by St. Vincent Charity Hospital, areas of major concern for serving the population are indicated on the map attached. However, geographic areas to which St. Vincent Charity Hospital provides services certainly is not limited to these delineations. The patient care service area expands greatly in terms of patient origin for the alcoholic unit. These indications were presented by the Sister Director of Rosary Hall. This pattern is not unusual in specialized services that have few locations in a large regional area.

In addition, the nature or characteristics of the population served-the alcoholic patient-indicates an above average level of mobility. Adding credence to this regional nature of patient referral is the policy at St. Vincent Charity Hospital to not readmit any patient (within 5 years). In fact, if a former patient at any time, requires additional inpatient service, the patient will probably obtain this service at either St. Thomas Hospital in Akron or Bay View Hospital. It appears that hospitals are not, in general, receptive to admitting and providing rehabilitative care for alcoholic patients. Within the Regional Hospital Planning Board six-county region, St. Vincent Charity Hospital and Bay View Hospitals are the only hospitals providing special units for the care of alcoholic patients on an inpatient basis.

Other types of organizations that might provide assistance would be Stella Maris and/or The Cleveland House of Correction.

We can anticipate that with the extension in the rehabilitation program at Rosary Hall from six to ten days, the average length of stay for each case will likewise increase. Length of stay has changed upwards since 1961. The occu

pancy rate in 1965 for the alcoholic unit functioned at over the 90% level, with an average daily census of 13. Currently St. Vincent Charity Hospital has indicated a considerable increase in the patient load. It has been stated that as many as 20 patients have been housed on a given day. The Sister Director reported these overload patients were provided beds in the halls of the alcoholic unit. No substantial data has been presented to document the useage of any facilities for female alcoholic patients. However, like the above, no special inpatient facilities now exist in the area for female alcoholics.

VI. REGIONAL HOSPITAL PLANNING BOARD STAFF EVALUATION

This application has been presented to the Regional Hospital Planning Board only after considerable ground work and extensive solicitation activity has taken place. Not until recently has St. Vincent Charity Hospital approached proper organizations through the known established procedure to seek endorsement of this project. The Capital Accounts Committee of the Welfare Federation and the Cleveland Chamber of Commerce have taken no action, pending a decision of the Regional Hospital Planning Board.

Although attempts are being made to generate the funds for this project independently, without the active participation of Charity Hospital, it is clear that this program is, and will continue to be, a responsibility of Charity Hospital. The assets generated will be assets of Charity Hosiptal. The responsibility for the development of the facilities and the continued conduct of the program will be an ongoing responsibility of Charity Hospital. For these reasons, it would have been preferable for the institution to have accepted the responsibility for the promotion of this project through well established channels at the outset, as in all other development programs dependent for their success on the use of community resources.

With a reported $100,000 on hand, St. Vincent Charity Hospital requests quick action. The Sister Director desires this renovation project to begin as soon as possible. An expected completion date is July 1, 1967.

Currently, through Rosary Hall, St. Vincent Charity Hospital provides the primary inpatient care unit for alcoholic patients in the area. The proposed renovation of the unit would provide inpatient beds, not only for males, but also for females with alcoholic problems. All this still leaves a number of unanswered questions-to name a few:

1. It is apparent that there is a potential patient load for a unit such as Rosary Hall considerably beyond the capacity of the 30 beds proposed. We do not, however, have the ability to measure accurately the size of this load, ie.— what is the unmet need in this area beyond the capacity of Rosary Hall. This raises several questions, including, How can the need be measured? Should St. Vincent Charity, or other institutions be encouraged to expand this service further? What studies could be done to more accurately measure the need?

2. It is believed that large numbers of individuals have been returned to productive lives in the community through this program. The implication is that these lives, otherwise, would have been lost, and, instead, would have become economic drains on the community. Questions raised relate to the economic cost to the community as a result of the loss of such individuals, as opposed to the gain by successful treatment in returning the individuals to the community. Can we do a better job of establishing the economic values in such treatment programs?

3. Will Rosary Hall continue to serve a rather selective segment of the community-that is, only those sponsored by the AA Organization? Could it be enhanced by altering its intake policy or would such alteration of the intake policy, in fact, tend to hamper the effectiveness of the program?

4. What is the position of the Mental Health Planning Committee of the Welfare Federation and those professionals in the care of the mentally ill relative to this program?

IN SUMMARY, this staff report attempts to set forth significant facts surrounding this program and raises certain questions that appear to be of primary importance. As in all such Staff Reports, its intent is to place before the Facilities Review Committee sufficient background data, so that the committee can, in confidence, consider appropriate action.

Rosary Hall was established at St. Vincent Charity Hospital, Cleveland, Ohio in 1952 as a treatment center for alcoholic patients who admit having a drinking problem with which they cannot cope. Here they are prepared to make a decision for sobriety and are instructed how to reach that state and to maintain that goal. Inasmuch as Rosary Hall is an integral part of Charity Hospital, we have at our disposal all the facilities of the hospital. However, Rosary Hall is separate in its administrative functions and differs from the general plan of hospitals. For instance, meals are served in a dining room and patients have access to our combination library, meeting room and chapel. So as not to embarrass our patients and to put them at ease, sponsors are requested to bring them directly to Rosary Hall rather than the hospital admitting office.

A sister director, appointed by the Sisters of Charity of St. Augustine to supervise Rosary Hall, has a staff consisting of graduate nurses who are in attendance at all times. The staff also includes a physician who is appointed by the hospital director of medicine, a resident doctor on call, a full time counselor, nurses aides, a secretary and a relief staff. A.A. member volunteers are on hand every evening and on Saturday and Sunday to assist the director and the nurses. A psychiatrist is always available should there by a necessity to consult him.

Our facilities are not designed merely to sober up the alcoholic and then send him on his way. Rather, it is a rehabilitation center where the primary objective is for permanent sobriety.

Patients are admitted only under the sponsorship of an active member of Alcoholics Anonymous. When a request for the admittance of a man is made, the director advises that an active member of A.A. should call on the prospective patient to ascertain:

1. Is he in proper physical condition for admission, i.e., he must be able to walk.

2. Does he truly admit the presence of a problem and desire assistance.

3. Does he carry hospital insurance? If not, is he able to make the necessary financial arrangements at this time?