of Mental Health, and his special assistant, Mr. Robert Lanier, and Dr. Jerome Hammerman, assistant professor at the School of Social Services Administration of the University of Chicago, to take these three chairs here. Gentlemen, I wonder if you could each identify yourself and it will not be necessary to swear you in. We want to welcome you. I am very apologetic about having you wait so long. Senator Stevenson and I were quite convinced that we could end the hearings by 1 o'clock, as we have both made unbreakable commitments to leave. Would Dr. Snoke please also come forward. Dr. Snoke, would you come forward as chairman of the State task force. Senator Stevenson and I will have to leave now. I would like to authorize and direct Mr. William Oriol, staff director for this committee, to take the chair now, and I can assure you that not only Senator Stevenson and I will read very carefully everything that you have to say as soon as the record is available to us early next week, but will also communicate with you should we find other areas. However, I can assure you that the staff will be drawing out for the public good from you, your expertise and knowledge in these fields, and that will be made available to the entire U.S. Senate. If, before we leave, there is any comment you would like to make, we would be happy to hear from you, but I am deeply sorry that we have come to the time when both of us must leave, but most appreciative of your being here, and we value your judgment and opinions and we will assure you that we will follow through on them. We took a far greater amount of time with our last witness than we ever anticipated that we would, of course. Senator STEVENSON. I want to add my apologies at having to leave the hearing. I have to catch an airplane to go to Rock Island. I want to back up what Senator Percy said, and I too, will read the testimony and profit from your contributions. I am very grateful to you and I apologize again for having to leave. (Senators Percy and Stevenson then left the hearings.) Mr. ORIOL. Dr. Glass, would you care to proceed? Dr. GLASS. Yes. I have a prepared statement which I think we have copies of. Dr. GLASS. I would like to read the statement, and you may inter rupt us with questions. Mr. ORIOL. If we interrupt you we will assure you that the whole text will be included as given here. STATEMENT OF DR. ALBERT GLASS, DIRECTOR, ILLINOIS Dr. GLASS. Thank you. The placement of elderly patients from State mental hospitals into nursing homes has been a common practice in Illinois as else where for some years. Available statistical data indicate that the largest decline of elderly patients (65 years and older), in Illinois State mental hospitals over the past 6 years, which included placement in nursing homes, occurred in fiscal 1968-69. I call your attention to the chart numbered 1 which demonstrates this in the presentation.* GERIATRIC TRANSFER PROGRAM Beginning early in fiscal 1970, the present State administration established screening and selective placement procedures for elderly, geriatric, admissions to state mental hospitals. By statutes commonly known as the Copeland bills, the definition of persons in need of mental treatment was amended in the Mental Health Code as follows: This term does not include a person whose mental processes have merely been weakened or impaired by reason of advanced years. The statutes also provided for a preadmissions screening examination period of 7 days for elderly persons with presumed mental disorders, which could be accomplished at general hospitals or at State mental hospitals to determine the need for mental hospitalization or other appropriate services, including nursing home placement. We have copies of the two Copeland bills introduced by Senator Copeland. The objective of the preadmissions screening procedure is to prevent unnecessary admissions to State mental hospitals of aged persons with predominantly physical diseases. In practice, however, admissions of aged to State mental hospitals declined only slightly because proper alternatives to mental hospitalization were not readily available. Thus in default, most aged persons, 88 percent, after preadmission evaluation, were still admitted to the State mental hospitals. Admissions of this aged group have continued at the rate of 150-200 per month, which produced a need for establishing selective placement in appropriate long-term-care facilities. Mr. ORIOL. May I interrupt Dr. Glass? Dr. GLASS. Yes. Mr. ORIOL. What you just said is that you agreed to the concept of preadmission evaluation, or precommitment agreement. Dr. GLASS. No, preadmission. Mr. ORIOL. Preadmission? Dr. GLASS. Yes. PEOPLE DIDN'T BELONG IN MENTAL INSTITUTIONS? Mr. ORIOL. On the grounds that the people really didn't belong in the mental institution? Dr. GLASS. Yes. They had mainly physical diseases, and this was the thrust of, or the purpose of the Copeland bills. Mr. ORIOL. But because appropriate alternative facilities were not available, they did enter the State institution. *See appendix 1, item 4, p. 1352. Dr. GLASS. 88 percent, yes sir. Mr. ORIOL. Now, what appropriate alternative facilities were you looking for? Dr. GLASS. Well, appropriate alternative facilities like home. health care or the ability of a family to take care of their elderly member, or general hospitalization or nursing home care. As I say, if these alternatives were not appropriately available it would take much more time than the 7 days. Mr. ORIOL. Why were nursing homes not available, or why weren't they applicable or appropriate? Dr. GLASS. The problem of getting, of helping these people obtain placement, and under the proper financial auspices would take more time than the 7 days, and usually it took several days to accomplish and reach a decision. So there wasn't sufficient time then to accomplish either the placement in a nursing facility, finding one, and so forth, near their home and all of that, or neither was there, in most instances, sufficient family help and support, or their own financial support or home health care, or some other way of solving the problem. Mr. ORIOL. You see what I am leading up to? Under the Copeland bill, they accelerate discharge on one hand and tried to prevent overadmissions on the other hand. Dr. GLASS. I beg to differ with you about the accelerated discharges. I haven't said anything about that. Mr. ORIOL. No. Dr. GLASS. You are informed that there were, and I want to go into that, but there was no accelerated discharge. Mr. ORIOL. Well, let me pursue this for a moment. Who would prescreen the nursing home to determine whether or not it was appropriate? Dr. GLASS. It could have been Mr. ORIOL. For people who are discharged it is quite often appropriate. BILL MANDATES FORMAL ADMISSION AFTER 7 DAYS Dr. GLASS. It could have been appropriate, but what I am saying is that in a 7-day period when an elderly person arrives from a mental home, evaluations must be done, lab tests must be done, and there just isn't enough time. Mr. ORIOL. Why couldn't you extend the period? Dr. GLASS. The law says 7 days. Mr. ORIOL. I see. Dr. GLASS. And then most of them entered the hospital and that made the fact that they came in-the fact that they came in made necessary a selective placement program thereafter, when you did have enough time in the mental hospital. You see, the admission procedure under the law was not completed during the 7-day period. Then formal admission took place at the end of 7 days. The bill only mandated 7 days. Mr. ORIOL. Roughly what average age were these patients who went through this preadmission? Dr. GLASS. The average age of the preadmission, of these individuals coming directly to the State mental hospitals, is approximately 72 years. Mr. ORIOL. Seventy-two? Dr. GLASS. Yes. Over 65 but they may be 85 or, in some instances, even 90. So we are talking about a group of elderly people with the prescreening examination which is done at the mental hospital which is under the statute which states a 7-day period. Now, in some instances when the family could assume care, or the family could have resources, financial resources to pay for care, that could be accomplished, but in most instances, 88 percent, that could not be accomplished. This then made it mandatory that we establish a placement program thereafter for them, so as to accomplish those matters which could not be accomplished in the 7-day period. Mr. ORIOL. I am sorry I interrupted you. Do you want to go on now? Dr. GLASS. Now, I want to point out that a relatively small number, 35 to 40 per month, reach age 65 from the existing patient population of State mental hospitals, which number is more than offset by attrition due to discharge and death. What I am pointing out, is that it is the number coming in that constitutes the reason for the placement procedure. To accomplish placement of the appropriate elderly patients from State mental hospitals in licensed facilities, a Geriatric Transfer Program, which you have heard about, was instituted in the fall of 1969, which includes the following procedural phases: In other words, persons who entered, having physical illnesses, we felt were not proper subjects for placements. Some had physical illnesses, some had had surgery and were being treated. THE FIRST STEP IN THE PROCEDURE IS SELECTION It is the responsiblity of the hospital staff to select those elderly patients who no longer require hospitalization for physical or mental disorders but need nursing care or a supervised living arrangement. In effect, selection for placement was confined to those patients with physical disorders such as heart disease, diabetes, anemia, vascular disease, or other systemic illness which were sufficiently controlled and stabilized. Aged patients who have progressive severe physical disease are maintained in the hospital. SECOND: PREPARATION Family members are informed by letter that hospitalization is no longer needed and that nursing or supervised care is indicated. A request is made for cooperation and assistance in the placement. Application is made to the department of public aid for medical assistance to the aged in order to provide payment for placement which is needed in the vast majority of aged patients. That is, the financial part is needed. The patients are prepared for transfer in special programs at the hospital which involve upgrading of self-help skills and other activities. A recent physical examination with laboratory tests is performed and summarized to include personal care needs, diet and medication, so that all necessary information will be readily available to the placement facility. THIRD: PLACEMENT Upon the completion of the second phase, State health department personnel are requested to locate a suitable vacancy in a licensed community facility near or at the site of the patient's origin. When all arrangements have been made, the placement is implemented. FOURTH FOLLOWUP Upon transfer, followup staff are assigned to visit the patient periodically in his new setting and to evaluate his needs and the program within the community placement facility. Currently 165 personnel are fully engaged in this followup responsibility. More staff are to be added. Staff are continuously being allocated to this followup program from their former assignments as patient-care staff within the mental hospitals. It should be understood that these personnel are not inspectors. Their role is to help community facilities improve programs designed to help the patient achieve a more gratifying life and a more self-reliant status. Mr. ORIOL. I would just like to understand this: A person who had been in a mental hospital and who had been discharged to a nursing home, let us say Dr. GLASS. Yes. Mr. ORIOL. How often would the followup staff visit this person, or would they not visit that person in a nursing home? Dr. GLASS. Yes, well, let me explain that since last fall when this program came on, and we have continually allocated more and more people until we have 165 personnel in the mental health section, and according to the code, we were required to visit every 3 months and we promptly lowered it to every month and now, as indicated, we will visit more often. Mr. ORIOL. Well, so these followup personnel do go to the nursing homes? Dr. GLASS. Oh, yes. Mr. ORIOL. And when they do go to nursing homes what do they determine? What do they look for? FOLLOWUP PERSONNEL'S INTEREST IS PROGRAM Dr. GLASS. Their interest is program. The program provided for the patients of the nursing home, that is their role. We are talking about other things, but their program has to do with the homes program and activities. |