VALLEY FALLS, Kansas — Dennis Ritchey stands in the kitchen of his modest apartment. He calls it efficient, but likes that it has plenty of cabinets.
Most importantly, that kitchen and the rest of the one-bedroom place are his, and his alone. Much like his life more broadly.
His life now stands in sharp contrast to the six years he spent in one of the state’s 10 nursing facilities for mental health. He couldn’t set his own schedule or typically come and go as he pleased.
Now, things are different. He tends to bird feeders outside his apartment window and has freedoms he didn’t enjoy before.
“Eat what I want. Watch what I want on TV. Go to bed when I want to. Get up when I want to,” he said. “I’ve been doing great ever since I left.”
The nursing homes serve as sort of a midpoint between state mental hospitals for people with the most serious problems and community mental health centers for those who need far less help.
Those mid-way outposts in state’s mental health care system — privately owned, taxpayer-funded — have long been a source of concern. That’s partly because the job of looking after people dealing with bipolar disorder, schizophrenia and a range of other problems is inherently difficult. It’s balancing treatment with giving patients a chance to thrive on their own.
A recent report from the Disability Rights Center of Kansas suggests the nursing homes are failing the state’s mentally ill, essentially warehousing people rather than giving them what they need to move on to more independent lives.
The report argues that more people could be living at home and using community-based services. State officials and the nursing home industry see room for improvement but say it will take a more significant remake of the state’s mental health system.
Ritchey isn’t sure what diagnosis sent him to the nursing home in 2011. He’d hit a rough patch and landed in a homeless shelter and mental facility in Lawrence before going to the nursing home. At first, he thought his stay would be short.
“Ninety days went by. Six months. A year. Two years,” he said. “Nobody said nothing to me.”
He got out of the facility in 2017 with the help of Kip Elliot, an attorney with the Disability Rights Center of Kansas. Elliot serves on the board of the local animal shelter, and he helped Ritchey start volunteering and later working there.
Elliot knew that the nursing facility wasn’t the right place for Ritchey.
“When I met Dennis and started seeing him more,” Elliot said, “(there was) absolutely no reason for him to be there.”
Getting Ritchey out wasn’t easy. Elliot said some of that was difficulty working with the facility and the state. But the challenges included lining up the services Ritchey would need, such as an apartment and care for his diabetes.
“That’s one of our biggest issues,” Elliot said. “Community supports, what people need, housing. It’s just not there.”
An attorney for the company that owns the facility where Ritchey lived, Midwest Health, did not respond to a request for comment. The administrator of the Valley Falls facility initially agreed to show the home and comment on the report, but later didn’t respond.
'Warehouses'
The Disability Rights Center of Kansas published the report calling the nursing homes warehouses. The group surveyed around half of the more than 600 residents of the homes, and 70% wanted to leave and find what support they needed on the outside.
“It’s just a lack of imagination (that) has caused this to happen,” said Rocky Nichols, executive director of the center. “People go to these places. They get stuck in these institutions, and it becomes very difficult for them to get out.”
The report also argues the state is violating the law by institutionalizing people who could live on their own if they received services in the community.
“That’s the textbook definition of unnecessary institutionalization,” Nichols said.
But the head of the advocacy group that represents the mental health nursing homes contends the report doesn’t paint a fair picture.
“These are not warehouses. These are people’s homes,” said Cindy Luxem, president and CEO of the Kansas Health Care Association. “They have no place else to go.”
There simply aren’t enough community-based services right now to take on people in the nursing homes, Luxem said.
She also wasn’t surprised by the survey results, because people often don’t want to live in nursing homes. But she said that doesn’t mean caregivers and family members would always agree that other places offer better results.
“Some of these are tied with not only mental health, but substance abuse issues,” she said. “They don’t have the wherewithal to be safe in the community.”
An alternative
Patrick Schmitz walks through mural-filled hallways at the Bert Nash Community Mental Health Center in Lawrence, where he’s the chief executive officer. The multi-colored paintings depict grassy rolling hills and colorful night skies. They’re meant to make the section for children more welcoming.
This facility offers a variety of treatments for conditions including depression, anxiety and childhood behavioral issues. They have about 20 spots in a long-term residential program, but most of the 5,000 people they serve annually are on an outpatient basis.
“The vast majority of people we treat are everyday people out in our community who come here for an hour of service,” he said. “(They) go back to work, go back to home.”
Schmitz calls those community-based facilities the front door to the mental health care system. They evaluate people in crisis and help route them to the correct services. They offer treatment as well as assistance with life skills and help navigating government programs.
The Disability Rights Center argues more people should be removed from the nursing homes and instead served at facilities like this one.
Funding for the state’s 26 community mental health centers dropped almost by half over a decade before creeping up in recent years, the report shows.
Even when budgets for those community facilities got cut deeply, funding for nursing homes went up.
“The disparity in how Kansas supports institutions versus community-based services is downright shocking,” the DRC wrote in the report.
A broader approach
There’s a common theme when talking to people about this issue. Community-based mental health services exist, but there’s a lack of availability in certain areas and a persistent shortage of housing needed for people leaving the nursing homes.
“This has to be tackled from a system-wide perspective,” said Shawn Sullivan, a former official in the administration of governors Sam Brownback and Jeff Colyer. Sullivan is now vice president at Mission Health Communities.
Mission Health oversees five of the nursing facilities in Kansas, and he agrees improvements are needed. They need to focus more on discharge planning and preparing residents with life skills so they can leave. But, there must be places for them to go.
“The number one challenge is a lack of affordable housing,” he said. “It’s just not there in a lot of parts of the state. And the places where there is affordable housing, then there may not be the services.”
Tight funding for community mental health centers in recent years has led to longer waits to see patients. It’s also sometimes meant cuts to programs or trouble recruiting and retaining staff.
The centers are ready to take part in a larger change to the mental health system, said Kyle Kessler, executive director of the Association of Community Mental Health Centers of Kansas. However, they can’t take on patients from the nursing homes without additional funding to go with it.
“To do anything within existing resources would mean we were taking from some other need,” Kessler said. “We need to identify additional funding.”
Kessler said expanding Medicaid is one of those steps. It would bolster the budgets of community mental health centers because they’d treat fewer uninsured people. Expansion supporters so far haven’t advanced an expansion bill through the Legislature.
The state is pursuing a waiver that would allow for Medicaid funding to flow to the mental health nursing homes. That could, in turn, jumpstart programs that offer job assistance or other services to help people move out of the facilities. In addition, recent changes mean Medicaid funding could be used for needed housing services.
Laura Howard, the secretary of both the Department for Children and Families and the Kansas Department for Aging and Disability Services, said the state needs to make progress on changes that make it easier for people to live somewhere besides nursing homes.
“The last thing that I would want to do,” she said, “is encourage us to move too quickly and not have the services and supports in place for the individuals.”
Stephen Koranda is Statehouse reporter for Kansas Public Radio and the Kansas News Service, a collaboration of KCUR, Kansas Public Radio, KMUW and High Plains Public Radio covering health, education and politics. Follow him on Twitter @kprkoranda or email skoranda (at) ku (dot) edu.
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