Psychiatric facilities across Kansas added enough beds last year to potentially dramatically cut the number of children waiting for intensive mental health care.
But about 100 of those spots remain empty — in large part because organizations can’t find workers.
In recent years, children have had to wait months for openings in specialized facilities that offer long-term psychiatric care. In mid-2018, the average wait neared 200 days.
The waits fell in 2019 and 2020. As of last month, the average wait stood at 44 days.
Yet 146 remain in line for their turn, even though 104 beds are open.
Despite significant efforts to expand capacity, the residential care centers have hit fresh roadblocks.
They’re struggling to compete in the current labor market. They need to fill shifts around the clock for physically and emotionally taxing work that sometimes pays less than $15 an hour.
And hiking wages is no simple task.
Take KidsTLC in Olathe. It’s searching for the money to make that happen, while also nudging the state of Kansas to help it explore other incentives. Those could range from college tuition waivers and signing bonuses to subsidies for health insurance or child care.
KidsTLC bought land in March 2020 to add another 50 beds for children.
The expansion included specialized units for children with the most severe traumas and disorders, who often face the longest waits for placement — such as a program for victims of sex abuse who lash out sexually.
That work finished in December, nearly doubling KidsTLC’s residential capacity. It hoped to fill the spots in two or three months, but 45 of the new beds remain empty.
“We had space, we were licensed, and were feeling just exceptional about that and being able to make a significant dent in that waitlist,” CEO Erin Dugan said. “And then it became really hard to hire staff.”
Longer-term care
Nonprofit facilities offer more than 400 beds for long-term psychiatric care of youths across Kansas. Many of those slots were added within the past year and a half as the administration of Gov. Laura Kelly worked to license more beds and reduce wait times.
“So we are proud of the improvement,” said Andrew Brown, the state’s commissioner of behavioral health services, “but ideally we would like to get to the point where people didn’t have to wait even a month, right? We’d like to get to the point where the average time is about a week or less.”
Psychiatric residential treatment facilities are for children and youths whose conditions don’t improve through other care. They may struggle with severe depression, for example, or attachment disorders resulting from childhood abuse.
Those services are different from acute mental health care. Children at risk of harming themselves, for example, can get immediate short-term care. But when they walk out of the hospital, the residential program that some may need for weeks or months of follow-up treatment takes longer to get into.
KidsTLC wants to fill its empty beds, but won’t until it has the personnel to do so safely. It has almost 300 workers but wants about 425.
The agency hasn’t struggled to recruit and retain therapists and other salaried specialists. Hourly staff trained to work on site 24-7 are a different matter. Dugan hopes more applicants — who must be at least 21 years old — will materialize as the pandemic winds down.
She isn’t counting on it.
Her organization offers $14-an-hour starting pay. It was working toward $15 before the pandemic hit, and is now considering $16.
“These folks need to be paid more, so that it is a living wage and they can take care of their families and do the job they love and make an impact in the community,” she said. “The Amazons of the world, the FedEx, the places where 21-year-olds go to work — they’re paying $18, $19, $20.”
Hiking pay will require significant fundraising by KidsTLC, which gets paid by Medicaid for its patients.
Medicaid rates are widely considered low compared to private health insurance. KidsTLC expects Medicaid would likely eventually increase its payments in recognition of the higher hourly pay, but it says adjustments like that take six months to a year to kick in and won’t help retroactively.
“We are this month sitting down to say, how do we find this large infusion of dollars, to at least get our minimum wage to 15 or 16?” Dugan said. “How does KidsTLC find a couple million dollars? It’s not sitting around. We don’t have a couple millions of dollars sitting around.”
She said the state is also encouraging her to put together cost estimates for her other ideas, such as child care subsidies.
Aetna paperwork delays
Meanwhile, the state has called on one of its Medicaid contractors to reduce wait times for kids.
The Kansas Medicaid system — also known as KanCare — is privatized. Anyone on Medicaid falls under one of three private companies that run the program: Aetna Better Health of Kansas, Sunflower or UnitedHealthcare.
Those companies review and approve applications for residential treatment. But after the state began tracking wait times by company in 2019, it revealed that children with Aetna waited significantly longer than those with Sunflower or UnitedHealthcare. The company appeared to have problems promptly gathering paperwork such as parental releases to get children in line for care.
“We hope that we will see improvements,” Brown said.
In a statement to the Kansas News Service, Aetna said it took swift action after the state pointed out the problem.
“We immediately took steps to review our process, identify causes for delays, and implement the changes necessary to minimize interruptions in care for our members,” the statement says. “As a result of our internal review we have modified our processes to eliminate avoidable delays.”
Editor’s note: This story was reported in memory of KCUR reporter Aviva Okeson-Haberman, a dedicated journalist who began the research for it and submitted the open records requests shortly before her death.
Celia Llopis-Jepsen reports on consumer health for the Kansas News Service. You can follow her on Twitter @celia_LJ or email her at celia (at) kcur (dot) org.
The Kansas News Service is a collaboration of KCUR, Kansas Public Radio, KMUW and High Plains Public Radio focused on health, the social determinants of health and their connection to public policy.
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