S99. REDUCTIONS IN INPATIENT AND RESIDENTIAL PROGRAM BED UTILIZATION AFTER FOSTER CARE PLACEMENT

Abstract

Background: Integrated community residential care for individuals with serious mental illness originated more than 600 years ago in Geel, Belgium, when individuals with mental illness symptoms seeking a miraculous cure would travel to a shrine at the Church of St. Dimphna. When the number of pilgrims exceeded the church's ability to house them, local villagers accommodated them. These lodging negotiations between the villager and the ill person's family were supervised by church authorities until the mid-19th century, when this supervisory authority was transferred to governmental agencies. Over the years Geel's family care system attracted the attention of prominent health care leaders, and in 1885 the first Geel-based system of care was implemented in the U.S. as an experiment by several Massachusetts state hospitals. Since the 1950s the Department of Veterans Affairs (DVA) has administered its own foster care program, the Community Residential Care (CRC) Program, which places Veterans by mutual agreement in privately owned and operated board and care homes. The CRC program's role is to match the Veteran's individual needs and financial means with the capabilities and social environment of the home, to provide ongoing support to the Veteran and the homeowner in the form of regular visits and logistical assistance by a case manager, and to ensure that the home maintains minimum quality standards. The Veteran pays the homeowner directly for room and board, but VA oversees this financial arrangement to ensure it is fair and reasonable. The CRC program of the VA Boston Healthcare System tracks pre- and post-placement bed utilization as a component of its ongoing internal quality improvement evaluation activity because effective long-term care planning should lead to less frequent use of higher intensity treatment services. The present work represents a formal analysis of inpatient and residential treatment program bed utilization data before and after placement in a CRC program home for a consecutive cohort of Veterans placed during a 6-year period. Method(s): All Veterans placed in a Community Residential Care (CRC) program home from October 2007 through September 2013 were included. Bed days during symmetric pre- and post-placement time intervals were counted for each patient (hospital: psychiatric, acute medical, substance use detoxification, or physical rehabilitation; and any mental health residential treatment program). If a patient was placed more than once, bed days were averaged across placements. The paired-sample t test was used to compare pre- and post-placement bed days by bed type. Result(s): The cohort consisted of 140 Veterans (11 women) with 159 CRC placements (median placement duration 562 days). Post-placement bed days were significantly reduced only for psychiatric hospitalization and residential treatment. The mean post-placement reduction of psychiatric bed utilization was 77.5%, and residential treatment program bed utilization showed a mean 99.8% reduction. Multiple placement was not associated with age or sex, but patients with multiple placements were more likely to be diagnosed with schizoaffective disorder (75.0% vs 41.1%, Fisher's exact p= .015) or alcohol use disorder (62.5% vs 31.5%, Fisher's exact p= .024). Discussion(s): Foster care is associated with significant reductions in psychiatric hospital and mental health residential treatment program utilization and has the potential to reduce long-term costs associated with persistent serious mental illness.