Board urges 'robust' support for Brattleboro Retreat
BRATTLEBORO — Select Board members "completely agree" with comments Gov. Phil Scott's made about the Brattleboro Retreat this month.
"Thank you for announcing in your State of the State address that the Brattleboro Retreat 'is simply too critical for us to let fail' and that its closure 'would have a devastating impact on our mental health system and the region's economy,'" Town Manager Peter Elwell said during the Select Board meeting Tuesday, reading from a letter to the governor signed by board members. "We completely agree. ... We are counting on you, your administration, the Legislature, and the Retreat's leadership to agree on a financial plan so these essential services continue to be available and so that this major employer continues to be an important economic driver for our region."
Reports of the not-for-profit specialty psychiatric and addiction treatment hospital potentially closing if the state could not provide additional funding preceded the Jan. 9 State of the State address. A few days earlier, Secretary of Human Services Mike Smith issued a statement blaming the need for increases on "alleviating a reoccurring financial
"Make no mistake, any threat of closure is both the decision and the result of the Retreat's current leadership," Smith said in the statement, referring to a letter from the hospital's board of trustees saying it would direct the CEO to plan to sell or close the institution if an agreement for funding could not be reached. "The agency has provided every reasonable financial option it can, but the Retreat is clearly at a point where significant management and operational changes are necessary to save it — and the jobs there. It is the responsibility of the Retreat's board to accomplish this task or assemble a team that can."
In his speech, Scott said he had directed his administration to help with "everything we can responsibly do to help the Retreat."
"We're very appreciative of the governor's recognition of our role in the state and his words of support," Louis Josephson, president and CEO of the Retreat, told the Reformer in an interview in his office Wednesday. "We've got to figure it out because Vermonters do need our services. And kudos to the Brattleboro community. I've gotta say, the support from the town and the townspeople has been remarkable."
Josephson described a meeting with Smith and the Agency of Human Services last week as productive. He expects to have weekly gatherings.
"We're still in a fragile position but I think we're on a productive path going forward," he said, noting that the talks involve balancing expectations of care with cost limitations. He anticipates that a third party might "come in and look at our operation and provide some assurances to the state."
The Select Board is calling for "a more robust state partnership with the Retreat."
"This is an issue of central importance to our constituents in Brattleboro, to our neighbors throughout Windham County and Vermont who depend on the Retreat for jobs and commerce, and — most importantly — to the individuals and families who depend on the Retreat to preserve and improve their very leaves," the letter states.
The board described the Retreat as "an important institution in our community for almost 200 years."
"Partnering with other health care providers, social service agencies, law enforcement, and others, the Retreat leverages its particular expertise in some of the most challenging aspects of our collective efforts to address mental illness and drug addiction," the letter states. "The Retreat provides essential services to Vermonters suffering such acute mental health issues that many other hospitals turn them away."
Before reading the letter during town manager's comments, Elwell said "unusual circumstances" prevented the document from getting on Tuesday night's Select Board agenda.
"There are just some things that evolved in a way that we didn't know last Friday when we warned the meeting that we would need to have this on this evening as part of this agenda," he said.
Elwell read the letter again at the ending of the meeting, right before the board approved sending it to the governor in a 4-0 vote.
The Windham County Legislative Delegation issued a statement the day Smith released his, saying that it "has been aware of ongoing financial challenges being experienced by the Brattleboro Retreat related to multi-year, inadequate Medicaid reimbursements, unexpected census declines, and the increasing cost of contract RNs and MDs due to national and state-wide workforce shortages."
"As we see play out every day across the country and our state, adequate funding for public healthcare remains an unsolved challenge," the statement continued. "Since Tropical Storm Irene, the Retreat has served as a contracted arm of the Agency of Human Services in the provision of state mental healthcare services. This means the Retreat has repeatedly been faced with decision making that requires it prioritize the public good over profit ... We support the decisions the Retreat has made to answer the Agency of Human Services' repeated requests to expand its state beds and services in order to help the State of Vermont provide mental healthcare to Vermonters in the most acute need."
Josephson has been using what he calls a "corny analogy" in which he compares the Retreat to a fire station: Even if a community has a year where there are less fires, it will still want the station and crews in place to fight them.
Currently, the Retreat has a high demand for spaces for children and adolescents.
"It feels like we could have more beds than we have online now and be full," Josephson said. "But in the summer, we have always historically dipped down."
He said after using much of the reserve funds in previous years, the Retreat is very dependent on revenue. While there may be times with less patients, operational expenses remain.
The hospital tends to have lower patient counts in the summer and holiday season, Josephson said. He estimated that about 15 percent of patients have commercial insurance and the majority have Medicaid and/or Medicare. The former is paid out by the state and the latter comes from the federal government.
Josephson said after Tropical Storm Irene in 2011, the Retreat went six or more years without rate increases in Medicaid and deficits would be covered with reserve funds.
"So we're exquisitely sensitive to the census now," he said. "Now, we're really living more paycheck to paycheck. That makes it much harder."
Josephson said the Retreat did not want these issues to be dealt with in such a public way. But he has received correspondence from patients telling him stories of their treatment or how they hospital saved their life.
"That's just been heartening to hear all of that," he said. "And I take the governor at his word. We will be here."
After some town hall-style meetings with the staff, Josephson described himself as "encouraged."
"I think we're going to come out on better footing," he said. "We've really lost no staff. Nobody's left, which is really wonderful ... Everyone seems united, committed to their jobs, committed to the Retreat. So that has been very gratifying."
Looking at portraits of his predecessors and reports that go back a couple of centuries, Josephson said he is "reminded we've been different things in different eras."
"We've been here a long time," he said. "Maybe we're going through a transition period that's hard, scary. We've been here for Vermonters for a long time. Who knows? We may look a little differently."
He anticipates 12 additional hospital beds set to open at the Retreat this summer will help a little with revenue.
Reach staff writer Chris Mays at firstname.lastname@example.org, at @CMaysBR on Twitter and 802-254-2311, ext. 273.
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