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VA facility cuts beds as focus shifts to treatment and reintegration
Mail Tribune - 4/23/2017
April 23--Ashley Hanson, a 36-year-old Army veteran, arrived at the Southern Oregon Rehabilitation Center and Clinics in February with only the clothes on his back -- a Hanes T-shirt, a jacket and a pair of jeans.
He'd been homeless since Dec. 21 and under the influence of drugs and alcohol for much longer.
"I started using when I was 13 years old -- marijuana and alcohol -- and then I stopped when I was in the military -- other than alcohol -- and picked it back up again in college," he said.
"I lost everything because of my substance abuse issues," he said. "I let some people in my life that I shouldn't have."
Hanson completed the 27-day substance abuse program at the Roseburg Veterans Affairs Medical Center before transitioning to the White City facility to continue his treatment and participate in a program for homeless vets.
"I was 40 pounds lighter Dec. 21 and had four substances in my body, and I've been sober ever since," he said proudly. (Saturday marked the four-month anniversary of his sobriety.)
SORCC gave him additional clothes, his own room, a paid job on campus and extracurricular opportunities, such as leather work classes and hiking excursions.
"The VA has a really holistic approach," Hanson said. "I have a care coordinator, a rec therapist, a nutritionist and a spiritual strength class with the chaplain.
"Everybody is just really, I don't know," he said, breaking down. "It's incredible."
Local VA officials have had their hands full this past year changing the culture of the SORCC from a domiciliary and "old soldier home" to a mental health and substance abuse treatment facility as mandated by new federal regulations.
And already, they've seen progress.
Between March 2016 and March 2017, the SORCC's total graduation rate jumped from about 55 percent to 80 percent, thanks in part to new, evidence-based practices and concurrent treatment programs, said Michael Weld, the facility's chief of residential care.
"Before that, people sat around with too much time on their hands and figured out how to fill it in ways that weren't social and healthy," he said.
The White City facility first opened as a domiciliary in 1949 but was converted into a treatment facility in 1995. It is currently the largest, free-standing treatment facility in the country.
"It went from being a place to live if you had no other resources to an environment where there were clinicians and treatment was being provided," Weld said.
For about 15 years, individual VA facilities were allowed to organize their operations independently, based on the needs in their respective areas, during which time the SORCC clung to many of its old ways.
Then in December 2010, the Veterans Health Administration released a handbook establishing admissions processes, reporting requirements, safety standards, staffing levels and more.
The SORCC is the last of large -- more than 100 beds -- residential facilities to undergo a residential redesign, Weld said.
In September 2016, the SORCC reduced the number of beds from 525 to 366, and it may scale back even further in the future, Weld said.
"Part of the redesign was to look at safety and security issues," he said. "At one point in time, we had 11 buildings with residences and 33 wings in those, so maintaining a safe, secure environment was difficult.
"To staff 525 beds per the handbook, we would have needed 231 frontline staff just to make sure there was no contraband coming in and to do welfare checks, room inspections and orientation," he said, adding that at the time, SORCC had only about 36 frontline staff.
None of the buildings on campus, now more than 70 years old, met seismic requirements. Six of the residential buildings have since been replaced, one is under construction and will be ready for occupancy this summer, and one will be torn down and rebuilt later this year. Two former residential buildings will be converted into treatment buildings, making it easier for residents to access clinicians and their treatment teams, and a third will house Choice Program staff. (Choice Program allows those enrolled in VA health care to receive medical treatment within their community.)
No one was displaced as a result of the downsizing or the construction, Weld said, adding that the SORCC has never run at capacity.
As of Wednesday morning, only 132 of the beds at the SORCC were occupied.
In the past, occupancy has varied by season as veteran "snowbirds" traveled from VA facility to VA facility, living in the residences and, in some cases, participating in the compensated Work Therapy Programs until their time was up, Weld said.
"The veteran grapevine is incredible," said SORCC spokeswoman Rhonda Haney. "We had veterans showing up here who expected to be able to stay for 18 months because they'd talked to other veterans who'd stayed that long."
Under the new VA guidelines, veterans receiving residential care are required to participate in at least four hours of treatment per day.
While the SORCC is not designed to be a shelter, veterans experiencing homelessness can enroll in the Community Reintegration Program to gain skills necessary to find housing and employment in the community, Weld said.
Although there are fewer beds, SORCC officials believe they will be able to serve as many as 1,250 veterans, compared with 1,100 in the last fiscal year, by improving the admissions process and allowing veterans to participate in more than one treatment program at a time.
Previously, admission was determined by a two- or three-person team of social workers. Now, each veteran's case is reviewed by a full interdisciplinary team, including a primary care provider, the three program managers and the admissions coordinator, who receive input from psychiatrists, psychologists, pharmacists and chaplains, to determine the best fit for the veteran, Weld said.
Based on the needs of its veteran population, the SORCC condensed its programming to address mental health issues and substance use disorder and provide housing and vocational rehabilitation.
Under the old model, veterans could participate in only one treatment program at a time and, therefore, stayed for longer periods.
"Veterans might be here four to six weeks before they started programming, and then go through six weeks of intensive substance use treatment, and then if they had mental health needs, they might have to wait another four to six weeks to begin that program," Weld said, adding that previously the average length of stay was 187 days.
Now, the SORCC offers three programs -- two that address mental health and substance use disorders simultaneously and one that helps veterans who may be homeless reintegrate into the community. Depending on the veteran's individual treatment plan, the projected length of stay is between 30 and 120 days for those in either of the first two programs and up to 180 days for those in the reintegration program.
However, the reintegration program could take longer if there is no housing available in the area, Weld said.
Veterans admitted before Oct. 1 were grandfathered in under the old time table, which frustrated some of the veterans admitted after Oct. 1 who were discharged after less time.
Don Norris was admitted into a substance abuse treatment program prior to Oct. 1 and, therefore, allowed to stay until his time was up, March 22.
"A lot of people I'm seeing are being told to leave after (about) 45 days," he said.
"There are so many empty beds in this place, I just don't get it. It's sad and ridiculous," he added.
Norris said he has no complaints about his own experience, as he is one of the "fortunate ones" who was able to stay more than five months and got everything he'd asked for.
Weld clarified that SORCC is not kicking people to the curb.
"There have been some instances where (veterans) have come to the end of their treatment plan, and they are unwilling to utilize the resources in the community," he said.
SORCC also has improved its outpatient services by hiring more staff, including dedicated post traumatic stress disorder and substance use disorder providers and therapists.
"It's more beneficial for veterans receiving mental health support to be integrated with their communities," he said. "We see veterans who say, 'I'm not ready because I'm not fixed.' We have to say, 'You're not going to be fixed this early, but you do have the skills to be successful and to continue your treatment (through our outpatient program).' It didn't take 45 or 60 days for these problems to develop, and we can't fix them that fast."
In an effort to get veterans out in the community, SORCC also revamped its Work Therapy Program to include more community employers and provide veterans with the skills to get competitive employment. Veterans may participate in the program for 90 days, and their wages are not taxed.
Hanson said he earns $9.75 an hour doing housekeeping on campus as part of the program.
"It helps me when I leave here to have a nest egg," he said.
His discharge date is Aug. 16, at which point he hopes to reconnect with his girlfriend of five years and her daughter.
"I'll be applying for jobs with VA because I want to stay close to what saved my life," he said.
Reach education reporter Teresa Thomas at 541-776-4497 or firstname.lastname@example.org. Follow her at www.twitter.com/teresathomas_mt.
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