State of Arizona
Office
of the
Auditor General
PERFORMANCE AUDIT
Report to the Arizona Legislature
By Douglas R. Norton
Auditor General
DEPARTMENT OF
HEALTH SERVICES
ARIZONA
STATE
HOSPITAL
May 1999
Report No. 99-9
2910 NORTH 44th STREET • SUITE 410 • PHOENIX, ARIZONA 85018 • (602) 553-0333 • FAX (602) 553-0051
DOUGLAS R. NORTON, CPA
AUDITOR GENERAL
DEBRA K. DAVENPORT, CPA
DEPUTY AUDITOR GENERAL
STATE OF ARIZONA
OFFICE OF THE
AUDITOR GENERAL
0D\
0HPEHUV RI WKH $UL]RQD /HJLVODWXUH
7KH +RQRUDEOH -DQH 'HH +XOO *RYHUQRU
'U -DPHV $OOHQ 'LUHFWRU
'HSDUWPHQW RI +HDOWK 6HUYLFHV
7UDQVPLWWHG KHUHZLWK LV D UHSRUW RI WKH $XGLWRU *HQHUDO $ 3HUIRUPDQFH $XGLW RI WKH
'HSDUWPHQW RI +HDOWK 6HUYLFHV $UL]RQD 6WDWH +RVSLWDO $6+ 7KLV UHSRUW LV LQ
UHVSRQVH WR D 0D\ UHVROXWLRQ RI WKH -RLQW /HJLVODWLYH $XGLW &RPPLWWHH 7KH
SHUIRUPDQFH DXGLW ZDV FRQGXFWHG DV SDUW RI WKH 6XQVHW UHYLHZ VHW IRUWK LQ $ 5 6
WKURXJK
7KLV LV WKH WKLUG LQ D VHULHV RI UHSRUWV WR EH LVVXHG RQ WKH 'HSDUWPHQW RI +HDOWK 6HUYLFHV
:H IRXQG WKDW WKH $UL]RQD 6WDWH +RVSLWDO KDV H[SHULHQFHG VHYHUH GLIILFXOWLHV HQVXULQJ
WKDW SDWLHQWV OLYH LQ D VDIH DQG WKHUDSHXWLF HQYLURQPHQW 6SHFLILFDOO\ WKH KRVSLWDO·V
SDWLHQW XQLWV DUH IUHTXHQWO\ XQGHUVWDIIHG OLPLWLQJ WKH KRVSLWDO·V DELOLW\ WR SURYLGH
DGHTXDWH WKHUDS\ IRU SDWLHQWV RU WR LQWHUYHQH LQ SDWLHQW GLVSXWHV 6WDIILQJ VKRUWDJHV DUH
ORQJ VWDQGLQJ DQG VWHP IURP VHYHUDO FRQGLWLRQV LQFOXGLQJ KLVWRULFDOO\ ORZ VDODULHV DQG
D GLIILFXOW ZRUNLQJ HQYLURQPHQW
,Q DGGLWLRQ WKH KRVSLWDO·V FXUUHQW IDFLOLWLHV DUH WRR VPDOO WR UHDVRQDEO\ DFFRPPRGDWH WKH
QXPEHU RI SDWLHQWV FXUUHQWO\ OLYLQJ DW WKH KRVSLWDO 7KH VLWXDWLRQ LV FRPSRXQGHG E\ WKH
KRVSLWDO·V ROG DQG GHWHULRUDWLQJ EXLOGLQJV 8OWLPDWHO\ WKH 6WDWH ZLOO QHHG D QHZ KRVSLWDO
IDFLOLW\ VLQFH UHQRYDWLRQV SUHVHQW RQO\ D VWRSJDS VROXWLRQ WR WKH PXOWLWXGH RI IDFLOLW\
GHILFLHQFLHV +RZHYHU WKH KRVSLWDO KDV RQO\ UHFHQWO\ LPSOHPHQWHG D SURFHVV WR SODQ IRU
D QHZ IDFLOLW\ 6LQFH EXLOGLQJ D QHZ IDFLOLW\ LV D ORQJ SURFHVV WKH KRVSLWDO VKRXOG
FRQWLQXH LWV FXUUHQW HIIRUWV WR OD\ WKH JURXQGZRUN IRU D QHZ IDFLOLW\
0D\
3DJH
$V RXWOLQHG LQ LWV UHVSRQVH WKH 'HSDUWPHQW DJUHHV ZLWK DOO RI WKH ILQGLQJV DQG
UHFRPPHQGDWLRQV DQG UHSRUWV WKDW LW LV DOUHDG\ LQ WKH SURFHVV RI LPSOHPHQWLQJ WKH
PDMRULW\ RI WKH UHFRPPHQGDWLRQV
0\ VWDII DQG , ZLOO EH SOHDVHG WR GLVFXVV RU FODULI\ LWHPV LQ WKH UHSRUW
7KLV UHSRUW ZLOO EH UHOHDVHG WR WKH SXEOLF RQ 0D\
6LQFHUHO\
'RXJODV 5 1RUWRQ
$XGLWRU *HQHUDO
(QFORVXUH
L
SUMMARY
7KH 2IILFH RI WKH $XGLWRU *HQHUDO KDV FRQGXFWHG D SHUIRUPDQFH DXGLW RI WKH 'HSDUWPHQW RI
+HDOWK 6HUYLFHV $UL]RQD 6WDWH +RVSLWDO $6+ LQ UHVSRQVH WR D 0D\ UHVROXWLRQ RI
WKH -RLQW /HJLVODWLYH $XGLW &RPPLWWHH 7KLV SHUIRUPDQFH DXGLW ZDV FRQGXFWHG XQGHU WKH
DXWKRULW\ YHVWHG LQ WKH $XGLWRU *HQHUDO E\ $ 5 6 WKURXJK 7KLV LV WKH
VHFRQG LQ D VHULHV RI VL[ DXGLWV RI WKH 'HSDUWPHQW RI +HDOWK 6HUYLFHV
$6+ LV WKH RQO\ VWDWH RSHUDWHG SV\FKLDWULF KRVSLWDO LQ $UL]RQD 8QGHU $ 5 6
WKURXJK WKH KRVSLWDO LV UHTXLUHG WR SURYLGH LQSDWLHQW FDUH DQG WUHDWPHQW WR SDWLHQWV
ZLWK PHQWDO GLVRUGHUV SHUVRQDOLW\ GLVRUGHUV RU HPRWLRQDO FRQGLWLRQV ,WV SDWLHQW SRSXODWLRQ
KDV FKDQJHG FRQVLGHUDEO\ LQ UHFHQW \HDUV +LVWRULFDOO\ $6+ PDLQO\ VHUYHG FLYLO SDWLHQWV
SHUVRQV ZKR KDYH EHHQ FRPPLWWHG DIWHU D FRXUW GHWHUPLQHV WKH\ SRVH D GDQJHU WR WKHP
VHOYHV RU RWKHUV +RZHYHU QHDUO\ KDOI RI LWV SDWLHQWV DUH QRZ IRUHQVLF SDWLHQWV SHUVRQV ZKR
DUH HLWKHU RUGHUHG WR WKH KRVSLWDO WR EH UHVWRUHG WR FRPSHWHQF\ WR VWDQG WULDO RU KDYH EHHQ
WULHG DQG IRXQG WR EH HLWKHU ´JXLOW\ H[FHSW LQVDQHµ RU ´QRW JXLOW\ E\ UHDVRQ RI LQVDQLW\ µ 7KH
FXUUHQW SRSXODWLRQ LQ WKH KRVSLWDO·V SDWLHQW XQLWV LV DERXW $6+ DOVR KDV D SURJUDP IRU
VH[XDOO\ YLROHQW SHUVRQV WKDW ZDV EHJXQ LQ DQG FXUUHQWO\ KDV DERXW UHVLGHQWV
ASH Has Difficulties
Maintaining Sufficient Staff
to Care for Patients
(See pages 7 through 17)
$6+·V SDWLHQW XQLWV DUH RIWHQ LQVXIILFLHQWO\ VWDIIHG WR SURYLGH SDWLHQWV ZLWK DSSURSULDWH
WUHDWPHQW DQG D WKHUDSHXWLF HQYLURQPHQW 3DUWO\ EHFDXVH RI WKHVH VWDIILQJ SUREOHPV WKH
)HGHUDO +HDOWK &DUH )LQDQFLQJ $GPLQLVWUDWLRQ GHQLHG $6+·V DSSOLFDWLRQ WR SDUWLFLSDWH
LQ WKH 0HGLFDUH UHLPEXUVHPHQW SURJUDP D VWHS WKDW HOLPLQDWHV IHGHUDO VWDWH DQG ORFDO
UHLPEXUVHPHQWV IRU ERWK 0HGLFDUH DQG $+&&&6 7LWOH ;,; SDWLHQWV 6HH 2WKHU 3HUWLQHQW
,QIRUPDWLRQ SDJHV WKURXJK IRU IXUWKHU LQIRUPDWLRQ RQ WKH ORVV RI WKHVH UHLPEXUVH
PHQWV $6+ VXIIHUV IURP KLJK YDFDQF\ DQG WXUQRYHU OHYHOV $V RI 1RYHPEHU RI
$6+·V SRVLWLRQV H[FOXGLQJ SRVLWLRQV DOORFDWHG WR WKH KRVSLWDO·V VH[XDOO\ YLROHQW SHU
VRQV XQLW ZHUH YDFDQW 9DFDQF\ UDWHV DPRQJ WKH YDULRXV W\SHV RI QXUVLQJ VWDII KDYH EHHQ
DERXW SHUFHQW DQG WXUQRYHU UDWHV IRU QXUVHV KDYH EHHQ DV KLJK DV SHUFHQW 7KH HIIHFWV
RI $6+·V VWDIILQJ VKRUWDJHV DUH FRPSRXQGHG E\ SUREOHPV LQ WKH PHWKRG XVHG WR DOORFDWH
VWDII DPRQJ WKH SDWLHQW XQLWV 7KLV PHWKRG GRHV QRW DFFXUDWHO\ LGHQWLI\ WKH QXPEHU RI VWDII
QHHGHG WR DGHTXDWHO\ FDUH IRU SDWLHQWV
,QDGHTXDWH VWDIILQJ KDV LPSOLFDWLRQV IRU SDWLHQW WUHDWPHQW DQG IRU VDIHW\ $ VWXG\
FRQGXFWHG E\ WKH KRVSLWDO IRXQG WKDW PDQ\ SDWLHQWV UHFHLYHG PXFK OHVV WUHDWPHQW WKDQ WKH
LL
KRXUV SHU ZHHN VXJJHVWHG E\ KRVSLWDO JXLGHOLQHV 6WDII UHSRUW WKDW DQ LQVXIILFLHQW QXPEHU
RI VWDII FDQ FUHDWH DQ XQVDIH HQYLURQPHQW ZLWK PRUH DVVDXOWV DQG YHUEDO DOWHUFDWLRQV LQ
YROYLQJ SDWLHQWV +HDOWK &DUH )LQDQFLQJ $GPLQLVWUDWLRQ RIILFLDOV QRWHG D OLQN EHWZHHQ LQVXI
ILFLHQW VWDIILQJ OHYHOV DQG WKH KRVSLWDO·V DELOLW\ WR SUHYHQW RU UHVSRQG WR DVVDXOWV DQG VLPLODU
LQFLGHQWV 7R KHOS FRPSHQVDWH IRU WKH ORZ VWDIILQJ OHYHOV WKH KRVSLWDO XVHV FRQWUDFW ZRUNHUV
DQG RYHUWLPH +RZHYHU FRQWUDFW VWDII DUH PXFK PRUH H[SHQVLYH WKDQ UHJXODU VWDII DQG
DFFRUGLQJ WR $6+ VWDII DUH IUHTXHQWO\ OHVV HIIHFWLYH DW SURYLGLQJ WUHDWPHQW ,QFUHDVLQJ
VWDIILQJ OHYHOV WKURXJK RYHUWLPH ZRUN DOVR KDV OLPLWDWLRQV LQ WKDW VWDII UHSRUW EXUQRXW IURP
ZRUNLQJ H[WUD KRXUV
/RZ VDODULHV D GLIILFXOW ZRUNLQJ HQYLURQPHQW DQG RWKHU IDFWRUV DGYHUVHO\ DIIHFW PRUDOH DQG
DUH NH\ IDFWRUV WKDW FRQWULEXWH WR SUREOHPV LQ UHFUXLWLQJ DQG UHWDLQLQJ TXDOLILHG VWDII 7KH
KRVSLWDO UHFHQWO\ UHFHLYHG D VXSSOHPHQWDO DSSURSULDWLRQ RI DERXW PLOOLRQ RI
ZKLFK ZDV IRU VDODU\ LQFUHDVHV IRU QXUVHV DQG RWKHU FOLQLFDO VWDII $GGLWLRQDOO\ WKH /HJLVOD
WXUH SURYLGHG DQRWKHU IRU 'HSDUWPHQW RI $GPLQLVWUDWLRQ VSHFLDO PDUNHW DGMXVW
PHQW VDODU\ LQFUHDVHV IRU VRPH RI LWV VWDII LQFOXGLQJ VHFXULW\ RIILFHUV DQG UHFUHDWLRQDO WKHUD
SLVWV DV ZHOO DV QXUVHV DQG SV\FKLDWULF WHFKQLFLDQV $FFRUGLQJ WR $6+·V &KLHI ([HFXWLYH
2IILFHU WKHVH DSSURSULDWLRQV LQFUHDVHG UHJLVWHUHG QXUVH DQG SV\FKLDWULF WHFKQLFLDQ VDODULHV
WR D PRUH FRPSHWLWLYH OHYHO +RZHYHU $6+ FRQWLQXHV WR KDYH D QHHG IRU DGGLWLRQDO VWDII 7R
DGGUHVV WKLV QHHG $6+ QHHGV WR FRQWLQXH LWV HIIRUWV WR GHYHORS D SRRO RI QXUVLQJ VWDII
ZKR FDQ ILOO LQ RQ DQ DV QHHGHG EDVLV ILOO VWDII YDFDQFLHV DQG VWXG\ UHDVRQV ZK\ VWDII
OHDYH WKH KRVSLWDO DQG DWWHPSW WR DGGUHVV WKHP $6+ VKRXOG DOVR PRGLI\ WKH PHWKRG LW XVHV
WR DOORFDWH VWDII DPRQJ WKH SDWLHQW XQLWV WR HQVXUH WKDW WKH PHWKRG DFFXUDWHO\ LGHQWLILHV
VWDIILQJ QHHGV
ASH Facilities
Are Inadequate
(See pages 19 through 28)
$6+·V IDFLOLWLHV GR QRW SURYLGH DQ DGHTXDWH HQYLURQPHQW IRU WUHDWLQJ SDWLHQWV $V RI -DQXDU\
RI LWV SDWLHQW XQLWV KDG PRUH SDWLHQWV WKDQ VWDWH OLFHQVLQJ VWDQGDUGV DOORZ )RU
H[DPSOH XQLW KDG PRUH SDWLHQWV WKDQ LWV FDSDFLW\ RI 7KH RYHUFURZGLQJ VRPHWLPHV
IRUFHV LQDSSURSULDWH XVH RI VSDFH 6HFOXVLRQ URRPV XVHG WR SURYLGH D WHPSRUDU\ VSDFH DZD\
IURP RWKHU SDWLHQWV PXVW IUHTXHQWO\ EH XVHG DV SDWLHQW EHGURRPV 7KH GHVLJQ RI WKH XQLWV
ZKLFK ZHUH EXLOW LQ WKH V LV LQ PDQ\ ZD\V XQVXLWHG IRU $6+·V FXUUHQW SDWLHQWV 7KH
XQLWV· ORQJ FRUULGRUV PDNH LW GLIILFXOW IRU VWDII WR HIIHFWLYHO\ SHUIRUP WKHLU MREV DQG HQVXUH
SDWLHQW VDIHW\ 6HSDUDWH VSDFH IRU LQGLYLGXDO DQG JURXS WKHUDS\ LV ODUJHO\ XQDYDLODEOH $V D
UHVXOW WKHUDS\ VHVVLRQV PXVW RIWHQ EH FRQGXFWHG LQ D URRP ZKHUH DOO WKH SDWLHQWV LQ WKH
XQLWV VSHQG WKHLU GD\WLPH KRXUV
0DQ\ RI $6+·V IDFLOLWLHV DUH ROG DQG GHWHULRUDWLQJ FUHDWLQJ DGGLWLRQDO KD]DUGV WKDW SODFH
SDWLHQWV DQG VWDII DW ULVN 6WDII DQG SDWLHQWV DUH RIWHQ DW ULVN RI LQMXULQJ WKHPVHOYHV IURP
IDFLOLW\ KD]DUGV VXFK DV VOLSSHU\ IORRUV ORRVH IORRU WLOHV DQG EURNHQ FHLOLQJ WLOHV )RU H[DP
LLL
SOH RQH SDWLHQW DWWDFNHG DQRWKHU SDWLHQW ZLWK D EURNHQ FHLOLQJ WLOH $GGLWLRQDOO\ $6+·V
XQGHUJURXQG WXQQHO V\VWHP ZKLFK SURYLGHV HOHFWULFLW\ KHDW ZDWHU DQG SKRQH OLQHV KDV
EHHQ GHHPHG D KD]DUG EHFDXVH LW LV OLQHG ZLWK DVEHVWRV DQG LV FROODSVLQJ 'HWHULRUDWLQJ
FRQGLWLRQV DUH FRPSRXQGHG E\ D PDLQWHQDQFH DQG UHSDLU SURFHVV WKDW LV VRPHWLPHV IUDJ
PHQWHG DQG LQHIILFLHQW 5HSDLU RUGHUV DUH QRW DGHTXDWHO\ SULRULWL]HG RU SODQQHG EHWZHHQ WKH
JURXSV WKDW SHUIRUP WKH UHSDLUV 3RRU FRRUGLQDWLRQ RIWHQ H[LVWV EHWZHHQ SURMHFW SODQQHUV
KRVSLWDO PDQDJHPHQW DQG RXWVLGH FRQWUDFWRUV
$OWKRXJK D QHZ IDFLOLW\ ZLOO XOWLPDWHO\ EH QHHGHG WKHUH DUH VRPH LPPHGLDWH VWHSV $6+ FDQ
WDNH WR LPSURYH SDWLHQWV· HQYLURQPHQWV 6HYHUDO UHODWLYHO\ LQH[SHQVLYH HQKDQFHPHQWV VXFK
DV LPSURYHG SDWLHQW XQLW OLJKWLQJ DQG ZDOO FRORUV FRXOG TXLFNO\ LPSURYH WKH IDFLOLWLHV DV
UHFRPPHQGHG E\ DQ DUFKLWHFWXUDO ILUP KLUHG E\ $6+ PDQDJHPHQW ,Q DGGLWLRQ LPSURYH
PHQWV WR WKH PDLQWHQDQFH SURFHVV FRXOG KHOS HQVXUH WKDW UHSDLUV DUH WLPHO\ DQG DGHTXDWH
)RU H[DPSOH PDQDJHPHQW FRXOG HQVXUH WKDW HDFK UHSDLU SURMHFW LV SULRULWL]HG SODQQHG DQG
VXSHUYLVHG WR PDNH VXUH WKH FRUUHFW ZRUN LV GRQH $GGLWLRQDOO\ $6+ VKRXOG FRQWLQXH LWV
HIIRUWV WR HDVH SDWLHQW RYHUFURZGLQJ LQ WKH XQLWV E\ PRYLQJ IRUZDUG ZLWK LWV SODQV WR GH
YHORS D WUDQVLWLRQDO XQLW
Effective Long-Term Planning
Process Is Needed
(See pages 29 through 34)
$6+ FXUUHQWO\ ODFNV ORQJ WHUP SODQV WR JXLGH LWV IXWXUH DV ZHOO DV DQ HIIHFWLYH SURFHVV WR
GHYHORS VXFK SODQV 7KH *RYHUQRU DQG /HJLVODWXUH KDYH DFNQRZOHGJHG WKDW EHFDXVH FXUUHQW
IDFLOLWLHV GR QRW SURYLGH DQ DGHTXDWH HQYLURQPHQW IRU SDWLHQWV QHZ IDFLOLWLHV ZLOO XOWLPDWHO\
EH QHHGHG 3UHSDULQJ IRU WKLV SRVVLELOLW\ UHTXLUHV FDUHIXO SODQQLQJ LQ DQ HQYLURQPHQW WKDW
FRQWDLQV PDQ\ XQFHUWDLQWLHV DQG FKDOOHQJHV )RU H[DPSOH WKH KRVSLWDO KDV OLWWOH FRQWURO RYHU
LWV SDWLHQW ORDG DQG LV SUHVHQWHG ZLWK VDIHW\ DQG VHFXULW\ QHHGV WKDW DUH JUHDWHU WKDQ WKRVH RI
PRVW RWKHU PHQWDO KHDOWK IDFLOLWLHV $6+ GRHV QRW KDYH D SURFHVV LQ SODFH IRU FRQVLGHULQJ
KRZ VXFK FKDUDFWHULVWLFV DIIHFW WKH EHVW FRXUVH RI DFWLRQ IRU IXWXUH IDFLOLWLHV )RU H[DPSOH WKH
KRVSLWDO KDV QRW GHYHORSHG SURMHFWLRQV RI IXWXUH GHPDQG IRU LWV VHUYLFHV
7XUQRYHU DPRQJ NH\ OHDGHUVKLS SRVLWLRQV DW WKH KRVSLWDO DQG DW WKH 'HSDUWPHQW RI +HDOWK
6HUYLFHV KDV FRQWULEXWHG WR D ODFN RI IRFXV RQ WKLV LVVXH +RZHYHU ZLWK OHDGHUVKLS SRVLWLRQV
QRZ ILOOHG WKH KRVSLWDO LV LQ D EHWWHU SRVLWLRQ WR PRYH IRUZDUG ZLWK LPSOHPHQWLQJ D ORQJ
WHUP SODQQLQJ SURFHVV 7KH KRVSLWDO LV EHJLQQLQJ WR GHYHORS D SURFHVV IRU FUHDWLQJ D VWUDWHJLF
SODQ GHILQLQJ WKH KRVSLWDO·V JRDOV DV ZHOO DV D SODQ WR JXLGH IXWXUH RSHUDWLRQV 7KH KRVSLWDO·V
ORQJ WHUP SODQQLQJ HIIRUWV IRU D QHZ IDFLOLW\ QHHG WR LQFOXGH WKH VL]H RI OLNHO\ IXWXUH SDWLHQW
ORDGV DQG WKH W\SH RI IDFLOLWLHV WKDW ZLOO EH QHHGHG
LY
Other Pertinent Information
(See pages 35 through 41)
7KH DXGLW DOVR SUHVHQWV LQIRUPDWLRQ RQ WZR RWKHU VXEMHFWV $6+·V SURJUDP IRU 6H[XDOO\
9LROHQW 3HUVRQV 693V DQG WKH VWDWXV RI LWV 0HGLFDUH FHUWLILFDWLRQ
693V DUH SHUVRQV ZKR KDYH EHHQ FRQYLFWHG RI FRPPLWWLQJ D VH[XDOO\ YLROHQW RIIHQVH KDYH
ILQLVKHG WKHLU VWDWH SULVRQ VHQWHQFH DQG KDYH EHHQ GHWHUPLQHG WR KDYH D PHQWDO GLVRUGHU
WKDW PDNHV WKHP OLNHO\ WR UHRIIHQG 6XFK D GHWHUPLQDWLRQ LQYROYHV D SURFHVV WKDW LQFOXGHV
SV\FKRORJLFDO HYDOXDWLRQV SUREDEOH FDXVH SHWLWLRQV DQG KHDULQJV DQG FRXUW KHDULQJV 693V
DUH RUGHUHG HLWKHU WR WKH 693 XQLW DW $6+ RU WR D OHVV UHVWULFWLYH VHWWLQJ DOVR RQ WKH KRVSLWDO
FDPSXV $6+ LV UHTXLUHG WR KRXVH DQG WUHDW 693V XQWLO WKH FRXUW UXOHV WKDW WKHLU UHOHDVH QR
ORQJHU SRVHV D WKUHDW WR WKH FRPPXQLW\ $V RI -DQXDU\ WKH SURJUDP KDG UHVLGHQWV
$FFRUGLQJ WR $6+ WKH H[SHFWHG JURZWK PRUH UHVLGHQWV SHU PRQWK ZLOO PHDQ WKDW WKH
FXUUHQW EHG FDSDFLW\ ZLOO EH ILOOHG E\ 1RYHPEHU $ VWXG\ JURXS KDV UHFRPPHQGHG
EXLOGLQJ DGGLWLRQDO IDFLOLWLHV RQ KRVSLWDO JURXQGV WR DFFRPPRGDWH WKH DQWLFLSDWHG SURJUDP
JURZWK 7KH $UL]RQD 'HSDUWPHQW RI $GPLQLVWUDWLRQ ZLOO VRRQ EHJLQ GHVLJQLQJ DQ DGGLWLRQDO
EHG IDFLOLW\ WR LQFUHDVH WKH XQLW·V FDSDFLW\ WR EHGV 7KH /HJLVODWXUH DSSURSULDWHG
PLOOLRQ LQ WKH ILVFDO \HDU FDSLWDO RXWOD\ EXGJHW IRU WKLV IDFLOLW\
$6+·V PRVW UHFHQW DSSOLFDWLRQ WR SDUWLFLSDWH LQ WKH 0HGLFDUH UHLPEXUVHPHQW SURJUDP ZDV
GHQLHG )HGHUDO LQVSHFWRUV FLWHG GHILFLHQFLHV LQ VL[ DUHDV UDQJLQJ IURP QXUVLQJ VHUYLFHV WR
LQIHFWLRQ FRQWURO )RU H[DPSOH LQVSHFWRUV FLWHG LQVWDQFHV LQ ZKLFK SDWLHQW XQLWV ZHUH LQDGH
TXDWHO\ VWDIIHG DQG SDWLHQWV GLG QRW UHFHLYH WKH DSSURSULDWH PHDOV %HFDXVH LWV DSSOLFDWLRQ
ZDV GHQLHG $6+ LV FXUUHQWO\ LQHOLJLEOH WR UHFHLYH 0HGLFDUH DQG $+&&&6 7LWOH ;,; UHLP
EXUVHPHQWV IRU DOO HOLJLEOH KRVSLWDO SDWLHQWV 7KH $+&&&6 7LWOH ;,; UHLPEXUVHPHQWV DUH
FRPSRVHG RI DSSUR[LPDWHO\ WZR WKLUGV IHGHUDO DQG RQH WKLUG VWDWH DQG ORFDO PRQLHV )RU
ILVFDO \HDU WKH ODVW IXOO \HDU RI HOLJLELOLW\ EHIRUH WKH GHQLDO WRRN HIIHFW WKHVH UHLPEXUVH
PHQWV WRWDOHG RYHU PLOOLRQ RI ZKLFK DSSUR[LPDWHO\ PLOOLRQ ZDV IRU $+&&&6 7LWOH
;,; HOLJLEOH SDWLHQWV DQG DSSUR[LPDWHO\ ZDV IRU 0HGLFDUH HOLJLEOH SDWLHQWV ,Q
DGGLWLRQ VLQFH $6+ LV LQHOLJLEOH WR FROOHFW $+&&&6 7LWOH ;,; UHLPEXUVHPHQWV DGGLWLRQDO
6WDWH *HQHUDO )XQG PRQLHV ZHUH QHHGHG WR IXQG WKH KRVSLWDO·V RSHUDWLRQV $OWKRXJK WKH
KRVSLWDO KDV DGGUHVVHG VHYHUDO RI WKH GHILFLHQFLHV PDQ\ UHPDLQHG DW WKH HQG RI DXGLW ZRUN
LQ -DQXDU\ $6+ PDQDJHPHQW H[SHFWV WKDW WKH KRVSLWDO ZLOO EH LQVSHFWHG DJDLQ E\
2FWREHU DQG ZLOO UHJDLQ FHUWLILFDWLRQ E\ 'HFHPEHU
Y
Table of Contents
Page
Introduction and Background ............................................................. 1
Finding I: ASH Has Difficulties
Maintaining Sufficient Staff
to Care for Patients .......................................................................... 7
%DFNJURXQG
6WDIILQJ /HYHOV 2IWHQ ,QVXIILFLHQW
/RZ 6WDIILQJ /HYHOV 0HDQ $6+
2IWHQ &DQQRW 3URYLGH $GHTXDWH
7UHDWPHQW DQG 7KHUDSHXWLF
(QYLURQPHQW
6DODU\ /HYHOV 'LIILFXOW :RUN
(QYLURQPHQW DQG 2WKHU )DFWRUV
&RQWULEXWH WR ,QDELOLW\
WR 5HFUXLW DQG 5HWDLQ 6WDII
0HWKRG RI $OORFDWLQJ 6WDII
$PRQJ 8QLWV ([DFHUEDWHV
6WDIILQJ 6KRUWDJHV
$6+ 6KRXOG &RQWLQXH 6WHSV WR
(QVXUH $GHTXDWH 6WDIILQJ LQ 8QLWV
5HFRPPHQGDWLRQV
Finding II: ASH Facilities
Are Inadequate.................................................................................. 19
$6+ 3URYLGHV 3RRU (QYLURQPHQW
IRU 3DWLHQWV DQG 6WDII
$6+·V %XLOGLQJV $UH 'HWHULRUDWLQJ
,QHIILFLHQWO\ 0DLQWDLQHG DQG 1RW
'HVLJQHG WR 0HHW &XUUHQW 1HHGV
YL
Table of Contents (cont’d)
Page
Finding II: (cont’d)
$6+ &RXOG 8QGHUWDNH
6HYHUDO 6KRUW 7HUP
,PSURYHPHQWV
5HFRPPHQGDWLRQV
Finding III: Effective Long-Term
Planning Process Is Needed........................................................... 29
8QDFFHSWDEOH )DFLOLW\
8QLTXH 3RSXODWLRQ +HLJKWHQ
1HHG IRU /RQJ 7HUP 3ODQQLQJ
$6+ +DV 1RW
$GHTXDWHO\ 3ODQQHG
IRU WKH )XWXUH
3DVW /HDGHUVKLS &KDOOHQJHV
$IIHFWHG $6+·V $ELOLW\ WR
'HYHORS /RQJ 7HUP 3ODQV
$6+ 6KRXOG 7DNH 6WHSV
WR 3ODQ IRU WKH )XWXUH
5HFRPPHQGDWLRQV
Other Pertinent Information................................................................. 35
1HZ 693 3URJUDP
DW WKH +RVSLWDO
0HGLFDUH &HUWLILFDWLRQ
Agency Response
Appendix................................................................................................. a-i
$Q 2YHUYLHZ RI 3DWLHQW 7\SHV
7UHDWHG E\ $6+
YLL
Table of Contents (cont’d)
Page
Figures
)LJXUH 'HSDUWPHQW RI +HDOWK 6HUYLFHV³
$UL]RQD 6WDWH +RVSLWDO
&RPSDULVRQ RI $YHUDJH +RXUO\ 5DWHV
&RQWUDFW 6WDII YHUVXV 5HJXODU 6WDII
$V RI $XJXVW
)LJXUH 6HYHQ SDWLHQWV DUH KRXVHG LQ WKLV
EHGURRP LQ -XQLSHU XQLW
)LJXUH $6+ KDV FORVHG WKH .DFKLQD XQLW ZKLFK KDV
FRQWULEXWHG WR SDWLHQW RYHUFURZGLQJ LQ RWKHU XQLWV
)LJXUH +LJK IHQFHV DQG UD]RU ZLUH JLYH WKH :LFN
XQLW D SULVRQ OLNH DSSHDUDQFH
Tables
7DEOH 'HSDUWPHQW RI +HDOWK 6HUYLFHV³
$UL]RQD 6WDWH +RVSLWDO
6WDWHPHQW RI 5HYHQXHV ([SHQGLWXUHV DQG 2WKHU
)LQDQFLQJ 6RXUFHV DQG 8VHV
<HDUV (QGHG RU (QGLQJ -XQH DQG
8QDXGLWHG
7DEOH 'HSDUWPHQW RI +HDOWK 6HUYLFHV³
$UL]RQD 6WDWH +RVSLWDO
&RPSDULVRQ RI 9DFDQF\ DQG 7XUQRYHU 5DWHV
$V RI 6HSWHPEHU
7DEOH 'HSDUWPHQW RI +HDOWK 6HUYLFHV³
$UL]RQD 6WDWH +RVSLWDO
1XPEHU RI 3DWLHQWV E\ 8QLW
-DQXDU\
YLLL
Table of Contents (concl’d)
Page
Tables (concl’d)
7DEOH 'HSDUWPHQW RI +HDOWK 6HUYLFHV³
$UL]RQD 6WDWH +RVSLWDO
+RVSLWDO 6SDFH 1R /RQJHU 8VHG
IRU +RVSLWDO 3DWLHQWV
7DEOH 'HSDUWPHQW RI +HDOWK 6HUYLFHV³
$UL]RQD 6WDWH +RVSLWDO
3DWLHQW 7\SH $GPLVVLRQ DQG 'LVFKDUJH
5HTXLUHPHQWV 1XPEHU RI 3DWLHQWV DQG
/HQJWK RI 6WD\ LQ 'D\V
-DQXDU\ D L
INTRODUCTION AND BACKGROUND
7KH 2IILFH RI WKH $XGLWRU *HQHUDO KDV FRQGXFWHG D SHUIRUPDQFH DXGLW RI WKH 'HSDUWPHQW RI
+HDOWK 6HUYLFHV $UL]RQD 6WDWH +RVSLWDO $6+ LQ UHVSRQVH WR D 0D\ UHVROXWLRQ RI
WKH -RLQW /HJLVODWLYH $XGLW &RPPLWWHH 7KLV SHUIRUPDQFH DXGLW ZDV FRQGXFWHG XQGHU WKH
DXWKRULW\ YHVWHG LQ WKH $XGLWRU *HQHUDO E\ $ 5 6 WKURXJK 7KLV LV WKH
VHFRQG LQ D VHULHV RI VL[ DXGLWV RI WKH 'HSDUWPHQW RI +HDOWK 6HUYLFHV
Hospital Clientele
Has Changed in
Recent Years
7KH $UL]RQD 6WDWH +RVSLWDO $6+ RSHQHG LQ DQG LV WKH RQO\ VWDWH RSHUDWHG SV\FKLDWULF
KRVSLWDO LQ $UL]RQD $ 5 6 WKURXJK UHTXLUHV $6+ WR SURYLGH LQSDWLHQW FDUH
DQG WUHDWPHQW WR LQGLYLGXDOV ZLWK VHYHUH PHQWDO GLVRUGHUV SHUVRQDOLW\ GLVRUGHUV RU HPR
WLRQDO FRQGLWLRQV $6+ VHUYHV FLYLO SDWLHQWV ZKR KDYH EHHQ RUGHUHG E\ D FRXUW WR UHFHLYH
WUHDWPHQW DW WKH KRVSLWDO EHFDXVH WKH\ SRVH D GDQJHU WR WKHPVHOYHV RU RWKHUV DQG IRUHQVLF
SDWLHQWV ZKR DUH SDWLHQWV WKDW KDYH EHHQ RUGHUHG WR $6+ E\ WKH FULPLQDO FRXUWV )RUHQVLF
SDWLHQWV DUH RI VHYHUDO W\SHV 6RPH KDYH EHHQ RUGHUHG WR $6+ IRU WUHDWPHQW VR WKDW WKH\ FDQ
EH UHVWRUHG WR FRPSHWHQF\ WR VWDQG WULDO 2WKHUV ZHUH HLWKHU WULHG DQG IRXQG WR EH QRW
JXLOW\ E\ UHDVRQ RI LQVDQLW\ D YHUGLFW WKDW ZDV HOLPLQDWHG IURP WKH VWDWXWHV LQ RU
WULHG DQG IRXQG WR EH JXLOW\ H[FHSW LQVDQH WKH UHSODFHPHQW YHUGLFW DGGHG LQ LWV SODFH $6+
LV DOVR UHVSRQVLEOH IRU WUHDWLQJ DQG KRXVLQJ SHUVRQV GHWHUPLQHG E\ WKH FRXUWV WR EH VH[XDOO\
YLROHQW SHUVRQV XQGHU D ODZ VHH 2WKHU 3HUWLQHQW ,QIRUPDWLRQ SDJHV WKURXJK
6HH WKH $SSHQGL[ SDJHV D L WKURXJK D Y IRU WKH FDWHJRULHV RI SDWLHQWV $6+ WUHDWV DORQJ ZLWK
WKH DGPLVVLRQ DQG GLVFKDUJH UHTXLUHPHQWV IRU HDFK FDWHJRU\
7KH SDWLHQWV DGPLWWHG WR $6+ DUH GLIIHUHQW IURP WKRVH DW SULYDWH KRVSLWDOV &RPSDUHG WR
SDWLHQWV UHFHLYLQJ WUHDWPHQW LQ SULYDWH LQVWLWXWLRQV $6+·V SDWLHQWV KDYH PRUH VHYHUH PHQWDO
LPSDLUPHQWV DUH RIWHQ PRUH YLROHQW DQG UHTXLUH PXFK ORQJHU KRVSLWDO VWD\V 0RVW RI $6+·V
SDWLHQWV KDYH QR LQVXUDQFH WR FRYHU WKH FRVWV RI D SULYDWH KRVSLWDO VWD\
7KH KRVSLWDO·V SRSXODWLRQ KDV FKDQJHG LQ UHFHQW \HDUV +LVWRULFDOO\ $6+ VHUYHG PRVWO\
FLYLOO\ FRPPLWWHG SDWLHQWV EXW QRZ RQO\ VOLJKWO\ RYHU KDOI RI LWV SDWLHQWV DUH FLYLOO\ FRPPLW
WHG 7KLV FKDQJH FDQ EH VHHQ LQ DGPLVVLRQ VWDWLVWLFV IRU DQG 'XULQJ $6+
DGPLWWHG FLYLO IRUHQVLF DQG DGROHVFHQW SDWLHQWV 'XULQJ WKH QXPEHU RI FLYLO
SDWLHQWV DGPLWWHG GURSSHG WR EXW WKH QXPEHU RI IRUHQVLF SDWLHQWV DGPLWWHG KDG JURZQ
WR DQG WKH QXPEHU RI DGROHVFHQWV DGPLWWHG ZDV $6+ HVWDEOLVKHG LWV 6H[XDOO\ 9LROHQW
3HUVRQV SURJUDP LQ ZKLFK KDG DGPLVVLRQV LQ $W WKH VDPH WLPH WKH UDQJH RI
IXQFWLRQLQJ OHYHOV DPRQJ FLYLOO\ FRPPLWWHG SDWLHQWV KDV QDUURZHG DV WKRVH ZKR FDQ EH
WUHDWHG LQ OHVV UHVWULFWLYH HQYLURQPHQWV QRZ JHQHUDOO\ UHFHLYH WUHDWPHQW LQ FRPPXQLW\
VHWWLQJV ZKLOH RQO\ WKRVH ZLWK WKH PRVW VHYHUH LPSDLUPHQWV UHFHLYH LQSDWLHQW FDUH DW WKH
KRVSLWDO
6HYHUDO IDFWRUV FRQWULEXWHG WR WKH FKDQJHV LQ $6+·V SDWLHQW SRSXODWLRQ
n )LUVW WKH QXPEHU RI IRUHQVLF SDWLHQWV $6+ ZDV RUGHUHG WR UHVWRUH WR FRPSHWHQF\ JUHZ
GUDPDWLFDOO\ DIWHU D VWDWXWRU\ FKDQJH WKDW HOLPLQDWHG D UHTXLUHPHQW WKDW FRXQW\ RU
PXQLFLSDO FRXUWV UHLPEXUVH WKH 6WDWH IRU WUHDWPHQW WR UHVWRUH FRPSHWHQF\ WR D SHUVRQ
ZKR ZDV IRXQG LQFRPSHWHQW WR VWDQG WULDO
n 6HFRQG WKH H[LW VWLSXODWLRQ RI D ODZVXLW $UQROG Y 6DUQ UHTXLUHG WKH 6WDWH WR OLPLW
WKH QXPEHU RI $6+ EHGV GHYRWHG WR 0DULFRSD &RXQW\ LQGLYLGXDOV ZLWK VHULRXV PHQWDO
LOOQHVVHV DQG SURYLGHG IXQGLQJ LQVWHDG WR WUHDWPHQW EHGV DQG RWKHU VHUYLFHV LQ WKH
FRPPXQLW\
n 7KLUG $6+ ZDV RQH RI PDQ\ PHQWDO KHDOWK LQVWLWXWLRQV WKDW WUDQVIHUUHG D VLJQLILFDQW
QXPEHU RI LWV FLYLOO\ FRPPLWWHG JHULDWULF SDWLHQWV WR UHFHLYH WUHDWPHQW LQ D FRPPXQLW\
EDVHG VHWWLQJ DQG
n )LQDOO\ WKH ODZ FUHDWLQJ WKH 6H[XDOO\ 9LROHQW 3HUVRQV SURJUDP DGGHG WKLV W\SH RI
SDWLHQW WR $6+·V UHVSRQVLELOLWLHV
Overview of ASH’s
Treatment Process
2QFH DGPLWWHG WR $6+ HDFK SDWLHQW LV DVVLJQHG D WUHDWPHQW WHDP 7KH WUHDWPHQW WHDP
ZKLFK LV FRPSRVHG RI D SV\FKLDWULVW VRFLDO ZRUNHU QXUVH SV\FKRORJLVW DQG UHKDELOLWDWLRQ
ZRUNHUV HYDOXDWHV WKH SDWLHQW DQG SUHSDUHV D WUHDWPHQW SODQ %DVHG RQ WKHLU SDUWLFXODU
QHHGV SDWLHQWV DUH WKHQ DVVLJQHG WR D SDUWLFXODU WUHDWPHQW XQLW &XUUHQWO\ $6+ KDV RQH
WUHDWPHQW XQLW IRU FKLOGUHQ DJHG WKURXJK WZR PDOH DQG WZR PL[HG JHQGHU XQLWV IRU
FLYLO SDWLHQWV IRXU PDOH IRUHQVLF XQLWV DQG RQH XQLW IRU IHPDOH FLYLO DQG IRUHQVLF SDWLHQWV
$6+ DOVR KDV D XQLW WKDW KRXVHV SDWLHQWV ZLWK VSHFLDO PHGLFDO QHHGV DQG D VHSDUDWHO\ OL
FHQVHG IDFLOLW\ WKDW KRXVHV VH[XDOO\ YLROHQW SHUVRQV 3DWLHQWV IURP DOO XQLWV H[FHSW IRU WKH
DGROHVFHQW DQG WKH VH[XDOO\ YLROHQW SHUVRQ XQLWV DUH DOORZHG WR LQWHUDFW ZLWK HDFK RWKHU
SURYLGHG WKH\ KDYH GHPRQVWUDWHG DSSURSULDWH EHKDYLRU
3DWLHQW WUHDWPHQW DW $6+ LQFOXGHV PHGLFDWLRQ WKHUDS\ HGXFDWLRQ DQG SV\FKLDWULF UHKDELOL
WDWLRQ $OO SDWLHQWV UHFHLYH LQGLYLGXDO DQG JURXS WKHUDS\ DQG PRVW UHFHLYH PHGLFDWLRQV DQG
PHGLFDWLRQ HGXFDWLRQ ,Q DGGLWLRQ SDWLHQWV UHFHLYH VSHFLDOL]HG WUHDWPHQW EDVHG RQ WKHLU
QHHGV )RU H[DPSOH SDWLHQWV LQ WKH UHVWRUH WR FRPSHWHQF\ SURJUDP UHFHLYH HGXFDWLRQ RQ
FRXUW SURFHGXUHV DQG DGROHVFHQWV SDUWLFLSDWH LQ DFDGHPLF SURJUDPV 2WKHU WUHDWPHQWV
LQFOXGH VXEVWDQFH DEXVH JURXSV DQJHU PDQDJHPHQW JURXSV UHFUHDWLRQDO WKHUDS\ JRDO
GHYHORSPHQW LQGLYLGXDO DQG JURXS WKHUDS\ DQG LQWHUSHUVRQDO VNLOOV GHYHORSPHQW
'LVFKDUJH SODQQLQJ DW $6+ LQYROYHV FRRUGLQDWLRQ EHWZHHQ $6+·V VRFLDO ZRUN GHSDUWPHQW
DQG RWKHU DJHQFLHV LQFOXGLQJ WKH 5HJLRQDO %HKDYLRUDO +HDOWK $XWKRULWLHV IRU FLYLO SDWLHQWV
DQG WKH FRXUWV IRU IRUHQVLF SDWLHQWV 7KH SDWLHQW·V WUHDWPHQW WHDP DVVHVVHV HDFK SDWLHQW·V
SURJUHVV WRZDUG WUHDWPHQW JRDOV DQG LGHQWLILHV ZKHQ GLVFKDUJH SODQV VKRXOG EH ILQDOL]HG
$6+ SDWLHQWV FDQ EH GLVFKDUJHG WR DQ DSDUWPHQW ZLWK YDU\LQJ OHYHOV RI VXSHUYLVLRQ D JURXS
KRPH ZLWK YDU\LQJ OHYHOV RI VXSHUYLVLRQ RU WKH KRPHV RI IDPLO\ PHPEHUV
Budget, Personnel,
and Organization
$6+ UHFHLYHV IXQGLQJ IURP VHYHUDO GLIIHUHQW VRXUFHV $V VKRZQ LQ 7DEOH VHH SDJH
*HQHUDO )XQG DSSURSULDWLRQV LQFOXGLQJ DSSUR[LPDWHO\ PLOOLRQ IRU FRPPXQLW\ SODFH
PHQW IRU GLVFKDUJHG SDWLHQWV DFFRXQW IRU DERXW SHUFHQW RI WKH DSSUR[LPDWHO\ PLOOLRQ
LQ IXQGLQJ IRU ILVFDO \HDU
,Q DIWHU UHYLHZLQJ $6+·V RSHUDWLRQV WKH IHGHUDO +HDOWK &DUH )LQDQFLQJ $GPLQLVWUD
WLRQ GHQLHG $6+·V DSSOLFDWLRQ WR SDUWLFLSDWH LQ WKH 0HGLFDUH UHLPEXUVHPHQW SURJUDP 7KLV
GHQLDO PHDQW WKDW WKH 6WDWH KDG WR IRUJR PRQLHV LW ZRXOG RWKHUZLVH KDYH UHFHLYHG LQ )HGHUDO
0HGLFDUH UHLPEXUVHPHQWV DQG IHGHUDO VWDWH DQG ORFDO UHLPEXUVHPHQWV IURP $+&&&6 IRU
7LWOH ;,; HOLJLEOH SDWLHQWV ,Q ILVFDO \HDU WKH ODVW \HDU $6+ ZDV HOLJLEOH WR UHFHLYH WKHVH
UHLPEXUVHPHQWV IRU QHZ VHUYLFHV SURYLGHG WR 0HGLFDUH DQG $+&&&6 HOLJLEOH SDWLHQWV LW
UHFHLYHG DERXW PLOOLRQ LQ UHLPEXUVHPHQWV IRU $+&&&6 HOLJLEOH SDWLHQWV DQG DERXW
IRU 0HGLFDUH HOLJLEOH SDWLHQWV 6HH 2WKHU 3HUWLQHQW ,QIRUPDWLRQ SDJHV WKURXJK
IRU IXUWKHU LQIRUPDWLRQ
$6+ ZDV DXWKRUL]HG )7(V IRU ILVFDO \HDU LQFOXGLQJ )7(V IRU D QHZ SDWLHQW
XQLW 7KLV WRWDO H[FOXGHV )7(V DOORFDWHG WR WKH VH[XDOO\ YLROHQW SHUVRQV XQLW 7KLV ZDV DQ
LQFUHDVH RI )7( IURP WKH SUHYLRXV \HDU $V RI 1RYHPEHU $6+ KDG ILOOHG
SRVLWLRQV OHDYLQJ YDFDQFLHV $6+·V FOLQLFDO VWDII LQFOXGHV SV\FKLDWULVWV QXUVHV SV\FKL
DWULF WHFKQLFLDQV SV\FKRORJLVWV VRFLDO ZRUNHUV DQG UHKDELOLWDWLRQ VWDII ZLWK D QXPEHU RI
SV\FKLDWULVWV HPSOR\HG RQ D FRQWUDFW EDVLV ,Q DGGLWLRQ $6+ HPSOR\V VXSSRUW VWDII WKDW
LQFOXGHV FOHULFDO VHFXULW\ DQG RWKHU DGPLQLVWUDWLYH VWDII
1 5HJLRQDO %HKDYLRUDO +HDOWK $XWKRULWLHV 5%+$V DUH DJHQFLHV WKDW SURYLGH RXWSDWLHQW EHKDYLRUDO
KHDOWK VHUYLFHV WR LQGLJHQW FOLHQWV WKURXJKRXW WKH 6WDWH 7KH VHUYLFHV DUH SDLG IRU WKURXJK FRQWUDFWV
EHWZHHQ WKH 5%+$V DQG WKH 'LYLVLRQ RI %HKDYLRUDO +HDOWK 6HUYLFHV
$+&&&6 LV WKH VWDWH DJHQF\ GHVLJQDWHG E\ WKH IHGHUDO JRYHUQPHQW DV WKH VROH UHFLSLHQW RI 7LWOH ;,;
0HGLFDLG DVVLVWDQFH LQ $UL]RQD 7KH 6WDWH SURYLGHV PDWFKLQJ PRQLHV IRU IHGHUDO 0HGLFDLG GROODUV
SURYLGHG WR WKH V\VWHP &XUUHQWO\ VWDWH DQG FRXQW\ PRQLHV ILQDQFH DERXW RQH WKLUG RI WKH H[SHQVH RI
0HGLFDLG FOLHQWV· VHUYLFHV
Table 1
Department of Health Services—
Arizona State Hospital
Statement of Revenues, Expenditures, and Other Financing Sources and Uses1
Years Ended or Ending June 30, 1997, 1998, and 1999
(Unaudited)
1997 1998 1999
(Actual) (Actual) (Estimated)
5HYHQXHV
6WDWH *HQHUDO )XQG DSSURSULDWLRQV
'LVSURSRUWLRQDWH 6KDUH
$+&&&6 DQG 0HGLFDUH UHLPEXUVHPHQWV
3DWLHQW DQG LQVXUDQFH UHLPEXUVHPHQWV
5HQWDO
2WKHU
7RWDO UHYHQXHV
([SHQGLWXUHV
3HUVRQDO VHUYLFHV
(PSOR\HH UHODWHG
3URIHVVLRQDO DQG RXWVLGH VHUYLFHV
7UDYHO LQ VWDWH
7UDYHO RXW RI VWDWH
$LG WR LQGLYLGXDOV DQG RUJDQL]DWLRQV
2WKHU RSHUDWLQJ
&DSLWDO RXWOD\
7RWDO H[SHQGLWXUHV
([FHVV RI UHYHQXHV RYHU XQGHU H[SHQGLWXUHV
2WKHU ILQDQFLQJ VRXUFHV XVHV
1HW RSHUDWLQJ WUDQVIHUV LQ
5HPLWWDQFHV WR WKH 6WDWH *HQHUDO )XQG
5HYHUVLRQV WR WKH 6WDWH *HQHUDO )XQG
1HW RWKHU ILQDQFLQJ XVHV
([FHVV RI UHYHQXHV DQG RWKHU ILQDQFLQJ VRXUFHV RYHU XQGHU
H[SHQGLWXUHV DQG RWKHU ILQDQFLQJ XVHV
([FOXGHV WKH WUXVW DFWLYLWLHV RI WKH '+6 6WDWH +RVSLWDO /DQG (DUQLQJV )XQGV
5HFHLYHG DGGLWLRQDO DSSURSULDWLRQV LQ ILVFDO \HDUV DQG WR LQFUHDVH QXPEHU RI VWDII DQG FRQWUDFW SRVLWLRQV LQFUHDVH VWDII
VDODULHV IXQG QHZ SURJUDPV DQG UHSODFH 'LVSURSRUWLRQDWH 6KDUH $+&&&6 DQG 0HGLFDUH UHYHQXHV ORVW ZKHQ WKH KRVSLWDO·V
0HGLFDUH FHUWLILFDWLRQ ZDV YROXQWDULO\ ZLWKGUDZQ DQG ODWHU GHQLHG
7KH KRVSLWDO EHFDPH LQHOLJLEOH IRU 'LVSURSRUWLRQDWH 6KDUH PRQLHV LQ ILVFDO \HDU DQG EHFDXVH LW ORVW LWV 0HGLFDUH FHUWLIL
FDWLRQ
$+&&&6 D )HGHUDO 7LWOH ;,; 0HGLFDLG :DLYHU SURJUDP UHLPEXUVHPHQWV ZHUH UHFHLYHG IRU VHUYLFHV SURYLGHG WR $+&&&6
HOLJLEOH SDWLHQWV )XQGLQJ IRU WKH SURJUDP LV FRPSULVHG RI IHGHUDO DQG VWDWH PRQLHV XQGHU D )HGHUDO 7LWOH ;,; 0HGLFDLG :DLYHU
3URJUDP 7KH KRVSLWDO EHFDPH LQHOLJLEOH IRU ERWK $+&&&6 DQG 0HGLFDUH UHLPEXUVHPHQWV RI QHZ VHUYLFHV SURYLGHG WR HOLJLEOH
SDWLHQWV DIWHU WKH ORVV RI 0HGLFDUH FHUWLILFDWLRQ
5HIOHFWV D SURMHFWHG DQG DFWXDO LQFUHDVH LQ WKH XVH RI QXUVLQJ UHJLVWU\ VHUYLFHV DQG QRQVWDII PHGLFDO GRFWRUV GXH WR VWDIILQJ
VKRUWDJHV LQ ILVFDO \HDUV DQG
(VWLPDWHV IRU LQFOXGH LQFUHDVHG QXPEHU RI VWDII DQG FRQWUDFW SRVLWLRQV LQFUHDVHG VDODULHV DQG QHZ RSHUDWLRQDO XQLWV
,QFOXGHV DSSUR[LPDWHO\ PLOOLRQ RI 'LVSURSRUWLRQDWH 6KDUH PRQLHV UHFHLYHG WKDW H[FHHGHG WKH OHJLVODWLYH VSHQGLQJ OLPLW DQG
ZDV WKHUHIRUH UHYHUWHG EDFN WR WKH 6WDWH *HQHUDO )XQG
'HILFLHQF\ JHQHUDOO\ FRYHUHG E\ PLOOLRQ FDUU\IRUZDUG EDODQFH RI $+&&&6 UHLPEXUVHPHQWV UHFHLYHG SULRU WR ILVFDO \HDU
EXW QRW DXWKRUL]HG WR EH VSHQW DW WKDW WLPH
3D\PHQWV IRU FRPPXQLW\ SODFHPHQW RI SDWLHQWV GLVFKDUJHG IURP $6+
6RXUFH 7KH $UL]RQD )LQDQFLDO ,QIRUPDWLRQ 6\VWHP $),6 $FFRXQWLQJ (YHQW ([WUDFW )LOH 6WDWXV RI $SSURSULDWLRQV DQG ([SHQGLWXUHV
UHSRUW DQG $),6 6WDWXV RI %XGJHW E\ 3&$ ,QGH[ DQG &DVK &RQWURO 6XPPDU\ ,QTXLU\ VFUHHQ SULQWV DV RI -DQXDU\ IRU
WKH \HDUV HQGHG -XQH DQG DQG KRVSLWDO SUHSDUHG ZRUNVKHHWV RI UHYHQXHV H[SHQGLWXUHV DQG RWKHU ILQDQFLQJ
XVHV IRU WKH \HDU HQGLQJ -XQH
$6+ KDV FRQWUDFWHG RXW VHYHUDO DGPLQLVWUDWLYH VHUYLFHV VXFK DV GLHWDU\ KRXVHNHHSLQJ DQG
JURXQGVNHHSLQJ 6WDIILQJ LVVXHV DUH GHDOW ZLWK LQ PRUH GHWDLO LQ )LQGLQJ , VHH SDJHV
WKURXJK
7KH KRVSLWDO LV SDUW RI WKH 'HSDUWPHQW RI +HDOWK 6HUYLFHV $6+·V &KLHI ([HFXWLYH 2IILFHU
UHSRUWV WR WKH $VVLVWDQW 'LUHFWRU RI WKH 'LYLVLRQ RI %HKDYLRUDO +HDOWK 6HUYLFHV ZLWKLQ WKH
'HSDUWPHQW 7KHUH LV DOVR DQ $6+ *RYHUQLQJ %RG\ DQ RYHUVLJKW ERG\ FRPSRVHG RI WKH
0HGLFDO 'LUHFWRU RI WKH GLYLVLRQ RI %HKDYLRUDO +HDOWK 6HUYLFHV DQ $6+ SK\VLFLDQ DQG D
FRPPXQLW\ UHSUHVHQWDWLYH 7KLV JURXS SURYLGHV VHUYLFH WR WKH KRVSLWDO LQ D YDULHW\ RI ZD\V
)RU H[DPSOH LW UHYLHZV WKH KRVSLWDO·V EXGJHW SULRU WR VXEPLVVLRQ WR WKH '+6 'LUHFWRU DQG
DGRSWV TXDOLW\ LPSURYHPHQW SURJUDPV IRU WKH KRVSLWDO $GGLWLRQDOO\ $6+ KDV DQ $GYLVRU\
%RDUG FRPSULVHG RI PHPEHUV DSSRLQWHG E\ WKH *RYHUQRU 7KH $GYLVRU\ %RDUG DGYLVHV
KRVSLWDO PDQDJHPHQW LQ GHYHORSLQJ DQG LPSOHPHQWLQJ JRDOV
Scope and Methodology
6HYHUDO PHWKRGV ZHUH XVHG WR FRQGXFW DXGLW ZRUN DW WKH KRVSLWDO )LUVW KRVSLWDO PDQDJH
PHQW DQG VWDII ZHUH LQWHUYLHZHG DQG WKH KRVSLWDO·V ILYH WUHDWPHQW XQLW PDQDJHUV DQG WHQ
SV\FKLDWULF QXUVH PDQDJHUV ZHUH VXUYH\HG WR GHWHUPLQH WKHLU YLHZV UHJDUGLQJ KRVSLWDO
VWDIILQJ DQG IDFLOLWLHV $XGLWRUV UHYLHZHG WUHDWPHQW XQLW VWDIILQJ OHYHOV DQG YDFDQF\ UDWHV
DQG UHYLHZHG VWXGLHV SHUWDLQLQJ WR VWDIILQJ DQG IDFLOLWLHV DW $6+ 7KHVH VWXGLHV LQFOXGHG
UHFHQW 0HGLFDUH FHUWLILFDWLRQ UHSRUWV ZULWWHQ E\ VXUYH\RUV IURP WKH IHGHUDO +HDOWK &DUH
)LQDQFLQJ $GPLQLVWUDWLRQ D UHSRUW ZULWWHQ E\ D JURXS RI ILYH PHQWDO KHDOWK H[SHUWV ZKR
UHYLHZHG $6+ LQ ODWH DUFKLWHFWXUDO UHSRUWV DVVHVVLQJ WKH FRQGLWLRQ RI $6+·V IDFLOLWLHV
DQG D UHSRUW GHVFULELQJ YDULRXV LPSURYHPHQWV WKDW FRXOG EH PDGH WR $6+·V IDFLOLWLHV WR
LPSURYH WKH RYHUDOO SDWLHQW HQYLURQPHQW
$XGLW PHWKRGV LQFOXGHG RQ VLWH REVHUYDWLRQV DQG UHYLHZV RI ILOHV $XGLWRUV REVHUYHG IRXU
WUHDWPHQW XQLWV WR GHWHUPLQH WKH W\SHV RI WUHDWPHQW SDWLHQWV UHFHLYH WKH QXPEHU RI VWDII RQ
WKH XQLW DQG WKH FRQGLWLRQ RI WKH IDFLOLWLHV $V SDUW RI WKH REVHUYDWLRQV DXGLWRUV REVHUYHG
SDWLHQW WKHUDS\ JURXSV DQG FRQIHUHQFHV WR GLVFXVV WUHDWPHQW SURJUHVV DQG JRDOV $XGLWRUV
DOVR UHYLHZHG DQ H[SORUDWRU\ VDPSOH RI SDWLHQW ILOHV WR JDLQ D EHWWHU XQGHUVWDQGLQJ RI
RWKHU VWXGLHV WKDW ZHUH FRQGXFWHG E\ $6+·V 4XDOLW\ 5HVRXUFH 0DQDJHPHQW GHSDUWPHQW
7KHVH VWXGLHV IRXQG WKDW SDWLHQWV ZHUH QRW UHFHLYLQJ WUHDWPHQW LQ DFFRUGDQFH ZLWK WKHLU
WUHDWPHQW SODQV
$XGLWRUV WRRN VHYHUDO DSSURDFKHV WR JDLQ FRPSDUDWLYH LQIRUPDWLRQ DERXW WKH RSHUDWLRQV RI
PHQWDO KHDOWK IDFLOLWLHV 7KH\ FRQWDFWHG VWDII IURP IRXU RWKHU VWDWH SV\FKLDWULF KRVSLWDOV WR
REWDLQ LQIRUPDWLRQ UHJDUGLQJ WKHLU IDFLOLWLHV DQG VWDIILQJ FRQGLWLRQV 7KH\ WRXUHG WKUHH
1 +RVSLWDOV FRQWDFWHG ZHUH WKH 8WDK 6WDWH +RVSLWDO LQ 3URYR 8WDK WKH 0RQWDQD 6WDWH +RVSLWDO LQ
:DUP 6SULQJV 0RQWDQD WKH /DV 9HJDV 0HGLFDO &HQWHU DW /DV 9HJDV 1HZ 0H[LFR DQG WKH &RORUDGR
0HQWDO +HDOWK ,QVWLWXWH DW 3XHEOR &RORUDGR 7KHVH KRVSLWDOV ZHUH VHOHFWHG EDVHG RQ WKHLU FRPSDUD
ELOLW\ ZLWK $6+ LQ WHUPV RI WKH W\SHV RI SDWLHQWV WKH\ VHUYH DQG WKHLU EXGJHWV
SV\FKLDWULF KRVSLWDOV LQ WKH 3KRHQL[ DUHD $GGLWLRQDOO\ WKH\ FRQWDFWHG VWDII IURP PHQWDO
KHDOWK DVVRFLDWLRQV LQFOXGLQJ WKH $UL]RQD $OOLDQFH IRU WKH 0HQWDOO\ ,OO WKH 1DWLRQDO 0HQWDO
+HDOWK $VVRFLDWLRQ WKH 1DWLRQDO ,QVWLWXWH RI 0HQWDO +HDOWK DQG WKH &HQWHU IRU 0HQWDO
+HDOWK 6HUYLFHV .QRZOHGJH ([FKDQJH
7KLV DXGLW FRQWDLQV ILQGLQJV DQG UHFRPPHQGDWLRQV LQ WKUHH DUHDV
n $6+·V LQDELOLW\ WR PDLQWDLQ DQ DGHTXDWH VWDIILQJ OHYHO WR SURYLGH WUHDWPHQW WR SDWLHQWV
n 7KH LQDGHTXDF\ RI $6+·V SDWLHQW WUHDWPHQW IDFLOLWLHV DQG
n 7KH KRVSLWDO·V QHHG WR FRQGXFW VXEVWDQWLDO ORQJ WHUP SODQQLQJ WR DGGUHVV SUREOHPV
UHODWLQJ WR LWV IDFLOLWLHV DQG FKDQJLQJ SDWLHQW SRSXODWLRQ
$GGLWLRQDOO\ DXGLWRUV GHYHORSHG LQIRUPDWLRQ UHJDUGLQJ $6+·V QHZ 6H[XDOO\ 9LROHQW 3HU
VRQ 693 SURJUDP DQG WKH VWDWXV RI WKH KRVSLWDO·V FHUWLILFDWLRQ E\ WKH IHGHUDO +HDOWK &DUH
)LQDQFLQJ $GPLQLVWUDWLRQ WR SDUWLFLSDWH LQ WKH 0HGLFDUH UHLPEXUVHPHQW SURJUDP 6HH
2WKHU 3HUWLQHQW ,QIRUPDWLRQ SDJHV WKURXJK
7KLV DXGLW ZDV FRQGXFWHG LQ DFFRUGDQFH ZLWK JRYHUQPHQW DXGLWLQJ VWDQGDUGV
7KH $XGLWRU *HQHUDO DQG VWDII H[SUHVV DSSUHFLDWLRQ WR WKH 'LUHFWRU RI WKH 'HSDUWPHQW RI
+HDOWK 6HUYLFHV DQG WR WKH &KLHI ([HFXWLYH 2IILFHU DQG VWDII RI WKH $UL]RQD 6WDWH +RVSLWDO
IRU WKHLU FRRSHUDWLRQ DQG DVVLVWDQFH WKURXJKRXW WKH DXGLW
$XGLWRUV WRXUHG WKH 0DULFRSD 0HGLFDO &HQWHU 3V\FKLDWULF $QQH[ 6W /XNH·V 0HGLFDO &HQWHU DQG WKH
&KDUWHU 'HVHUW 9LVWD %HKDYLRUDO +HDOWK &HQWHU
FINDING I
ASH HAS DIFFICULTIES
MAINTAINING SUFFICIENT STAFF TO
CARE FOR PATIENTS
$6+·V SDWLHQW XQLWV RIWHQ DUH LQDGHTXDWHO\ VWDIIHG WR SURYLGH SDWLHQWV ZLWK DSSURSULDWH
WUHDWPHQW DQG D WKHUDSHXWLF HQYLURQPHQW $OWKRXJK $6+ KDV UHFHLYHG IXQGLQJ IRU DGGL
WLRQDO SRVLWLRQV DQG LQ )HEUXDU\ UHFHLYHG D VXSSOHPHQWDO DSSURSULDWLRQ WR LQFUHDVH
VRPH RI LWV VDODULHV KLJK YDFDQF\ DQG WXUQRYHU UDWHV KDYH OLPLWHG WKH KRVSLWDO·V DELOLW\ WR XVH
WKH SRVLWLRQV WR SURYLGH DSSURSULDWH OHYHOV RI WUHDWPHQW DQG VDIHW\ $6+ PDQDJHPHQW KDV
WULHG WR FRPSHQVDWH E\ XVLQJ FRQWUDFW VWDII DQG RYHUWLPH EXW WKHVH PHDVXUHV DUH H[SHQVLYH
DQG RIWHQ LQHIIHFWLYH 7KH HIIHFW RI ORZ VWDIILQJ OHYHOV LV IXUWKHU FRPSOLFDWHG E\ WKH PHWKRG
$6+ XVHV WR DOORFDWH VWDII ZKLFK GRHV QRW DGHTXDWHO\ LGHQWLI\ WKH QXPEHU RI VWDII HDFK XQLW
QHHGV 7R KHOS DGGUHVV WKHVH SUREOHPV WKH KRVSLWDO VKRXOG FRQWLQXH LWV FXUUHQW HIIRUWV WR
IRUP D SRRO RI RQ FDOO VWDII UHVROYH WXUQRYHU DQG LPSURYH ZRUNLQJ FRQGLWLRQV ,W VKRXOG DOVR
PRGLI\ LWV V\VWHP IRU DOORFDWLQJ VWDII DPRQJ XQLWV
Background
6HYHUDO W\SHV RI VWDII SURYLGH WUHDWPHQW WR $6+ SDWLHQWV LQFOXGLQJ SV\FKLDWULVWV SV\FKROR
JLVWV VRFLDO ZRUNHUV DQG UHKDELOLWDWLRQ ZRUNHUV +RZHYHU WKH PDMRULW\ RI $6+·V FOLQLFDO
VWDII DUH LQ WKUHH SRVLWLRQV ZKR ZRUN GLUHFWO\ ZLWK SDWLHQWV LQ WKH WUHDWPHQW XQLWV 5HJLVWHUHG
QXUVHV PRQLWRU DQG GRFXPHQW SDWLHQWV· WUHDWPHQW DQG SURJUHVV VXSHUYLVH DQG HGXFDWH VWDII
DQG SDWLHQWV DQG DVVHVV GLUHFW SDWLHQW FDUH /LFHQVHG SUDFWLFDO QXUVHV SUHSDUH DQG GLVSHQVH
PHGLFDWLRQV DQG GRFXPHQW DQG WUDQVFULEH SK\VLFLDQV· RUGHUV 3V\FKLDWULF WHFKQLFLDQV WKH
ODUJHVW RI WKH JURXSV FRQGXFW WKHUDSHXWLF DFWLYLWLHV IRU SDWLHQWV PRQLWRU FRPPRQ SDWLHQW
DUHDV LQ WKH XQLWV DQG LQWHUYHQH LQ SDWLHQW GLVSXWHV
:LWKLQ SDWLHQW XQLWV VWDIILQJ OHYHOV YDU\ GHSHQGLQJ RQ WKH WLPH RI GD\ DQG GD\ RI WKH ZHHN
2I WKH WKUHH GDLO\ VKLIWV ZRUNHG E\ WKH QXUVHV DQG SV\FKLDWULF WHFKQLFLDQV WKH GD\ VKLIWV
JHQHUDOO\ KDYH WKH PRVW VWDII EHFDXVH WKLV LV ZKHQ SDWLHQWV DUH PRVW DFWLYH DQG PRVW WUHDW
PHQW LV SURYLGHG )RU H[DPSOH RQ )ULGD\ -DQXDU\ WKHUH ZHUH UHJLVWHUHG QXUVHV
OLFHQVHG SUDFWLFDO QXUVH DQG SV\FKLDWULF WHFKQLFLDQV DVVLJQHG WR PDQDJH SDWLHQWV RQ WKH
GD\ VKLIW LQ -XQLSHU D XQLW WKDW KRXVHV VRPH RI WKH KRVSLWDO·V PRVW YLROHQW SDWLHQWV ,Q FRQ
WUDVW WKHUH ZHUH UHJLVWHUHG QXUVH DQG SV\FKLDWULF WHFKQLFLDQV WR PDQDJH WKH VDPH QXPEHU
RI SDWLHQWV DW QLJKW
Staffing Levels
Often Insufficient
$6+·V SDWLHQW XQLWV RIWHQ ODFN VXIILFLHQW VWDII 7KLV ODFN RI VWDII ZDV D FRQWULEXWLQJ IDFWRU LQ
$6+·V IDLOXUH WR PHHW 0HGLFDUH FHUWLILFDWLRQ UHTXLUHPHQWV LQ $OWKRXJK WKH QXPEHU RI
VWDII SRVLWLRQV DXWKRUL]HG IRU $6+ KDV EHHQ LQFUHDVHG KLJK YDFDQF\ DQG WXUQRYHU UDWHV KDYH
NHSW VWDIILQJ OHYHOV EHORZ ZKDW LV QHHGHG
7UHDWPHQW XQLWV VKRUWVWDIIHG³6HYHUDO SUHYLRXV UHYLHZV KDYH FDOOHG DWWHQWLRQ WR WKH ODFN RI
VWDII
n Medicare certification review findings³:KHQ WKH +HDOWK &DUH )LQDQFLQJ $GPLQLVWUD
WLRQ +&)$ GHQLHG $6+·V DSSOLFDWLRQ IRU SDUWLFLSDWLRQ LQ WKH 0HGLFDUH UHLP
EXUVHPHQW SURJUDP LW FLWHG VWDIILQJ VKRUWDJHV DV RQH RI WKH UHDVRQV VHH 2WKHU 3HUWLQHQW
,QIRUPDWLRQ SDJHV WKURXJK IRU D IXOOHU GLVFXVVLRQ 'HQLDO RI 0HGLFDUH HOLJLELOLW\
PHDQW WKH KRVSLWDO KDG WR PDNH XS IHGHUDO VWDWH DQG ORFDO UHLPEXUVHPHQWV IRU ERWK
0HGLFDUH DQG $+&&&6 7LWOH ;,; SDWLHQWV +&)$ LQVSHFWRUV QRWHG WKDW WKH KRVSLWDO KDG
RQO\ QXUVHV DQG SV\FKLDWULF WHFKQLFLDQV DYDLODEOH WR FDUH IRU SDWLHQWV EXW WKH KRVSLWDO
QHHGHG DSSUR[LPDWHO\ WR SURYLGH DQ DGHTXDWH OHYHO RI WUHDWPHQW 7KH\ QRWHG VSHFLILF
LQVWDQFHV LQ ZKLFK WRR IHZ VWDII ZHUH DYDLODEOH RQ D WUHDWPHQW XQLW WR DGHTXDWHO\ PRQLWRU
DQG SURYLGH WUHDWPHQW WR SDWLHQWV
n Outside review by mental health experts³$V SDUW RI WKH DWWHPSW WR DGGUHVV VWDIILQJ
SUREOHPV WKDW ODWHU OHG WR +&)$·V GHQLDO RI $6+·V DSSOLFDWLRQ ILYH PHQWDO KHDOWK H[SHUWV
UHYLHZHG $6+·V RSHUDWLRQV LQ 2FWREHU DQG FRQFOXGHG WKDW WKH KRVSLWDO ODFNHG VXIIL
FLHQW QXPEHUV RI WUHDWPHQW VWDII LQFOXGLQJ QXUVHV DQG SV\FKLDWULF WHFKQLFLDQV
2EVHUYDWLRQV DW WKH XQLW OHYHO E\ $XGLWRU *HQHUDO VWDII VKRZHG VLPLODU LQVWDQFHV RI LQVXIIL
FLHQW VWDIILQJ )RU H[DPSOH WKH -XQLSHU XQLW ZKLFK KRXVHV FLYLOO\ FRPPLWWHG PDOHV DQG
IHPDOHV KDG RQO\ RU RI LWV DVVLJQHG VWDII DYDLODEOH WR FDUH IRU WKH XQLW·V DSSUR[LPDWHO\
SDWLHQWV GXULQJ WKH VKLIW REVHUYHG $FFRUGLQJ WR WKH -XQLSHU XQLW PDQDJHU WKH XQLW VKRXOG
KDYH KDG VHYHUDO PRUH VWDII GXULQJ WKDW VKLIW WR DGHTXDWHO\ PRQLWRU DQG FDUH IRU SDWLHQWV
(IIHFW RI UHFHQW VWDIILQJ LQFUHDVHV LV OLPLWHG E\ KLJK YDFDQFLHV DQG WXUQRYHU³7R KHOS DGGUHVV
WKH SUREOHPV WKDW OHG WR WKH GHQLDO RI 0HGLFDUH FHUWLILFDWLRQ $6+ UHFHLYHG DSSURSULDWLRQV IRU
DGGLWLRQDO SRVLWLRQV IRU ILVFDO \HDU +RZHYHU $6+ KDV EHHQ XQDEOH WR KLUH DQG
UHWDLQ HQRXJK VWDII WR XVH WKHVH KLJKHU VWDIILQJ OHYHOV +RVSLWDO ZLGH DV RI 1RYHPEHU
$6+ KDG YDFDQFLHV LQ RI LWV DXWKRUL]HG SRVLWLRQV H[FOXGLQJ WKRVH DVVLJQHG WR WKH
VH[XDOO\ YLROHQW SHUVRQV XQLW $6+ GDWD IURP )HEUXDU\ VKRZHG WKDW YDFDQF\ UDWHV IRU
UHJLVWHUHG QXUVHV DQG OLFHQVHG SUDFWLFDO QXUVHV ZHUH SHUFHQW DQG IRU SV\FKLDWULF WHFKQL
FLDQV ZHUH SHUFHQW $XGLWRUV· UHYLHZV RI VSHFLILF XQLWV VKRZHG YDFDQF\ SUREOHPV VXFK DV
WKH IROORZLQJ
n 7KH -XQLSHU XQLW ZKLFK KRXVHV FLYLOO\ FRPPLWWHG PHQ DQG ZRPHQ KDG YDFDQFLHV LQ
RI WKH VWDII SRVLWLRQV SHUPDQHQWO\ DOORFDWHG WR LW
n 7KH :LFN XQLW ZKLFK KRXVHV PDOH UHVWRUDWLRQ WR FRPSHWHQF\ SDWLHQWV KDG YDFDQFLHV LQ
RI WKH VWDII SRVLWLRQV DVVLJQHG WR LW
,Q D VXUYH\ RI IRXU KRVSLWDOV LQ RWKHU VWDWHV $6+ IRXQG WKDW LWV YDFDQF\ UDWHV IRU QXUVLQJ DQG
SV\FKLDWULF WHFKQLFLDQ SRVLWLRQV ZHUH JHQHUDOO\ KLJKHU WKDQ WKRVH RI WKH RWKHU KRVSLWDOV $V
VKRZQ LQ 7DEOH $6+ KDG WKH KLJKHVW YDFDQF\ UDWHV IRU OLFHQVHG SUDFWLFDO QXUVHV DQG WKH
VHFRQG KLJKHVW UDWH DPRQJ UHJLVWHUHG QXUVHV DQG SV\FKLDWULF WHFKQLFLDQV
Table 2
Department of Health Services—Arizona State Hospital
Comparison of Vacancy and Turnover Rates1
As of September 1998
Psychiatric
Nurse II
Licensed Practical
Nurse II
Psychiatric
Technician II
Vacancy Turnover Vacancy Turnover Vacancy Turnover
$UL]RQD 6WDWH +RVSLWDO
(DVWHUQ 6WDWH +RVSLWDO
0HGLFDO /DNH :DVKLQJWRQ
/DNH·V &URVVLQJ &HQWHU
6SDUNV 1HYDGD 1 $ 1 $
1DSD 6WDWH +RVSLWDO
1DSD &DOLIRUQLD
8WDK 6WDWH +RVSLWDO
3URYR 8WDK
7HQ VWDWH SV\FKLDWULF KRVSLWDOV LQ WKH ZHVWHUQ 8QLWHG 6WDWHV ZHUH VXUYH\HG KRZHYHU RQO\ UHVSRQGHG DV
RI 6HSWHPEHU 7XUQRYHU UDWHV ZHUH GHILQHG DV WKH SHUFHQWDJH RI VWDII ZKR OHIW WKH KRVSLWDO EHWZHHQ
-XO\ DQG -XQH 9DFDQFLHV ZHUH GHILQHG DV WKH SHUFHQWDJH RI VWDII SRVLWLRQV YDFDQW DV RI WKH
GDWH VXUYH\HG
7KH 1HYDGD KRVSLWDO GLG QRW UHSRUW YDFDQF\ DQG WXUQRYHU UDWHV IRU /LFHQVHG 3UDFWLFDO 1XUVH ,,
6RXUFH :HVWHUQ 3V\FKLDWULF +RVSLWDO &OLQLFDO (PSOR\PHQW 6XUYH\ FRQGXFWHG E\ $UL]RQD 6WDWH +RVSLWDO VWDII
6HSWHPEHU
$6+ DOVR KDV KLJK WXUQRYHU UDWHV $FFRUGLQJ WR WKH 'HSDUWPHQW RI +HDOWK 6HUYLFHV WXUQRYHU
UDWHV DPRQJ FHUWDLQ FODVVHV RI SV\FKLDWULF WHFKQLFLDQV UDQJHG IURP WR SHUFHQW GXULQJ
ILVFDO \HDU DQG IRU UHJLVWHUHG DQG OLFHQVHG SUDFWLFDO QXUVHV KDYH UDQJHG IURP WR
SHUFHQW $V 7DEOH VHH SDJH LOOXVWUDWHV $6+·V WXUQRYHU UDWHV IRU UHJLVWHUHG DQG OLFHQVHG
SUDFWLFDO QXUVHV DUH KLJKHU WKDQ WKH IRXU RWKHU KRVSLWDOV VXUYH\HG DQG WKH WXUQRYHU UDWH IRU
SV\FKLDWULF WHFKQLFLDQV LV KLJKHU WKDQ WKUHH RI WKH IRXU +LJK WXUQRYHU UDWHV KDYH PDGH LW
FUXFLDO IRU $6+ WR HQVXUH WKDW QHZ VWDII DUH DGHTXDWHO\ WUDLQHG DQG RULHQWHG WR ZRUNLQJ LQ D
SV\FKLDWULF KRVSLWDO 7KH -RLQW &RPPLVVLRQ RQ $FFUHGLWDWLRQ RI +HDOWKFDUH 2UJDQL]DWLRQV LQ
LWV 'HFHPEHU LQVSHFWLRQ FLWHG $6+ ZLWK D FULWLFDO GHILFLHQF\ FRQFHUQLQJ WKH DGHTXDF\ RI
LWV QHZ VWDII WUDLQLQJ DQG RULHQWDWLRQ
Low Staffing Levels Mean ASH
Often Cannot Provide
Adequate Treatment and
Therapeutic Environment
$6+·V GLIILFXOW\ LQ ILOOLQJ SRVLWLRQV KDV FRQVHTXHQFHV IRU WKH KRVSLWDO·V DELOLW\ WR PHHW WUHDW
PHQW UHTXLUHPHQWV DQG SURYLGH D VDIH HQYLURQPHQW IRU SDWLHQWV DQG VWDII (IIRUWV WR LQFUHDVH
VWDIILQJ OHYHOV E\ XVLQJ FRQWUDFW VWDII IURP QXUVLQJ UHJLVWULHV DQG UHTXLULQJ VWDII WR ZRUN
RYHUWLPH KDYH EHHQ H[SHQVLYH DQG QRW DOZD\V HIIHFWLYH
7UHDWPHQW JXLGHOLQHV QRW PHW³6HYHUDO UHYLHZV EHVLGHV WKLV RQH KDYH VKRZQ WKDW EHFDXVH
WUHDWPHQW XQLWV ODFN DGHTXDWH VWDII $6+ SDWLHQWV RIWHQ UHFHLYH PXFK OHVV WKDQ WKH KRXUV
SHU ZHHN RI DFWLYH WUHDWPHQW FDOOHG IRU LQ KRVSLWDO JXLGHOLQHV
n Internal review findings³$6+·V RZQ VWXGLHV LQ 'HFHPEHU DQG )HEUXDU\
IRXQG WKDW SDWLHQWV FRQVLVWHQWO\ UHFHLYHG IHZHU WKDQ KRXUV RI DFWLYH WUHDWPHQW SHU
ZHHN )RU H[DPSOH WKH )HEUXDU\ VWXG\ IRXQG WKDW SDWLHQWV LQ WKUHH IRUHQVLF XQLWV UH
FHLYHG DQ DYHUDJH RI WR KRXUV RI DFWLYH WUHDWPHQW HDFK ZHHN $PRQJ RWKHU XQLWV SD
WLHQWV LQ WKH *UDQDGD XQLW ZKLFK KRXVHV LOO DQG HOGHUO\ SDWLHQWV UHFHLYHG IHZHU WKDQ
KRXUV SHU ZHHN DQG SDWLHQWV IURP WKH DGROHVFHQW XQLW UHFHLYHG DERXW KRXUV SHU ZHHN
LQ DGGLWLRQ WR KRXUV RI VFKRROLQJ
n Medicare certification review findings³'XULQJ WKH 0HGLFDUH FHUWLILFDWLRQ UHYLHZ
+&)$ VXUYH\RUV REVHUYHG FDVHV LQ ZKLFK PDQ\ SDWLHQWV GLG QRW DSSHDU WR EH UHFHLYLQJ
WUHDWPHQW DQG WKHLU UHYLHZ RI SDWLHQW ILOHV DOVR IDLOHG WR ILQG HYLGHQFH WKDW SDWLHQWV ZHUH
UHFHLYLQJ DGHTXDWH WUHDWPHQW )RU H[DPSOH VXUYH\RUV REVHUYHG SDWLHQWV LQ WKH :LFN
XQLW ZKR KDG QR LQWHUDFWLRQ ZLWK VWDII IRU RQH KRXU DOWKRXJK WKH\ ZHUH VXSSRVHG WR EH
UHFHLYLQJ VXEVWDQFH DEXVH DQG UHVWRUDWLRQ WR FRPSHWHQF\ FODVVHV GXULQJ WKLV WLPH DQG
n Auditors’ review³$XGLWRUV UHYLHZHG SDWLHQW ILOHV IURP GLIIHUHQW WUHDWPHQW XQLWV WR
YHULI\ WKH UHVXOWV RI $6+·V LQWHUQDO VWXGLHV DQG WR JDLQ D JUHDWHU XQGHUVWDQGLQJ RI WKH
DPRXQW DQG W\SHV RI WUHDWPHQW SDWLHQWV UHFHLYHG 2Q RQH XQLW WKH SDWLHQWV ZKRVH ILOHV
ZHUH UHYLHZHG DOO UHFHLYHG OHVV WKDQ KDOI RI WKH WUHDWPHQW FDOOHG IRU RQ WKHLU LQGLYLGXDO
WUHDWPHQW SODQV 2Q DQRWKHU XQLW QRQH RI WKH UHFHLYHG DQ\ RI WKH FDOOHG IRU WUHDWPHQW
,QVXIILFLHQW VWDIILQJ OHDGV WR GDQJHURXV HQYLURQPHQW³,QVXIILFLHQW VWDIILQJ FDQ OHDG QRW RQO\
WR LQDGHTXDWH WUHDWPHQW EXW DOVR WR DQ XQVDIH HQYLURQPHQW IRU ERWK SDWLHQWV DQG VWDII $F
FRUGLQJ WR XQLW PDQDJHUV DQG SV\FKLDWULF QXUVH PDQDJHUV VXUYH\HG GXULQJ WKH DXGLW XQLWV
WKDW KDYH DQ LQVXIILFLHQW QXPEHU RI VWDII FDQ FUHDWH DQ XQVDIH HQYLURQPHQW ZLWK PRUH DV
VDXOWV DQG YHUEDO DOWHUFDWLRQV WKDW LQFOXGH SDWLHQWV 'DWD FROOHFWHG E\ $6+·V 4XDOLW\ 5HVRXUFH
0DQDJHPHQW GHSDUWPHQW VKRZV WKDW SDWLHQWV FRPPLWWHG DVVDXOWV DJDLQVW RWKHU SDWLHQWV LQ
$XJXVW DQG DVVDXOWV RQ VWDII
+&)$ VXUYH\RUV QRWHG D OLQN EHWZHHQ LQVXIILFLHQW VWDIILQJ OHYHOV DQG WKH DELOLW\ WR SUHYHQW
VXFK LQFLGHQWV RU UHVSRQG WR WKHP 'XULQJ WKH 0HGLFDUH FHUWLILFDWLRQ UHYLHZ WKH\ QRWHG
LQVWDQFHV LQ ZKLFK $6+·V XQLWV GLG QRW DSSHDU WR KDYH VXIILFLHQW VWDII 7KH\ DOVR QRWHG WKDW
VWDII DEVHQFHV DQG LQMXULHV DW WLPHV OHDYH VPDOO QXPEHUV RI H[SHULHQFHG VWDII ZKR DUH IDPLOLDU
ZLWK WKH FKDQJLQJ QHHGV RI SDWLHQWV 7KHLU LQWHUYLHZV ZLWK VWDII RQ DOO VKLIWV LQGLFDWHG VDIHW\
FRQFHUQV IRU SDWLHQWV DQG VWDII GXH WR LQVXIILFLHQW H[SHULHQFHG VWDII FRYHUDJH WKURXJKRXW WKH
KRVSLWDO
8QLW PDQDJHUV DQG SV\FKLDWULF QXUVH PDQDJHUV VXUYH\HG GXULQJ WKH DXGLW GHVFULEHG WKH
HIIHFWV RI LQVXIILFLHQW VWDII RQ SDWLHQW WUHDWPHQW DQG VDIHW\ )RU H[DPSOH WKH\ UHSRUWHG WKDW
WKH\ ZHUH VRPHWLPHV XQDEOH WR SURYLGH WKHUDS\ JURXSV WR SDWLHQWV EHFDXVH WKH XQLW GLG QRW
KDYH HQRXJK VWDII 7KH\ DOVR VDLG WKDW KDYLQJ WRR IHZ VWDII RQ WKH XQLWV FRQWULEXWHG WR WKH
QXPEHU RI DVVDXOWV RFFXUULQJ RQ WKH XQLWV
6WRSJDS PHDVXUHV DUH H[SHQVLYH QRW DOZD\V HIIHFWLYH³7R KHOS FRPSHQVDWH IRU YDFDQFLHV RQ
LWV RZQ VWDII $6+ XVHV FRQWUDFW VWDII DQG RYHUWLPH KRXUV ZRUNHG E\ LWV UHJXODU VWDII $6+
VSHQW DSSUR[LPDWHO\ PLOOLRQ RQ SD\PHQWV WR FRQWUDFW ILUPV LQ ILVFDO \HDU $V VKRZQ
LQ )LJXUH VHH SDJH FRQWUDFW QXUVHV DQG SV\FKLDWULF WHFKQLFLDQV FRVW PXFK PRUH WKDQ
UHJXODU VWDII $GGLWLRQDOO\ DFFRUGLQJ WR DQ DQDO\VLV FRQGXFWHG E\ -RLQW /HJLVODWLYH %XGJHW
&RPPLWWHH VWDII FRQWUDFW VWDII FRVW DERXW SHUFHQW PRUH WKDQ SHUPDQHQW IXOO WLPH VWDII
1RQHWKHOHVV $6+ XVHV FRQWUDFW VWDII WR FRYHU DERXW HLJKW KRXU VKLIWV GXULQJ D W\SLFDO
PRQWK PRVWO\ WR FRYHU SV\FKLDWULF WHFKQLFLDQ VKLIWV )RU H[DPSOH GXULQJ RQH ZHHN LQ 2FWR
EHU $6+ XVHG FRQWUDFW VWDII WR FRYHU UHJLVWHUHG QXUVH VKLIWV OLFHQVHG SUDFWLFDO
QXUVH VKLIWV DQG SV\FKLDWULF WHFKQLFLDQ VKLIWV 7KHVH FRQWUDFW VWDII ZHUH HTXLYDOHQW WR
DERXW UHJXODU $6+ VWDII GXULQJ WKLV SHULRG
%HVLGHV EHLQJ H[SHQVLYH FRQWUDFW VWDII PD\ KDYH OLPLWHG HIIHFWLYHQHVV $6+ VWDII UHSRUW WKDW
WKH FRQWUDFW VWDII DUH RIWHQ LQHIIHFWLYH DQG FDQQRW IXOILOO WKH UROH RI UHJXODU VWDII &RQWUDFW VWDII
DUH RIWHQ XQIDPLOLDU ZLWK KDQGOLQJ WKH VHYHUHO\ LPSDLUHG SV\FKLDWULF SDWLHQWV ZKR QHHG WKH
OHYHO RI FDUH $6+ SURYLGHV ,Q DGGLWLRQ $6+ FDQQRW DVVLJQ FRQWUDFW VWDII WR WKH KRVSLWDO ZLGH
WHDP WKDW KDQGOHV PHGLFDO DQG SV\FKLDWULF HPHUJHQFLHV 7KHUHIRUH ZKHQ DQ HPHUJHQF\
RFFXUV RQO\ UHJXODU $6+ VWDII DUH DOORZHG WR DVVLVW ZKLFK FDQ DGG WR WKH SUREOHP RI XQLWV
EHLQJ LQDGHTXDWHO\ VWDIIHG
Figure 1
Department of Health Services³Arizona State Hospital
Comparison of Average Hourly Rates
Contract Staff versus Regular Staff
As of August 20, 1998
6RXUFH $UL]RQD 'HSDUWPHQW RI +HDOWK 6HUYLFHV· DQDO\VLV RI FRQWUDFW VWDII KRXUO\ UDWHV FRPSDUHG WR UHJXODU VWDII
DV RI $XJXVW
+RVSLWDO VWDII VXUYH\HG GXULQJ WKH DXGLW VDLG WKH\ ZRXOG UDWKHU KDYH UHJXODU VWDII ZRUNLQJ
RQ WKH XQLWV VLQFH FRQWUDFW VWDII UHTXLUH VLJQLILFDQW JXLGDQFH DQG DVVLVWDQFH WR GR WKHLU MREV
6RPH DOVR FLWHG IUXVWUDWLRQ ZLWK VRPH FRQWUDFW VWDII ZKR GR RQO\ D PLQLPDO DPRXQW RI ZRUN
+DYLQJ UHJXODU VWDII ZRUN RYHUWLPH SURYLGHV DGGLWLRQDO VWDIILQJ UHVRXUFHV EXW DOVR FDUULHV
DGGLWLRQDO FRVWV :KHQ VWDII ZRUN RYHUWLPH WKH\ UHFHLYH WLPH DQG RQH KDOI ZDJHV 'XULQJ
RQH ZHHN LQ 2FWREHU $6+ XVHG DERXW RYHUWLPH KRXUV RI ZKLFK ZHUH ZRUNHG
E\ SV\FKLDWULF WHFKQLFLDQV 8QLW PDQDJHUV DQG QXUVH PDQDJHUV DOVR UHSRUWHG WKDW H[WHQVLYH
XVH RI RYHUWLPH FDQ OHDG WR VWDII H[KDXVWLRQ DQG EXUQRXW
Salary Levels, Difficult Work Environment,
and Other Factors Contribute to Inability
to Recruit and Retain Staff
$OWKRXJK WKH 'HSDUWPHQW RI +HDOWK 6HUYLFHV DQG WKH KRVSLWDO KDYH WDNHQ DFWLRQ WR ILOO YDFDQ
FLHV VHYHUDO IDFWRUV PDNH UHFUXLWLQJ DQG UHWDLQLQJ VWDII GLIILFXOW /RZ VDODULHV D GLIILFXOW
ZRUNLQJ HQYLURQPHQW DQG RWKHU IDFWRUV DGYHUVHO\ DIIHFWLQJ PRUDOH DUH NH\ IDFWRUV WKDW FRQ
$33.69
$22.76
$24.68
$15.07 $14.65
$12.13
$-
$5
$10
$15
$20
$25
$30
$35
Registered Nurses Licensed Practical Nurses Psychiatric Technicians
Contract Staff Regular Staff
WULEXWH WR SUREOHPV LQ UHFUXLWLQJ DQG UHWDLQLQJ TXDOLILHG VWDII 7KH KRVSLWDO KDV DGGUHVVHG
WKHVH SUREOHPV E\ FRQGXFWLQJ H[LW LQWHUYLHZV WR OHDUQ ZK\ VWDII OHDYH DQG KDV HVWDEOLVKHG DQ
HPSOR\HH FRPPLWWHH WR KHOS UHWDLQ VWDII
)DFWRUV DIIHFWLQJ $6+·V DELOLW\ WR PDLQWDLQ DGHTXDWH VWDIILQJ LQFOXGH
n Difficulties filling positions³$6+ KDV GLIILFXOW\ DWWUDFWLQJ TXDOLILHG DSSOLFDQWV ZKR DUH
LQWHUHVWHG LQ ZRUNLQJ DW WKH KRVSLWDO $FFRUGLQJ WR $6+·V KXPDQ UHVRXUFHV GLUHFWRU DO
WKRXJK $6+ DGYHUWLVHV LWV YDFDQFLHV LQ VHYHUDO $UL]RQD QHZVSDSHUV DQG GLVWULEXWHV DS
SOLFDWLRQ LQIRUPDWLRQ DW PDQ\ MRE IDLUV IHZ TXDOLILHG DSSOLFDQWV DUH LQWHUHVWHG LQ WKH SR
VLWLRQV ,W LV GLIILFXOW WR DWWUDFW TXDOLILHG FDQGLGDWHV GXH WR WKH GHPDQGV RI WKH SRVLWLRQ DQG
WKH VDODU\ RIIHUHG IDFWRUV FRYHUHG LQ PRUH GHWDLO EHORZ
n Low salaries³6DODULHV $6+ SD\V LWV QXUVHV DQG SV\FKLDWULF WHFKQLFLDQV DUH ORZ ZKHQ
FRPSDUHG ZLWK VLPLODU SRVLWLRQV HOVHZKHUH $6+·V SDUHQW DJHQF\ WKH 'HSDUWPHQW RI
+HDOWK 6HUYLFHV IRXQG WKDW WKH 'HSDUWPHQW·V VDODULHV IRU QXUVHV ZHUH RQ DYHUDJH
ORZHU SHU PRQWK WKDQ VDODULHV SDLG WR QXUVHV ZRUNLQJ LQ SULYDWH KRVSLWDOV 7R EH FRPSD
UDEOH WKH VWXG\ IRXQG ZRXOG PHDQ LQFUHDVLQJ QXUVHV· VDODULHV E\ SHUFHQW $GGLWLRQ
DOO\ D VWXG\ FRQGXFWHG E\ -RLQW /HJLVODWLYH %XGJHW &RPPLWWHH VWDII IRXQG WKDW VDODULHV
SDLG WR $6+·V FOLQLFDO SRVLWLRQV ZHUH DERXW SHUFHQW ORZHU WKDQ WKRVH SDLG WR WKHLU SUL
YDWH VHFWRU FRXQWHUSDUWV
n Difficult work environment³$6+·V ZRUN HQYLURQPHQW FDQ EH PRUH GLIILFXOW WKDQ RWKHU
SV\FKLDWULF KRVSLWDOV $6+·V SDWLHQW SRSXODWLRQ LQFOXGHV PDQ\ VHYHUH SDWLHQWV ZKR FDQ
EH PRUH XQSUHGLFWDEOH DQG YLROHQW WKDQ RWKHU KRVSLWDOV· SDWLHQWV $GGLWLRQDOO\ WKH KRV
SLWDO·V SDWLHQWV VRPHWLPHV KDYH PRUH PHGLFDO SUREOHPV VXFK DV WXEHUFXORVLV KHSDWLWLV &
DQG +,9 $OWKRXJK VWDII LQWHUYLHZHG GXULQJ WKH DXGLW VDLG WKH\ JDLQHG VDWLVIDFWLRQ IURP
KHOSLQJ WKH SDWLHQWV VWDII UHSRUWHG WKDW WKH SDWLHQWV DUH RQH IDFWRU WKDW FRQWULEXWHV WR D
PRUH GLIILFXOW ZRUN HQYLURQPHQW ZKLFK LQ WXUQ FRQWULEXWHV WR GLIILFXOWLHV UHFUXLWLQJ DQG
UHWDLQLQJ VWDII
n Organizational turmoil³$6+ VWDII KDYH DOVR XQGHUJRQH VLJQLILFDQW RUJDQL]DWLRQDO
WXUPRLO RYHU WKH SDVW VHYHUDO \HDUV $FFRUGLQJ WR WKH PHPRUDQGXP WKH KRVSLWDO GH
YHORSHG D SODQ WR DEROLVK SRVLWLRQV EHWZHHQ $SULO DQG -XO\ LQ DQ
WLFLSDWLRQ RI WKH SODQQHG UHGXFWLRQ LQ FLYLO SDWLHQWV FDXVHG E\ WKH $UQROG Y 6DUQ ODZVXLW
$W WKH VDPH WLPH WKH 'HSDUWPHQW LQLWLDWHG D SURFHVV WR GHWHUPLQH WKH IHDVLELOLW\ RI SUL
YDWL]LQJ WKH KRVSLWDO 0DQ\ VWDII IHDULQJ WKDW WKH KRVSLWDO ZRXOG FORVH OHIW $FFRUGLQJ WR
PDQ\ VWDII LQWHUYLHZHG GXULQJ WKH DXGLW VWDII PRUDOH VXIIHUHG DIWHU WKH SULYDWL]DWLRQ
VWXG\
n Frequent transfers between units³$FFRUGLQJ WR PDQ\ $6+ VWDII LQWHUYLHZHG DQG
VXUYH\HG GXULQJ WKH DXGLW $6+·V SUDFWLFH RI WHPSRUDULO\ WUDQVIHUULQJ VWDII IURP WKHLU DV
VLJQHG XQLW WR DQRWKHU XQLW ORZHUV VWDII PRUDOH DQG FDXVHV IUXVWUDWLRQ 6WDII DUH RIWHQ RS
SRVHG WR WKH SUDFWLFH ZKLFK RFFXUV VHYHUDO WLPHV HDFK GD\ LQ VRPH XQLWV EHFDXVH WKH\ DUH
RIWHQ XQIDPLOLDU ZLWK DQRWKHU XQLW·V SDWLHQWV $FFRUGLQJ WR SV\FKLDWULF QXUVH PDQDJHUV
DQG XQLW PDQDJHUV VXUYH\HG GXULQJ WKH DXGLW QXUVHV DQG SV\FKLDWULF WHFKQLFLDQV DUH IUH
TXHQWO\ DIUDLG WR EH WUDQVIHUUHG WR XQLWV ZLWK YLROHQW SDWLHQWV $GGLWLRQDOO\ ZKHQ VWDII DUH
XQDZDUH RI SDWLHQWV· SDUWLFXODU QHHGV DQG SHUVRQDOLWLHV SDWLHQWV ORVH VRPH FRQWLQXLW\ RI
WKHLU FDUH $FFRUGLQJ WR QXUVLQJ VWDII IDPLOLDULW\ ZLWK D XQLW·V SDWLHQWV LV LPSRUWDQW VR
VWDII FDQ UHFRJQL]H LQGLYLGXDO FXHV WKDW VLJQDO D SDWLHQW UHTXLUHV DWWHQWLRQ
6RPH VWHSV XQGHUZD\ WR DGGUHVV SD\ DQG RWKHU FRQFHUQV³7KH KRVSLWDO UHFHLYHG D VXSSOH
PHQWDO DSSURSULDWLRQ RI DSSUR[LPDWHO\ PLOOLRQ GXULQJ HDUO\ )HEUXDU\ 7KH DSSUR
SULDWLRQ LQFOXGHG IRU VDODU\ LQFUHDVHV IRU QXUVHV DQG RWKHU FOLQLFDO VWDII 7KH KRVSLWDO
DOVR UHFHLYHG D 'HSDUWPHQW RI $GPLQLVWUDWLRQ VSHFLDO PDUNHW DGMXVWPHQW WRWDOLQJ DERXW
WR SURYLGH VDODU\ LQFUHDVHV IRU VRPH RI LWV VWDII LQFOXGLQJ VHFXULW\ RIILFHUV DQG UHF
UHDWLRQDO WKHUDSLVWV DV ZHOO DV QXUVHV DQG SV\FKLDWULF WHFKQLFLDQV $FFRUGLQJ WR $6+·V &KLHI
([HFXWLYH 2IILFHU WKHVH DSSURSULDWLRQV LQFUHDVHG UHJLVWHUHG QXUVH DQG SV\FKLDWULF WHFKQLFLDQ
VDODULHV WR PRUH FRPSHWLWLYH VDODU\ OHYHOV +RZHYHU $6+ FRQWLQXHV WR KDYH D QHHG IRU DGGL
WLRQDO VWDII 7KH VWDIILQJ VWXG\ FRQGXFWHG E\ WKH IRUPHU SV\FKLDWULVW FRQFOXGHG WKDW WKH KRV
SLWDO QHHGHG DQ DGGLWLRQDO DXWKRUL]HG FOLQLFDO )7(V WR SURYLGH SDWLHQWV ZLWK DQ DGHTXDWH
OHYHO RI WUHDWPHQW +RZHYHU IURP ILVFDO \HDUV WR WKH KRVSLWDO ZDV DXWKRUL]HG
DGGLWLRQDO SRVLWLRQV $GGLWLRQDOO\ WKH 'HSDUWPHQW KDV SURSRVHG UHFODVVLI\LQJ WKH SV\FKLDWULF
WHFKQLFLDQ DQG FHUWDLQ QXUVLQJ SRVLWLRQV D VWHS WKDW ZRXOG LPSURYH WKH SD\ VFDOH 7R DWWUDFW
VRPH QHZ HPSOR\HHV WKH KRVSLWDO QRZ RIIHUV VSHFLDO HQWUDQFH VDODULHV
7KH KRVSLWDO KDV DOVR EHJXQ VHYHUDO DFWLRQV GHVLJQHG WR LGHQWLI\ DQG DGGUHVV RWKHU IDFWRUV
DGYHUVHO\ DIIHFWLQJ PRUDOH 7R JDLQ D JUHDWHU XQGHUVWDQGLQJ RI WKH UHDVRQV ZK\ VWDII OHDYH
WKH KRVSLWDO KDV EHJXQ WR FRQGXFW H[LW LQWHUYLHZV ZLWK VWDII 7KXV IDU WKHVH LQWHUYLHZV KDYH
LQGLFDWHG WKDW HPSOR\HHV· GHFLVLRQV WR OHDYH DUH DIIHFWHG E\ PDQ\ IDFWRUV )RU H[DPSOH VRPH
VWDII FLWHG SHUVRQDO UHDVRQV RWKHUV FLWHG ILQDQFLDO UHDVRQV RU WKH ZRUN FOLPDWH 6RPH VWDII
LQGLFDWHG WKDW EHWWHU VDODULHV ZRXOG KDYH HQFRXUDJHG WKHP WR VWD\ $6+·V +XPDQ 5HVRXUFHV
'HSDUWPHQW SODQV WR FRQWLQXH VXUYH\LQJ IRUPHU VWDII WR JDLQ D EHWWHU XQGHUVWDQGLQJ RI WKH
IDFWRUV WKDW DIIHFW VWDII GHFLVLRQV WR VWD\ RU OHDYH 7R KHOS LPSURYH VWDII PRUDOH DQG ZRUNLQJ
FRQGLWLRQV WKH KRVSLWDO KDV WDNHQ VWHSV VXFK DV IRUPLQJ DQ HPSOR\HH UHFRJQLWLRQ SURJUDP WR
UHFRJQL]H RXWVWDQGLQJ VWDII SHUIRUPDQFH DQG WR FRRUGLQDWH VSHFLDO HYHQWV IRU VWDII
Method of Allocating Staff Among
Units Exacerbates Staffing Shortages
7KH HIIHFWV RI $6+·V VWDIILQJ VKRUWDJHV DUH FRPSRXQGHG E\ SUREOHPV LQ WKH PHWKRG XVHG WR
DOORFDWH VWDII DPRQJ WKH SDWLHQW XQLWV 7KLV PHWKRG NQRZQ DV DQ DFXLW\ V\VWHP GRHV QRW
DFFXUDWHO\ LGHQWLI\ WKH QXPEHU RI VWDII QHHGHG WR ZRUN RQ WKH XQLWV 7KH PHWKRG DOORFDWHV D
FRPELQDWLRQ RI QXUVHV DQG SV\FKLDWULF WHFKQLFLDQV WR HDFK XQLW EDVHG RQ WKH SDWLHQWV· IXQF
WLRQLQJ OHYHOV DQG FDUH QHHGV +RZHYHU WKH PHWKRG GRHV QRW DFFRXQW IRU VHYHUDO LPSRUWDQW
IDFWRUV WKDW GHWHUPLQH D XQLW·V VWDIILQJ QHHGV
n Off-site appointments³$6+ SDWLHQWV URXWLQHO\ UHTXLUH VWDII HVFRUWV WR DSSRLQWPHQWV
VXFK DV GHQWLVWV RU H\H GRFWRUV 7KHVH DSSRLQWPHQWV RIWHQ ODVW RYHU WZR KRXUV HDFK 'XU
LQJ $XJXVW RYHU VWDII KRXUV ZHUH VSHQW HVFRUWLQJ SDWLHQWV WR WKHVH DSSRLQW
PHQWV
n Constant monitoring³7KH V\VWHP GRHV QRW WDNH LQWR DFFRXQW ZKHWKHU SDWLHQWV QHHG
WHPSRUDU\ RQH RQ RQH PRQLWRULQJ E\ VWDII $OWKRXJK $6+·V SDVW DFXLW\ V\VWHP FRQVLG
HUHG ZKHWKHU SDWLHQWV UHTXLUHG D KLJK OHYHO RI PRQLWRULQJ LWV FXUUHQW V\VWHP GRHV QRW
$FFRUGLQJ WR VRPH VWDII VXUYH\HG GXULQJ WKH DXGLW WKLV LV D SUREOHP VLQFH PDQ\ SDWLHQWV
UHTXLUH RQH RQ RQH PRQLWRULQJ
n Other staff duties³7KH V\VWHP GRHV QRW WDNH LQWR DFFRXQW RWKHU VWDII GXWLHV VXFK DV
GLVSHQVLQJ PHGLFDWLRQV DQG DWWHQGLQJ SDWLHQW FRQIHUHQFHV $ FRQVXOWDQW KLUHG WR DVVLVW
$6+ LQ LWV HIIRUWV WR JDLQ +&)$ UHFHUWLILFDWLRQ QRWHG WKDW HYHQ ZKHQ VWDII DUH DVVLJQHG WR
XQLWV DSSURSULDWHO\ WKH\ DUH RIWHQ XQDYDLODEOH WR DWWHQG WR SDWLHQWV GXH WR RWKHU WDVNV )RU
H[DPSOH DXGLWRUV REVHUYHG RQH XQLW DOORFDWHG VWDII WR PDQDJH SDWLHQWV +RZHYHU
RI WKH VWDII ZDV GLVSHQVLQJ PHGLFDWLRQV WR SDWLHQWV DQRWKHU ZDV DWWHQGLQJ SDWLHQW FRQIHU
HQFHV DQG RWKHUV ZHUH DFFRPSDQ\LQJ SDWLHQWV WR DSSRLQWPHQWV OHDYLQJ VWDII WR DWWHQG
WR DSSUR[LPDWHO\ SDWLHQWV OHIW LQ WKH XQLW
ASH Should Continue Steps
to Ensure Adequate
Staffing in Units
$6+ VKRXOG WDNH D QXPEHU RI VWHSV WR HQVXUH WKDW LWV SDWLHQW XQLWV DUH DGHTXDWHO\ VWDIIHG
)LUVW WKH KRVSLWDO VKRXOG FRQWLQXH LWV HIIRUWV WR LPSOHPHQW D SRRO RI QXUVLQJ VWDII WR FDOO RQ
ZKHQ WKH XQLWV DUH LQVXIILFLHQWO\ VWDIIHG 6HFRQG LW VKRXOG FRQWLQXH WR DGGUHVV VWDII WXUQRYHU
DQG LPSURYH ZRUNLQJ FRQGLWLRQV 7KLUG LW VKRXOG PRGLI\ LWV DFXLW\ V\VWHP WR HQVXUH WKDW LW
DVVLJQV HDFK WUHDWPHQW XQLW D VXIILFLHQW QXPEHU RI VWDII
$6+ QXUVLQJ SRRO SURSRVDO FRXOG KHOS HQVXUH DGHTXDWH VWDIILQJ RQ XQLWV³7R HQVXUH WKDW LWV
WUHDWPHQW XQLWV DUH DGHTXDWHO\ VWDIIHG $6+ KDV SURSRVHG WKH XVH RI D SRRO RI QXUVLQJ VWDII
ZKR DUH QRW DVVLJQHG WR D SDUWLFXODU XQLW $FFRUGLQJ WR KRVSLWDO PDQDJHPHQW WKH SRRO
ZRXOG FRQVLVW RI D JURXS RI LQGLYLGXDOV ZKR ZRXOG ZRUN IRU $6+ RQ DQ DV QHHGHG EDVLV
DQG ZKR ZRXOG EH DYDLODEOH WR ZRUN GXULQJ D SDUWLFXODU VKLIW $ SRRO FRXOG SURYLGH VWDII IRU
VXFK WDVNV DV HVFRUWLQJ SDWLHQWV WR RII XQLW DSSRLQWPHQWV RU ZDWFKLQJ SDWLHQWV ZKR QHHG
FRQVWDQW PRQLWRULQJ 7KUHH RI WKH VWDWH KRVSLWDOV FRQWDFWHG GXULQJ WKH DXGLW XVH VXFK D SRRO
1 3DWLHQWV RIWHQ UHTXLUH SV\FKLDWULF DQG RWKHU PHGLFDWLRQV ZKLFK WKH QXUVH PXVW SUHSDUH DQG GLVSHQVH
%HFDXVH PDQ\ RI WKHVH PHGLFDWLRQV PXVW EH WDNHQ VHYHUDO WLPHV SHU GD\ DW VFKHGXOHG WLPHV XQLWV
PXVW GHVLJQDWH D QXUVH WR VSHQG DQ HQWLUH VKLIW GLVSHQVLQJ DQG GRFXPHQWLQJ PHGLFDWLRQV JLYHQ WR
HDFK SDWLHQW
$6+ UHFHLYHG DSSURYDO IURP WKH 'HSDUWPHQW RI $GPLQLVWUDWLRQ WR LPSOHPHQW WKH SRRO -DQX
DU\ 7KH SRRO FRQVLVWV RI WHPSRUDU\ HPSOR\HHV ZKR ZRXOG QRW EH DVVLJQHG WR D SDU
WLFXODU XQLW EXW ZRXOG ILOO WKH XQLWV RQ DQ DV QHHGHG EDVLV 3RWHQWLDO EHQHILWV IURP VXFK D SRRO
LQFOXGH XVLQJ SRRO SHUVRQQHO WR DVVLVW VWDII ZLWK FRPSOHWLQJ WDVNV DQG SURYLGLQJ EHWWHU FRQ
WLQXLW\ RI SDWLHQW FDUH 7KH SURSRVDO ZRXOG DOVR VDYH PRQH\ ZKHQ FRPSDUHG WR XVLQJ FRQ
WUDFW VWDII LQ WKDW SRRO VWDII ZRXOG EH SDLG DQ HVWLPDWHG WR SHU KRXU FRPSDUHG ZLWK
WKH UDWH RI WR FXUUHQWO\ SDLG WR DJHQFLHV WKDW VXSSO\ FRQWUDFW VWDII (YHQ WKRXJK FRVWV
WR $6+ ZRXOG EH OHVV SRRO VWDII ZRXOG HDUQ PRUH WKDQ WKH\ ZRXOG DW D FRQWUDFW ILUP EH
FDXVH WKH\ FXUUHQWO\ DUH SDLG OHVV WKDQ RI WKH WR UDWH FKDUJHG E\ WKH FRQWUDFW ILUP
$6+ ZLOO IDFH FKDOOHQJHV LQ GHYHORSLQJ D SRRO VLQFH LW DOUHDG\ IDFHV GLIILFXOWLHV LQ KLULQJ DQG
UHWDLQLQJ LWV FXUUHQW VWDII $OWKRXJK SRRO VWDII ZRXOG QRW EH IXOO WLPH KRVSLWDO HPSOR\HHV
UHWDLQLQJ WKHP PD\ SURYH WR EH GLIILFXOW LI WKH KRVSLWDO·V VWDII HQYLURQPHQW LQFOXGLQJ ZRUN
LQJ FRQGLWLRQV VDODULHV DQG PRUDOH LVVXHV LV QRW DGGUHVVHG
$6+ VKRXOG FRQWLQXH HIIRUWV WR UHVROYH WXUQRYHU SUREOHPV DQG LPSURYH ZRUNLQJ FRQGL
WLRQV³+RVSLWDO PDQDJHPHQW VKRXOG FRQWLQXH WR PDNH ILOOLQJ VWDII YDFDQFLHV DQG UHGXFLQJ
WXUQRYHU D KLJK SULRULW\ 7KH KRVSLWDO KDV WDNHQ DFWLRQ E\ SRVWLQJ MRE DGYHUWLVHPHQWV LQ
QHZVSDSHUV DQG SXEOLFL]LQJ KRVSLWDO SRVLWLRQV DW MRE IDLUV +RZHYHU VLQFH PDQ\ YDFDQFLHV
UHPDLQ WKH KRVSLWDO QHHGV WR VSHHG XS DQG VWUHQJWKHQ LWV UHFUXLWLQJ SURFHVV
7R KHOS DGGUHVV VWDII WXUQRYHU $6+ VKRXOG FRQWLQXH WR XVH H[LW LQWHUYLHZV WR VWXG\ WKH
UHDVRQV ZK\ VWDII OHDYH $6+ VKRXOG DOVR FRQWLQXH LWV HIIRUWV WR XVH WKH LQIRUPDWLRQ LW OHDUQV
IURP WKH LQWHUYLHZV WR PDNH FKDQJHV WKDW FRXOG LPSURYH VWDII PRUDOH )LQDOO\ $6+ VKRXOG
FRQWLQXH WR UHTXHVW DGGLWLRQDO IXQGLQJ IRU VWDII VDODU\ LQFUHDVHV WR PDNH LWV VDODULHV PRUH
FRPSHWLWLYH ZLWK RWKHU KRVSLWDOV
6LQFH WKH KRVSLWDO·V VWDIILQJ SUREOHPV DUH ORQJ VWDQGLQJ DQG FRPSOH[ WKH\ ZLOO OLNHO\ WDNH D
ORQJ WLPH WR UHVROYH DQG UHTXLUH VWHSV EH\RQG WKRVH GLVFXVVHG KHUH )LQGLQJ ,,, VHH SDJHV
WKURXJK SUHVHQWV D PRUH GHWDLOHG GLVFXVVLRQ RI WKH ORQJ WHUP SODQQLQJ DVSHFWV RI VWDIILQJ
LVVXHV
$6+ VKRXOG PRGLI\ LWV DFXLW\ V\VWHP³7R EHWWHU DOORFDWH H[LVWLQJ VWDII DPRQJ WKH WUHDWPHQW
XQLWV $6+ VKRXOG PRGLI\ LWV DFXLW\ V\VWHP $6+ VKRXOG HQVXUH WKDW WKH DFXLW\ V\VWHP WDNHV
LQWR DFFRXQW DOO PDMRU WDVNV WKDW VWDII SHUIRUP WKURXJKRXW WKH GD\ 2WKHU VWDWH KRVSLWDOV·
DFXLW\ V\VWHPV DFFRXQW IRU VXFK DFWLYLWLHV )RU H[DPSOH WKH 8WDK 6WDWH +RVSLWDO·V V\VWHP
DFFRXQWV IRU SDWLHQWV ZKR QHHG FRQVWDQW PRQLWRULQJ DV ZHOO DV RII JURXQGV HVFRUWLQJ $GGL
WLRQDOO\ WKH &RORUDGR 0HQWDO +HDOWK ,QVWLWXWH·V V\VWHP DFFRXQWV IRU SDWLHQWV ZKR QHHG WR EH
PRQLWRUHG RQ DQ KRXUO\ DV ZHOO DV D PLQXWH EDVLV DQG DOVR FRQVLGHUV ZKHWKHU QHZ SD
WLHQWV DUH DGPLWWHG RU WUDQVIHUUHG WR WKH XQLW
Recommendations
$6+ VKRXOG PRYH IRUZDUG ZLWK LWV SODQV WR LPSOHPHQW D SRRO RI QXUVLQJ VWDII
$6+ VKRXOG FRQWLQXH WR ILOO LWV YDFDQW SRVLWLRQV E\ FRQGXFWLQJ RQJRLQJ UHFUXLWLQJ HIIRUWV
$6+ VKRXOG FRQWLQXH LWV HIIRUWV WR UHGXFH VWDII WXUQRYHU E\ FRQGXFWLQJ H[LW LQWHUYLHZV
ZLWK VWDII ZKR OHDYH $6+ DQG PDNLQJ DSSURSULDWH FKDQJHV EDVHG RQ ZKDW LW OHDUQV
$6+ VKRXOG PRGLI\ LWV DFXLW\ V\VWHP WR WDNH RWKHU VWDII DFWLYLWLHV LQWR DFFRXQW 6SHFLIL
FDOO\ WKH DFXLW\ V\VWHP VKRXOG FRQVLGHU DGGLWLRQDO VWDII WLPH QHHGHG WR
n 'LVSHQVH PHGLFDWLRQV WR SDWLHQWV
n (VFRUW SDWLHQWV WR DSSRLQWPHQWV
n 3URFHVV DGPLVVLRQV DQG GLVFKDUJHV
n 3HUIRUP RQH RQ RQH PRQLWRULQJ RI SDWLHQWV DQG
n $WWHQG SDWLHQW FRQIHUHQFHV
7KLV 3DJH ,V ,QWHQWLRQDOO\ /HIW %ODQN
)LJXUH 6HYHQ SDWLHQWV DUH KRXVHG LQ WKLV EHGURRP LQ -XQLSHU XQLW
FINDING II
ASH FACILITIES ARE INADEQUATE
7KH IDFLOLWLHV $6+ XVHV WR KRXVH PHQWDOO\ LOO SDWLHQWV GR QRW SURYLGH DQ DSSURSULDWH DQG
WKHUDSHXWLF HQYLURQPHQW IRU WKH KRVSLWDO·V SDWLHQWV $6+·V EXLOGLQJV DUH ROG DQG GHWHULR
UDWLQJ DQG PDQ\ UHTXLUH FRQVWDQW UHSDLU ,Q DGGLWLRQ VRPH EXLOGLQJV DUH RYHUFURZGHG
)XUWKHUPRUH WKH VL]H DQG GHVLJQ RI WKH IDFLOLWLHV DUH LQDSSURSULDWH IRU WKH W\SH RI SDWLHQW WKH
KRVSLWDO FXUUHQWO\ VHUYHV 7KHUHIRUH $6+ PDQDJHPHQW VKRXOG WDNH VRPH LPPHGLDWH VWHSV
WR LPSURYH WKH IDFLOLWLHV LQ WKH VKRUW WHUP VXFK DV LQLWLDWLQJ LQH[SHQVLYH UHQRYDWLRQV LP
SURYLQJ PDLQWHQDQFH SURFHGXUHV DQG FRQWUDFW PRQLWRULQJ DQG FRQVWUXFWLQJ D WUDQVLWLRQDO
XQLW IRU SDWLHQWV +RZHYHU WKHVH LPSURYHPHQWV ZLOO QRW DGGUHVV SUREOHPV DULVLQJ IURP WKH
RYHUDOO GHVLJQ RI WKH IDFLOLWLHV ,Q WKH ORQJ UXQ QHZ KRVSLWDO IDFLOLWLHV ZLOO EH QHHGHG WR SUR
YLGH SDWLHQWV ZLWK DQ DSSURSULDWH DQG VDIH HQYLURQPHQW
ASH Provides Poor Environment
for Patients and Staff
$6+·V SDWLHQW WUHDWPHQW XQLWV DUH FURZGHG DQG QRW LQ FRPSOLDQFH ZLWK VWDWH OLFHQVLQJ VWDQ
GDUGV LQWHQGHG WR HQVXUH SDWLHQWV OLYH LQ D VDIH DQG FRPIRUWDEOH HQYLURQPHQW 7KH IDFLOLWLHV
SODFH VWDII DQG SDWLHQW VDIHW\ DW ULVN DQG LQWHUIHUH ZLWK SDWLHQW WKHUDS\ LQ WKDW WKH\ SURYLGH
LQVXIILFLHQW VSDFH IRU WUHDWPHQW DQG ODFN GHVLJQ IHDWXUHV IRXQG LQ QHZHU KRVSLWDOV 7KH
OLPLWHG VSDFH PHDQV WKDW
SDWLHQWV PXVW VRPHWLPHV EH
KRXVHG WRJHWKHU LQDSSUR
SULDWHO\ RU SODFHG LQ VSDFH
LQWHQGHG IRU RWKHU XVHV
3DWLHQW XQLWV RYHUFURZGHG³
$6+ LV QRW FRPSOLDQW ZLWK
OLFHQVXUH VWDQGDUGV UHJDUGLQJ
WKH DPRXQW RI VSDFH HDFK SDWLHQW
KDV DYDLODEOH WR RFFXS\ $6+ LV
URXWLQHO\ LQVSHFWHG E\ WKH
'HSDUWPHQW RI +HDOWK 6HUYLFHV
'LYLVLRQ RI $VVXUDQFH DQG
/LFHQVXUH ZKLFK HYDOXDWHV
KRVSLWDOV XVLQJ VWDQGDUGV GH
VLJQHG WR HQVXUH WKDW SDWLHQWV
OLYH LQ D VDIH FRPIRUWDEOH DQG WKHUDSHXWLF HQYLURQPHQW ,Q PDQ\ RI $6+·V XQLWV WKH QXPEHU
RI SDWLHQWV VXEVWDQWLDOO\ H[FHHGV ZKDW WKH VWDQGDUGV ZRXOG DOORZ 7DEOH VKRZV WKH QXPEHU
RI SDWLHQWV LQ HDFK RI $6+·V XQLWV DV RI -DQXDU\ DQG WKH QXPEHU RI SDWLHQWV E\
ZKLFK WKH XQLWV H[FHHGHG OLFHQVXUH VWDQGDUGV )ROORZLQJ DUH H[DPSOHV RI ZD\V LQ ZKLFK
$6+ GRHV QRW PHHW VSHFLILF VWDQGDUGV
n 3DWLHQW URRPV PXVW KDYH DW OHDVW VTXDUH IHHW IRU HDFK SDWLHQW %\ WKLV VWDQGDUG RI
$6+·V SDWLHQW WUHDWPHQW XQLWV H[FHHGHG WKHLU SDWLHQW FDSDFLW\ $OO RI WKH -XQLSHU
XQLWV ZKLFK KRXVH FLYLOO\ FRPPLWWHG SDWLHQWV ZHUH RYHU FDSDFLW\ ,Q IDFW RQH PL[HG
JHQGHU XQLW KDG SDWLHQWV RYHU LWV FDSDFLW\ RI
Table 3
Department of Health Services—Arizona State Hospital
Number of Patients by Unit
January 20, 1999
Unit Patient Type
Current
Number
Number
Permitted1
Number in
Excess
-XQLSHU &LYLO PDOH
-XQLSHU &LYLO PDOH
-XQLSHU &LYLO PDOH DQG IHPDOH
-XQLSHU &LYLO PDOH DQG IHPDOH
*UDQDGD &R HG DGXOW PHGLFDO DQG
SV\FKLDWULF SDWLHQWV
$GROHVFHQW $GROHVFHQW
:LFN )RUHQVLF³UHVWRUH WR
FRPSHWHQF\ PDOH
:LFN )RUHQVLF³UHVWRUH WR
FRPSHWHQF\ PDOH
:LFN )RUHQVLF³UHVWRUH WR
FRPSHWHQF\ PDOH
:LFN )RUHQVLF &LYLO³IHPDOH
:LFN )RUHQVLF³JXLOW\ H[FHSW
LQVDQH QRW JXLOW\ E\
UHDVRQ RI LQVDQLW\ PDOH
7RWDO
1XPEHU DXWKRUL]HG E\ 'HSDUWPHQW RI +HDOWK 6HUYLFHV 'LYLVLRQ RI $VVXUDQFH DQG /LFHQVXUH
1RUPDOO\ SDWLHQWV DUH KRXVHG RQ :LFN +RZHYHU RQ -DQXDU\ WKH XQLW·V SDWLHQWV ZHUH WHPSRUDULO\ UHDVVLJQHG WR
WKH :LFN DQG XQLWV VR WKH :LFN XQLW FRXOG EH FOHDQHG
$OWKRXJK WKH KRVSLWDO GRHV QRW H[FHHG WKH RYHUDOO QXPEHU RI SDWLHQWV DXWKRUL]HG E\ OLFHQVXUH VWDQGDUGV SDWLHQWV LW
GRHV H[FHHG WKHVH VWDQGDUGV RQ D SHU XQLW EDVLV
6RXUFH $UL]RQD 6WDWH +RVSLWDO UHSRUW 7UHDWPHQW 8QLW &XUUHQW &HQVXV DQG $UL]RQD 6WDWH +RVSLWDO :DUG 2YHUYLHZ
n $OWKRXJK VWDQGDUGV SURKLELW DVVLJQLQJ PRUH WKDQ SDWLHQWV WR D EHGURRP VHYHUDO XQLWV
DW $6+ WKDW ZRXOG FRPIRUWDEO\ KRXVH SDWLHQWV URXWLQHO\ KRXVH WR SDWLHQWV SHU
URRP EHFDXVH QR DOWHUQDWLYH VSDFH LV DYDLODEOH
n $OWKRXJK VWDQGDUGV FDOO IRU D VKRZHU IRU HYHU\ SDWLHQWV DQG D WRLOHW IRU HYHU\ SD
WLHQWV VHYHUDO XQLWV GR QRW PHHW VWDQGDUGV )RU H[DPSOH WKH -XQLSHU XQLW KDV RQO\
VKRZHUV RU IRU HYHU\ RI LWV PL[HG JHQGHU SDWLHQWV
2QH UHDVRQ IRU WKH RYHU
FURZGLQJ LV WKDW WKH DPRXQW RI
VSDFH DYDLODEOH WR WKH KRVSLWDO
KDV GHFUHDVHG HYHQ DV SDWLHQW
ORDGV KDYH EHJXQ WR ULVH
$OWKRXJK $6+ DW RQH WLPH
KRXVHG RYHU SDWLHQWV
FORVXUH RI VRPH EXLOGLQJV DQG
FRQYHUVLRQ RI RWKHUV WR GLIIHUHQW
XVHV KDV OHIW WKH KRVSLWDO ZLWK
LQVXIILFLHQW VSDFH IRU LWV FXUUHQW
FHQVXV RI RYHU SDWLHQWV 7KH
KRVSLWDO·V FHQVXV LV QRZ
LQFUHDVLQJ IURP LWV ORZ RI
SDWLHQWV LQ $W WKH VDPH
WLPH DV 7DEOH VHH SDJH
VKRZV VHYHUDO EXLOGLQJV WKDW
ZHUH XVHG WR KRXVH SDWLHQWV SULRU WR DUH QRZ FORVHG RU XVHG IRU RWKHU SXUSRVHV FRP
SUHVVLQJ SDWLHQWV LQWR WKH UHPDLQLQJ :LFN -XQLSHU DQG *UDQDGD XQLWV $6+ FXUUHQWO\ OHDVHV
RXW VTXDUH IHHW RI EXLOGLQJV WR RWKHU VWDWH DJHQFLHV ZKLOH KRXVLQJ $6+ SDWLHQWV LQ
RQO\ WRWDO VTXDUH IHHW 7KH &KROOD %XLOGLQJ ZKLFK SUHYLRXVO\ KRXVHG SDWLHQWV ZLWK
VHYHUH EHKDYLRUDO SUREOHPV QRZ KRXVHV 693V ,Q DGGLWLRQ WKH .DFKLQD XQLW ZKLFK ZDV
XVHG WR KRXVH DSSUR[LPDWHO\ SDWLHQWV ZDV FORVHG LQ GXH WR WKH FRVWO\ UHSDLUV QHF
HVVDU\ WR IL[ LWV URRI DQG FRROLQJ V\VWHP DQG EULQJ LW LQWR FRPSOLDQFH ZLWK OLIH VDIHW\ FRGHV
7KLV DFFRXQWHG IRU D ORVV RI VTXDUH IHHW RI XVDEOH SDWLHQW VSDFH 1R QHZ SDWLHQW IDFLOL
WLHV KDYH EHHQ EXLOW VLQFH
6WDII DQG SDWLHQW VDIHW\ RIWHQ DW ULVN³6WDII DQG SDWLHQW VDIHW\ DUH RIWHQ FRPSURPLVHG GXH
WR SDWLHQW RYHUFURZGLQJ )RU H[DPSOH GLVSXWHV EHWZHHQ SDWLHQWV LQ RYHUFURZGHG XQLWV
RFFXU PRUH IUHTXHQWO\ WKDQ LI SDWLHQWV ZHUH QRW VR FUDPSHG $FFRUGLQJ WR VWDII VXUYH\HG
GXULQJ WKH DXGLW ZKHQ SV\FKLDWULF SDWLHQWV GR QRW KDYH VXIILFLHQW SULYDF\ LW RIWHQ OHDGV WR
YHUEDO RU SK\VLFDO DOWHUFDWLRQV ZLWK RWKHU SDWLHQWV
7KH GHVLJQ DQG FRQGLWLRQ RI WKH ROG IDFLOLWLHV PDNH LW GLIILFXOW IRU VWDII WR HIIHFWLYHO\ SHUIRUP
WKHLU MREV DQG HQVXUH SDWLHQW VDIHW\ /RQJ KDOOZD\V FUHDWH DUHDV WKDW FDQQRW EH PRQLWRUHG E\
VWDII LQ WKH QXUVLQJ VWDWLRQ )RU H[DPSOH WKH *UDQDGD XQLW ZKLFK KRXVHV SDWLHQWV ZLWK
)LJXUH $6+ KDV FORVHG WKH .DFKLQD XQLW ZKLFK KDV FRQWULEXWHG
WR SDWLHQW RYHUFURZGLQJ LQ RWKHU XQLWV
VSHFLDO PHGLFDO SUREOHPV WKDW PD\ UHTXLUH ,9V DQG SRVW RSHUDWLYH WUHDWPHQW KDV SDWLHQW
URRPV XS WR IHHW DZD\ IURP WKH RQO\ QXUVH·V VWDWLRQ LQ WKH XQLW 3DWLHQW URRPV ORFDWHG VR
IDU DZD\ IURP VWDII DVVLVWDQFH FDQ OHDG WR XQVDIH FRQGLWLRQV LI SDWLHQWV QHHG LPPHGLDWH KHOS
Table 4
Department of Health Services—Arizona State Hospital
Hospital Space No Longer Used for Hospital Patients
Building Current User Square Feet
+DZN 8QLW 6H[XDOO\ 9LROHQW 3HUVRQV 8QLW
$ODPR +DOO 6H[XDOO\ 9LROHQW 3HUVRQV 8QLW
(QFDQWR +DOO 'HSW RI -XYHQLOH &RUUHFWLRQV
%LUFK +DOO 'HSW RI +HDOWK 6HUYLFHV
$GPLQLVWUDWLRQ
$VSHQ +DOO 'HSW RI &RUUHFWLRQV
&KROOD +DOO 6H[XDOO\ 9LROHQW 3HUVRQV 8QLW
)ODPHQFR +DOO 'HSW RI &RUUHFWLRQV
.DFKLQD +DOO &ORVHG
$OKDPEUD &RPSOH[ 'HSW RI &RUUHFWLRQV
7RWDO
6RXUFH ':/ $UFKLWHFWV $UL]RQD 6WDWH +RVSLWDO 0DVWHU 3ODQ DQG $UL]RQD 6WDWH +RVSLWDO %XLOGLQJ 6WDWLVWLFV
'HWHULRUDWLQJ FRQGLWLRQV RIWHQ FUHDWH DGGLWLRQDO KD]DUGV WKDW SODFH SDWLHQWV DQG VWDII DW ULVN
$FFRUGLQJ WR VWDII VXUYH\HG VWDII DQG SDWLHQWV DUH RIWHQ DW ULVN RI LQMXULQJ WKHPVHOYHV IURP
IDFLOLW\ KD]DUGV VXFK DV VOLSSHU\ IORRUV ORRVH IORRU WLOHV DQG EURNHQ FHLOLQJ WLOHV ,Q RQH FDVH
D SDWLHQW XVHG D EURNHQ SLHFH RI
FHLOLQJ WLOH WR DVVDXOW DQRWKHU
SDWLHQW DQG DGROHVFHQWV KDYH
DFFHVV WR XQSURWHFWHG IOXR
UHVFHQW OLJKWEXOEV ZKLFK WKH\
KDYH EURNHQ DQG XVHG WR LQIOLFW
LQMXULHV XSRQ WKHPVHOYHV
3DWLHQW WKHUDS\ DGYHUVHO\
DIIHFWHG³7KHUH DUH VLJQLILFDQW
FRQWUDVWV EHWZHHQ WKH WKHUD
SHXWLF HQYLURQPHQW SURYLGHG
E\ $6+·V IDFLOLWLHV DQG WKRVH
SURYLGHG E\ RWKHU SV\FKLDWULF
KRVSLWDOV WKDW DXGLWRUV YLVLWHG LQ
WKH 3KRHQL[ DUHD ,Q RQH $6+
)LJXUH +LJK IHQFHV DQG UD]RU ZLUH JLYH WKH :LFN XQLW D SULVRQ
OLNH DSSHDUDQFH
XQLW D SDWLHQW VKDUHV D URRP ZLWK RWKHU SDWLHQWV DQG VKDUHV VKRZHUV ZLWK SDWLHQWV
ZKHUHDV D SDWLHQW LQ WKHVH RWKHU KRVSLWDOV W\SLFDOO\ VKDUHV D URRP ZLWK RU SDWLHQWV DQG
KDV SULYDWH VKRZHU DQG WRLOHW IDFLOLWLHV 7KHVH RWKHU KRVSLWDOV KDYH FHQWUDO QXUVHV· VWDWLRQV WR
PRQLWRU SDWLHQWV VSDFLRXV FRUULGRUV DQG SDWLHQW URRPV DQG ZHOO OLW DQG FRORUIXO IDFLOLWLHV
(QYLURQPHQWV OLNH WKRVH LQ RWKHU KRVSLWDOV DUH LPSRUWDQW EHFDXVH WKH\ FDQ DIIHFW WUHDWPHQW
RXWFRPHV 5HVHDUFK LQGLFDWHV WKDW KRPH OLNH SDWLHQW HQYLURQPHQWV UHVXOW LQ PRUH HIIHFWLYH
DQG UDSLG WUHDWPHQW $FFRUGLQJ WR RQH DUWLFOH ´7KHUDSHXWLF HQYLURQPHQWV UHTXLUH PRUH
IUHHGRP RI PRYHPHQW DQG VWDII LQWHUDFWLRQ WKDQ WUDGLWLRQDO FRUUHFWLRQDO VHWWLQJV $ WKHUD
SHXWLF HQYLURQPHQW DOVR UHTXLUHV DWWHQWLRQ WR LQWHULRU GHVLJQ ,W LV LPSRUWDQW WR DYRLG ORQJ
FRUULGRUV DV WKH\ PD\ KDYH D GLVRULHQWLQJ HIIHFW RQ WKH PHQWDOO\ LOO µ $ VXLWDEOH HQYLURQ
PHQW LV ODUJHO\ DEVHQW DW $6+
$6+·V IDFLOLWLHV KDYH DQ HYHQ PRUH LPPHGLDWH DGYHUVH HIIHFW RQ WUHDWPHQW LQ WKDW WUHDWPHQW
XQLWV ODFN DQ\ GHGLFDWHG VSDFH IRU JURXS RU LQGLYLGXDO WKHUDS\ 7KH XQLWV· GD\URRPV DUH
RIWHQ WKH RQO\ DUHDV DYDLODEOH WR FRQGXFW VXFK WKHUDS\ 7KHUHIRUH PRVW WUHDWPHQW KDV WR EH
JLYHQ WR DOO SDWLHQWV DW WKH VDPH WLPH 2WKHU SV\FKLDWULF KRVSLWDOV WKDW DXGLWRUV WRXUHG KDG
PRUH VSDFH DYDLODEOH IRU SDWLHQW WUHDWPHQW )RU H[DPSOH HDFK XQLW KDG PRUH WKDQ RQH URRP
ZKHUH SDWLHQW JURXSV RU LQGLYLGXDO WKHUDS\ FRXOG RFFXU
)DFLOLW\ LQDGHTXDFLHV IRUFH LQDSSURSULDWH KRXVLQJ DUUDQJHPHQWV³7KH OLPLWHG DPRXQW RI
VSDFH RIWHQ IRUFHV WKH KRVSLWDO WR XVH VSDFH LQDSSURSULDWHO\ )RU H[DPSOH $6+ KRXVHV GLI
IHUHQW SDWLHQW W\SHV WRR FORVHO\ WR HDFK RWKHU $6+ KDV WZR DGXOW XQLWV ZLWK ERWK PDOH DQG
IHPDOH SDWLHQWV DQG KRXVHV DOO FKLOGUHQ DJHG WKURXJK WRJHWKHU $GGLWLRQDOO\ WKH FXU
UHQW FRQILJXUDWLRQ RI WKH SDWLHQW XQLWV GRHV QRW FRPSO\ ZLWK WKH ODZ UHTXLULQJ D VLJKW DQG
VRXQG EDUULHU EHWZHHQ FKLOGUHQ DQG DGXOWV
7KH DGROHVFHQW XQLW LV SDUWLFXODUO\ SUREOHPDWLF EHFDXVH RI WKH PDQ\ W\SHV RI SDWLHQWV LW
PL[HV ,W QRW RQO\ PL[HV SDWLHQWV RI ERWK JHQGHUV EXW WKHVH SDWLHQWV LQFOXGH ERWK FKLOGUHQ
DQG WHHQDJHUV VRPH RI ZKRP DUH DOVR IRUHQVLF SDWLHQWV 0L[LQJ FKLOGUHQ ZLWK WHHQDJHUV DQG
PHQWDOO\ LOO SDWLHQWV RI GLIIHUHQW JHQGHUV FDQ OHDG WR LQDSSURSULDWH EHKDYLRUV DQG GLVSXWHV
,Q FRQWUDVW WR $6+ WKH 8WDK 6WDWH +RVSLWDO VHSDUDWHV IRUHQVLF DQG FLYLO SDWLHQWV DGXOW SD
WLHQWV IURP \RXWKV DQG FKLOGUHQ IURP DGROHVFHQWV
6RPH RYHUFURZGHG XQLWV DUH IRUFHG WR KRXVH SDWLHQWV LQ URRPV WKDW DUH QHHGHG IRU RWKHU
SXUSRVHV )RU H[DPSOH WKH :LFN XQLW ZKLFK KRXVHV SDWLHQWV MXGJHG ´JXLOW\ H[FHSW LQ
VDQHµ RU ´QRW JXLOW\ E\ UHDVRQ RI LQVDQLW\ µ KDV EHHQ IRUFHG WR XVH LWV VHFOXVLRQ URRP WR
KRXVH H[FHVV SDWLHQWV +RZHYHU WKLV SUDFWLFH OLPLWV WKH DYDLODELOLW\ RI VHFOXVLRQ URRPV IRU
WKHLU LQWHQGHG XVH ZKLFK LV WR SURYLGH DUHDV IRU YLROHQW RU VXLFLGDO SDWLHQWV ZKR UHTXLUH
VHFXULW\ DQG SURWHFWLRQ
1 &DUS 6FDUOHWW 9 DQG 'DYLG -R\FH $ &RUUHFWLRQV 7RGD\ $SULO .
ASH’s Buildings Are
Deteriorating, Inefficiently
Maintained, and Not Designed
to Meet Current Needs
$6+·V IDFLOLWLHV DUH ROG GHWHULRUDWLQJ DQG UHTXLUH FRQVWDQW UHSDLU 7KH KRVSLWDO·V PDLQWH
QDQFH SURFHVV LV RIWHQ LQHIIHFWLYH ZKLFK DGGV WR WKH SUREOHP 7KH IDFLOLWLHV ZHUH RULJLQDOO\
EXLOW LQ WKH V WR KRXVH D GLIIHUHQW W\SH RI SDWLHQW SRSXODWLRQ DQG ZKLOH VHYHUDO EXLOGLQJV
KDYH EHHQ UHQRYDWHG WR DFFRPPRGDWH \RXQJHU PRUH YLROHQW SDWLHQWV UHQRYDWLRQV FDQQRW
RYHUFRPH WKH SUREOHPV RI JHQHUDOO\ LQDSSURSULDWH GHVLJQ DQG GHWHULRUDWLQJ LQIUDVWUXFWXUH
$6+ EXLOGLQJV DQG LQIUDVWUXFWXUH DUH ROG DQG GHWHULRUDWLQJ³$6+ KDV EHHQ VHUYLQJ SDWLHQWV
DW LWV FXUUHQW VLWH VLQFH DQG WKH LQIUDVWUXFWXUH WKDW VXSSRUWV LWV EXLOGLQJV LV ROG DQG
GHWHULRUDWLQJ )RU H[DPSOH WKH XQGHUJURXQG WXQQHO V\VWHP WKURXJKRXW $6+ ZKLFK ZDV
FRQVWUXFWHG LQ SURYLGHV SKRQH OLQHV VWHDP KRW DQG FROG ZDWHU DQG HOHFWULFDO XWLOLWLHV
WR $6+ XQLWV 7KH WXQQHOV DUH LQVXODWHG ZLWK DVEHVWRV DQG DUH FROODSVLQJ $VVHVVPHQWV E\ DQ
DUFKLWHFWXUDO ILUP DQG 6RGH[KR 0DUULRWW WKH ILUP $6+ KDV FRQWUDFWHG ZLWK WR SURYLGH
PDLQWHQDQFH VHUYLFHV KDYH GHWHUPLQHG WKDW WKH WXQQHO V\VWHP LV KD]DUGRXV ,Q IDFW 6R
GH[KR 0DUULRWW KDV UHIXVHG WR DOORZ LWV VWDII WR SURYLGH DQ\ IXUWKHU VHUYLFH WR WKH WXQQHOV IRU
IHDU RI WKHLU HPSOR\HHV· VDIHW\
$OO RI $6+·V SDWLHQW XQLWV ZHUH FRQVWUXFWHG LQ WKH V DQG GXH WR WKHLU DJH UHTXLUH FRQ
VWDQW UHSDLU 'XULQJ 2FWREHU $6+ IDFLOLWLHV QHHGHG DQ DYHUDJH RI RYHU URXWLQH UH
SDLUV HDFK GD\ 5RXWLQH UHSDLUV LQFOXGH RQO\ LWHPV WKDW FDQ EH UHSDLUHG IRU XQGHU VXFK
DV UHSDLULQJ GRRU ORFNV XQFORJJLQJ VLQNV DQG WRLOHWV UHSODFLQJ FHLOLQJ WLOHV DQG SDWFKLQJ
DQG SDLQWLQJ KROHV 7KH IDFLOLWLHV DOVR UHJXODUO\ QHHG VSHFLDO SURMHFWV VXFK DV UHQRYDWLRQV
DQG UHPRGHOLQJ DQG ODUJHU UHSDLUV WKDW UHTXLUH PRUH WLPH DQG PRQH\ WR FRPSOHWH )RU
H[DPSOH GXULQJ WKH DXGLW WKH SDWLHQW UHKDELOLWDWLRQ FHQWHU ZDV UHPRGHOHG LQWR D SDWLHQW XQLW
WR UHOLHYH RYHUFURZGLQJ LQ RWKHU XQLWV
(YHQ ZLWK UHQRYDWLRQ WKHUH LV D OLPLW WR ZKLFK LPSURYHPHQWV FDQ EH PDGH )RU H[DPSOH WKH
FHQWUDO V\VWHP WKDW SURYLGHV WKH KHDWLQJ DQG FRROLQJ WR $6+ EXLOGLQJV SURYLGHV RQO\ OLP
LWHG FRQWURO RYHU EXLOGLQJ WHPSHUDWXUHV 7KH DQWLTXDWHG WZR SLSH V\VWHP FDQ SURYLGH HLWKHU
FROG RU KRW DLU EXW FDQQRW PL[ WKHP WR PRGHUDWH EXLOGLQJ WHPSHUDWXUHV 7KLV RIWHQ UHVXOWV LQ
H[WUHPHO\ XQFRPIRUWDEOH EXLOGLQJ WHPSHUDWXUHV IRU SDWLHQWV DQG VWDII LQ WKH VSULQJ DQG IDOO
$OVR EHFDXVH WKH ZDWHU ERLOHUV DUH ORFDWHG DFURVV FDPSXV IURP WKH SDWLHQW XQLWV VKXWWLQJ RII
VRPH SDWLHQW VKRZHUV GXULQJ FROGHU PRQWKV UHVXOWV LQ D GHOD\ RI PLQXWHV WR KRXU IRU
ZDUP ZDWHU 7KHUHIRUH WKH -XQLSHU FR HG SDWLHQW XQLW FRQWLQXRXVO\ UXQV RQH RI LWV VKRZ
HUV GXULQJ WKH ZLQWHU PRQWKV WR HQVXUH KRW ZDWHU IRU WKH SDWLHQWV
0DLQWHQDQFH SURFHVV LV LQHIIHFWLYH³$6+·V SURFHGXUH IRU UHSDLUV H[FHHGLQJ UHTXLUHV
FRRUGLQDWLRQ ZLWKLQ VHYHUDO JURXSV RI SHRSOH DQG RIWHQ ZLWK VHYHUDO DJHQFLHV 7KLV SURFH
GXUH LV RIWHQ IUDJPHQWHG DQG LQHIILFLHQW 7KH KRVSLWDO FRQWUDFWV ZLWK 6RGH[KR 0DUULRWW IRU
DOO URXWLQH PDLQWHQDQFH VHUYLFHV DQG HPSOR\V D WZR SHUVRQ PDLQWHQDQFH FUHZ VXSSRUWHG E\
IHPDOH 'HSDUWPHQW RI &RUUHFWLRQV LQPDWHV IRU PRVW IDFLOLW\ UHQRYDWLRQV ,W DOVR XVHV RWKHU
FRQWUDFWRUV IRU SURMHFWV WKDW QHLWKHU 6RGH[KR 0DUULRWW QRU WKH $6+ FUHZ FDQ FRPSOHWH $6+
ODFNV DQ HIIHFWLYH SURFHGXUH IRU SULRULWL]LQJ SURMHFWV DQG LQIRUPLQJ WKH PDLQWHQDQFH FUHZV
RI WKHLU UHVSRQVLELOLWLHV 7KLV SUREOHP LV PDGH ZRUVH E\ D ODFN RI FRPPXQLFDWLRQ DPRQJ WKH
YDULRXV JURXSV UHVSRQVLEOH IRU FRPSOHWLQJ WKH SURMHFWV $V D UHVXOW SURMHFWV RIWHQ UHIOHFW
LQDGHTXDWH SODQQLQJ DQG FRRUGLQDWLRQ )RU H[DPSOH DQ RXWVLGH FRQWUDFWRU ZDV KLUHG WR
FRPSOHWH D VSHFLDO SURMHFW WR EXLOG D VWRUDJH URRP RII RI D SDWLHQW XQLW +RZHYHU WKH JUHDWHU
QHHG RQ WKH XQLW ZDV IRU DQ DFWLYLW\ URRP EXW WKLV ZDV QRW GHWHUPLQHG XQWLO WKH VWRUDJH
URRP ZDV FRPSOHWH $V D UHVXOW GXH WR ODFN RI FRPPXQLFDWLRQ SURSHU SODQQLQJ DQG SURSHU
FRQWUDFW PRQLWRULQJ $6+·V PDLQWHQDQFH VWDII KDG WR UHGR WKH FRQWUDFWRU·V ZRUN
(YHQ ZKHQ UHSDLUV WR WKH IDFLOLWLHV DUH FRPSOHWHG WKH\ DUH IUHTXHQWO\ GHOD\HG IURP D IHZ
GD\V WR VHYHUDO PRQWKV )RU H[DPSOH RQH SURMHFW UHTXHVW ZDV LQLWLDWHG LQ )HEUXDU\ EXW
DV RI 'HFHPEHU WKH SURMHFW KDG QRW \HW EHHQ VWDUWHG $GGLWLRQDOO\ RQH XQLW ZDLWHG RYHU
RQH PRQWK IRU LQVWDOODWLRQ RI SOXPELQJ DQG HOHFWULFDO KRRNXSV LQ RUGHU WR FRQQHFW D QHZ
ZDVKHU DQG GU\HU
5HQRYDWLRQ RIIHUV RQO\ OLPLWHG KHOS LQ RYHUFRPLQJ GHVLJQ OLPLWDWLRQV³$6+·V SDWLHQW XQLWV
ZHUH GHVLJQHG IRU D GLIIHUHQW W\SH RI SDWLHQW WKDQ $6+ FXUUHQWO\ VHUYHV ,Q WKH V $6+·V
SDWLHQWV ZHUH W\SLFDOO\ ROGHU DQG OLYHG SHUPDQHQWO\ DW WKH KRVSLWDO ,Q FRQWUDVW FXUUHQW
SDWLHQWV DUH \RXQJHU PRUH YLROHQW DQG VWD\ D VKRUWHU OHQJWK RI WLPH $V D UHVXOW $6+ KDV
KDG WR UHQRYDWH LWV EXLOGLQJV WR PDNH WKHP PRUH VHFXUH :KHQ IRUHQVLF SDWLHQWV ILUVW EHJDQ
WR FRPH WR $6+ WKH\ URXWLQHO\ EHQW WKH VHFXULW\ EDUV WRUH RXW ZLQGRZ IUDPHV DQG HVFDSHG
E\ FOLPELQJ RYHU WKH URRIV $6+ KDV PDGH FHUWDLQ XQLWV PRUH VHFXUH E\ LQVWDOOLQJ DGGLWLRQDO
IHQFLQJ PRGLI\LQJ FHLOLQJV DQG OLJKW IL[WXUHV DQG SURYLGLQJ XSJUDGHG VHFXULW\ PHDVXUHV
6XFK UHQRYDWLRQV DUH RQO\ D VWRSJDS PHDVXUH WR HQKDQFH WKH HQYLURQPHQW DQG VHFXULW\ RI
WKH SDWLHQW XQLWV )RU H[DPSOH LQ ILVFDO \HDU $6+ UHQRYDWHG :LFN XQLWV DQG
DW D FRVW RI PLOOLRQ 6LPLODUO\ LQ $6+ UHQRYDWHG -XQLSHU DW D FRVW RI
:KLOH WKHVH UHQRYDWLRQV LPSURYHG WKH XQLW·V VHFXULW\ DQG DHVWKHWLF TXDOLWLHV WKH\ GLG QRW
FKDQJH WKH RYHUDOO GHVLJQ DQG LQIUDVWUXFWXUH RI WKH IDFLOLWLHV RU WKH ORQJ KDOOZD\V )RU H[
DPSOH -XQLSHU KDV KDG OHDNLQJ ZDWHU SLSHV LQ WKH ZDOOV UHSDLUHG VLQFH LWV UHQRYDWLRQ
/LNHZLVH SDWLHQW URRPV DUH VWLOO RYHU IHHW DZD\ IURP WKH QXUVH·V VWDWLRQ ZKLFK PDNHV
PRQLWRULQJ SDWLHQWV GLIILFXOW
7KH GHVLJQ DOVR FRQWULEXWHV WR VHYHUDO SUREOHPV WKDW DUH GLIILFXOW WR RYHUFRPH HYHQ ZLWK
UHQRYDWLRQ )RU H[DPSOH WKH ORQJ DQG QDUURZ KDOOZD\V LQ WKH SDWLHQW XQLWV FRQWULEXWH WR D
ODFN RI DGHTXDWH DLUIORZ DQG FDXVH SDWLHQWV· EHGURRPV WR UHFHLYH LQVXIILFLHQW YHQWLODWLRQ
RIWHQ OHDGLQJ WR VWXII\ XQFRPIRUWDEOH OLYLQJ FRQGLWLRQV 7KH 'HSDUWPHQW RI $GPLQLVWUDWLRQ
UHFHQWO\ FRQGXFWHG D VWXG\ WKDW LGHQWLILHG KLJK OHYHOV RI FDUERQ GLR[LGH LQ SDWLHQW XQLWV
$OWKRXJK WKHVH OHYHOV ZHUH QRW KLJK HQRXJK WR FRQVWLWXWH D KHDOWK KD]DUG WKH\ PD\ FRQ
WULEXWH WR XQFRPIRUWDEOH FRQGLWLRQV
ASH Could Undertake Several
Short-Term Improvements
$OWKRXJK WKH KRVSLWDO·V IDFLOLWLHV KDYH PDQ\ GHILFLHQFLHV WKHUH DUH VRPH LPPHGLDWH VWHSV
$6+ PDQDJHPHQW FRXOG WDNH WR LPSURYH SDWLHQWV· HQYLURQPHQWV 0RVW RI WKHVH VWHSV LQ
YROYH UHODWLYHO\ LQH[SHQVLYH HQKDQFHPHQWV VXFK DV SDLQWLQJ DQG OLJKWLQJ ,PSURYLQJ WKH
KRVSLWDO·V PDLQWHQDQFH DQG UHSDLU SURFHVV FRXOG HQKDQFH WKH DGHTXDF\ DQG WLPHOLQHVV RI
UHSDLUV 2WKHU VKRUW WHUP VWHSV VXFK DV GHYHORSPHQW RI D WUDQVLWLRQDO OLYLQJ IDFLOLW\ IRU SD
WLHQWV ZKR DUH QHDUO\ UHDG\ WR EH GLVFKDUJHG FDQ DOVR KHOS 1HYHUWKHOHVV LQ WKH ORQJ UXQ D
QHZ IDFLOLW\ LV QHHGHG LI WKH KRVSLWDO LV WR FRQWLQXH
,PSURYHPHQW WKURXJK LQH[SHQVLYH HQKDQFHPHQWV³6HYHUDO LQH[SHQVLYH UHQRYDWLRQV FRXOG
TXLFNO\ LPSURYH WKH HQYLURQPHQW IRU $6+ SDWLHQWV $ UHFHQW DVVHVVPHQW RI $6+·V SDWLHQW
IDFLOLWLHV GHVFULEHV WKH QHHG IRU LPSURYHPHQWV VXFK DV EHWWHU OLJKWLQJ DQG WKH SDLQW FRORU RI
WKH SDWLHQW IDFLOLWLHV 7KH FRVW IRU WKHVH HQKDQFHPHQWV LV SURMHFWHG WR EH IRU WKH :LFN
DQG -XQLSHU XQLWV 7KH UHSRUW SUHSDUHG E\ DQ DUFKLWHFWXUDO ILUP VWDWHV ´7KHUH LV LQFUHDVLQJ
HYLGHQFH WKDW OLJKW DQG FRORU UHODWH WR PRUH WKDQ MXVW LOOXPLQDWLRQ RU DHVWKHWLF YDOXH 7KH\
LQIOXHQFH VOHHSLQJ ZDNHIXOQHVV HPRWLRQV DQG KHDOWK DQG FDQ SOD\ D PDMRU UROH LQ WKH
WUHDWPHQW RI EHKDYLRUDO KHDOWK µ 7KLV UHSRUW UHFRPPHQGV LPSURYHPHQWV LQFOXGLQJ
n Repainting units³ZLWK VRRWKLQJ FRORUV VXFK DV EOXH WXUTXRLVH DQG JUHHQ XVLQJ ZKLWH
IRU FHLOLQJV DQG RYHUKHDG VWUXFWXUHV &XUUHQWO\ SDWLHQW XQLWV DUH ZKLWH RU FUHDP FRORUHG
n Installation of fluorescent lighting³WKURXJKRXW XQLWV WR SURYLGH D PRUH WKHUDSHXWLF
DWPRVSKHUH
n Installation of skylights³LQ GD\URRPV WR SURYLGH SDWLHQWV ZLWK D EHWWHU VHQVH RI WLPH
n Installation of acoustic ceilings and floors³LQ VHFOXVLRQ URRPV DQG SDWLHQW URRPV WR
UHGXFH HFKRHV DQG KROORZ VRXQGV
n Improved seating and flooring³LQ WKH SDWLHQW GLQLQJ URRP &XUUHQWO\ WKH -XQLSHU
GLQLQJ URRP KDV LQVWLWXWLRQDO JURXS VHDWLQJ DUUDQJHPHQWV WKDW DUH EROWHG WR WKH IORRU
n Increased artwork³WKURXJKRXW WKH XQLWV WR SURYLGH D PRUH UHVLGHQWLDO TXDOLW\
7KHVH LPSURYHPHQWV ZLOO EH VXEPLWWHG WR WKH 'HSDUWPHQW RI $GPLQLVWUDWLRQ E\ WKH 'H
SDUWPHQW RI +HDOWK 6HUYLFHV DV D FRPSRQHQW RI LWV ILVFDO \HDU EXLOGLQJ UHQHZDO SURMHFW
UHTXHVW $6+ LV DOVR WDNLQJ RWKHU VWHSV WR GHWHUPLQH ZKDW VKRUW WHUP LPSURYHPHQWV PLJKW
EH DSSURSULDWH )RU H[DPSOH $6+ KDV GHYHORSHG DQ LQVSHFWLRQ SURFHVV IRU WKH SDWLHQW XQLWV
7KLV SURFHVV LQYROYHV $6+ HPSOR\HHV PDNLQJ IDFLOLW\ ZDONWKURXJKV LQ WHDPV XVLQJ D
1 ':/ $UFKLWHFWV DQG 3ODQQHUV ´$UL]RQD 6WDWH +RVSLWDO 5HIXUELVKLQJ RI :LFN DQG -XQLSHU :LQJV µ
$XJXVW
JXLGHOLQH ZLWK VSHFLILF VWDQGDUGV WR URXWLQHO\ HYDOXDWH IDFLOLWLHV $FFRUGLQJ WR PDQDJHPHQW
WKLV SURFHVV VKRXOG DLG LQ SHULRGLFDOO\ UHYLHZLQJ DQG GHWHUPLQLQJ URXWLQH UHSDLUV DQG VSH
FLDO SURMHFWV RQ SDWLHQW XQLWV
5HSDLU SURFHGXUH LPSURYHPHQW WR VSHHG UHSDLUV³%\ LPSURYLQJ LWV PDLQWHQDQFH SURFHVV
$6+ FRXOG HQKDQFH LWV DELOLW\ WR FRPSOHWH UHSDLUV DGHTXDWHO\ DQG HIILFLHQWO\ )LUVW $6+
PDQDJHPHQW VKRXOG HQVXUH WKDW WKH PDLQWHQDQFH SURFHVV LQYROYHV DGHTXDWH FRPPXQLFD
WLRQ DQG SODQQLQJ )RU H[DPSOH PDQDJHPHQW VKRXOG UHTXLUH UHJXODU PHHWLQJV DPRQJ DOO
PDLQWHQDQFH JURXSV LQYROYHG LQ VSHFLDO SURMHFWV ,Q DGGLWLRQ DOO VSHFLDO SURMHFWV VKRXOG EH
SODQQHG FRRSHUDWLYHO\ E\ WKH DSSURSULDWH DGPLQLVWUDWLYH RIILFLDOV PDLQWHQDQFH JURXSV
DVVLJQHG WR WKH SURMHFW DQG WKH SDUW\ UHTXHVWLQJ WKH SURMHFW
,Q DGGLWLRQ WR LWV PDLQWHQDQFH DQG UHSDLU SURFHVV $6+ QHHGV WR LPSURYH LWV PDLQWHQDQFH
FRQWUDFW PRQLWRULQJ WR HQVXUH SUREOHPV JHW UHVROYHG ,WV FXUUHQW SUDFWLFH RI FRQWUDFW PRQL
WRULQJ LV LQDGHTXDWH +RZHYHU 6RGH[KR 0DUULRWW KDV DJUHHG WR IXQG D SRVLWLRQ IRU RQH \HDU
WKDW ZLOO PRQLWRU WKHLU FRQWUDFW $6+ KDV UHTXHVWHG IXQGLQJ LQ LWV EXGJHW IRU D SRVL
WLRQ WR PRQLWRU DOO WKH KRVSLWDO·V FRQWUDFWV 6WDWH KRVSLWDOV LQ 1HZ 0H[LFR 8WDK DQG &ROR
UDGR GHYRWH DW OHDVW RQH VWDII PHPEHU WR VROHO\ RYHUVHH FRQWUDFW FRPSOLDQFH 7R SURSHUO\
PRQLWRU PDLQWHQDQFH SURMHFWV WKDW DUH FRQWUDFWHG RXW $6+ VKRXOG FRQWLQXH LWV HIIRUWV WR
FUHDWH D SRVLWLRQ ZKRVH VROH IXQFWLRQ ZRXOG HQVXUH VXIILFLHQW FRPSOLDQFH ZLWK EXLOGLQJ
FRGHV DQG WKH SURSHU FRPSOHWLRQ RI SURMHFWV
$6+ SDWLHQW WUDQVLWLRQDO XQLW WR HDVH RYHUFURZGLQJ³$6+ VKRXOG FRQWLQXH WR PRYH IRU
ZDUG ZLWK LWV SODQV WR FRQVWUXFW D WUDQVLWLRQDO OLYLQJ IDFLOLW\ IRU SDWLHQWV ZKR DUH QHDUO\
UHDG\ WR EH GLVFKDUJHG 7KH SURJUDP ZLOO IRFXV RQ HQKDQFLQJ SDWLHQW VNLOOV IRU PRUH LQGH
SHQGHQW IXQFWLRQLQJ LQ VRFLHW\ ZKLOH LQWHJUDWLQJ SDWLHQWV LQWR FRPPXQLW\ EDVHG SURJUDPV
,Q HDUO\ )HEUXDU\ $6+ UHFHLYHG PLOOLRQ LQ IXQGLQJ WR GHYHORS DQG RSHUDWH WKH
SURJUDP 7KLV XQLW LV SODQQHG WR KRXVH WR SDWLHQWV ZKR DUH WKH PRVW UHDG\ WR EH GLV
FKDUJHG IURP $6+
1HZ IDFLOLW\ LV RQO\ ORQJ WHUP VROXWLRQ³$OWKRXJK VKRUW WHUP FKDQJHV FDQ SURGXFH WHPSR
UDU\ LPSURYHPHQWV WKH RQO\ ORQJ WHUP VROXWLRQ LV WR EXLOG D QHZ KRVSLWDO IDFLOLW\ 6KRUW
WHUP LPSURYHPHQWV GR QRW DGGUHVV WKH SUREOHPV LQKHUHQW LQ WKH GHVLJQ DQG DJH RI WKH SD
WLHQW XQLWV )LQGLQJ ,,, VHH SDJHV WKURXJK SUHVHQWV LQIRUPDWLRQ UHJDUGLQJ WKH KRVSL
WDO·V QHHG WR SODQ IXWXUH IDFLOLWLHV
Recommendations
$6+ VKRXOG FRPSOHWH WKH WKHUDSHXWLF LPSURYHPHQWV VR WKDW WKH HQYLURQPHQW RI WKH
SDWLHQW XQLWV LV PRUH OLNH WKDW UHFRPPHQGHG E\ ':/ $UFKLWHFWV DQG 3ODQQHUV
$6+ VKRXOG FRQWLQXH WKH SDWLHQW XQLW LQVSHFWLRQ SURFHVV DQG XVH LW DV D WRRO LQ SHULRGL
FDOO\ HYDOXDWLQJ IDFLOLW\ QHHGV
$6+ PDQDJHPHQW VKRXOG HQVXUH WKDW DOO JURXSV SHUIRUPLQJ VSHFLDO SURMHFWV DGHTXDWHO\
FRPPXQLFDWH WKURXJKRXW WKH SURFHVV )RU H[DPSOH VSHFLDO SURMHFWV PHHWLQJV VKRXOG EH
KHOG EHIRUH HDFK PDMRU UHQRYDWLRQ WKURXJK ZKLFK $6+ RIILFLDOV DSSURSULDWH PDLQWH
QDQFH VWDII DQG VSHFLDO SURMHFW UHTXHVWHUV MRLQWO\ GHFLGH GRFXPHQWHG SURMHFW GHWDLOV
$6+ VKRXOG FRQWLQXH LWV HIIRUWV WR LPSOHPHQW D SRVLWLRQ VROHO\ UHVSRQVLEOH IRU WKH FRQ
WUDFW PRQLWRULQJ RI IDFLOLW\ UHQRYDWLRQV
$6+ VKRXOG FRQWLQXH LWV HIIRUWV WR FRQVWUXFW WKH SDWLHQW WUDQVLWLRQDO XQLW WKDW LW KDV SUR
SRVHG WR KRXVH WKRVH SDWLHQWV PRVW UHDG\ IRU GLVFKDUJH
FINDING III
EFFECTIVE LONG-TERM PLANNING
PROCESS IS NEEDED
$6+ FXUUHQWO\ ODFNV ORQJ WHUP SODQV WR JXLGH LWV IXWXUH DQG DQ HIIHFWLYH SURFHVV WR GHYHORS
VXFK SODQV 7KH *RYHUQRU DQG /HJLVODWXUH KDYH DFNQRZOHGJHG WKDW EHFDXVH FXUUHQW IDFLOLWLHV
GR QRW SURYLGH DQ DGHTXDWH HQYLURQPHQW IRU SDWLHQWV QHZ IDFLOLWLHV ZLOO XOWLPDWHO\ EH
QHHGHG $6+·V DELOLW\ WR WUDQVODWH WKLV FRPPLWPHQW LQWR D SODQ IRU WKH IXWXUH LV PDGH PRUH
GLIILFXOW E\ WKH NLQGV RI SDWLHQWV LW LV QRZ WUHDWLQJ 7KH KRVSLWDO KDV OLWWOH FRQWURO RYHU LWV
SDWLHQW ORDG DQG LV SUHVHQWHG ZLWK VDIHW\ DQG VHFXULW\ QHHGV WKDW DUH JUHDWHU WKDQ WKRVH RI
PRVW RWKHU PHQWDO KHDOWK IDFLOLWLHV $6+ GRHV QRW KDYH D SURFHVV LQ SODFH IRU FRQVLGHULQJ
KRZ VXFK FKDUDFWHULVWLFV DIIHFW WKH EHVW FRXUVH RI DFWLRQ IRU IXWXUH IDFLOLWLHV 7XUQRYHU LQ NH\
OHDGHUVKLS SRVLWLRQV DW WKH KRVSLWDO DQG DW WKH 'HSDUWPHQW RI +HDOWK 6HUYLFHV KDV FRQWULE
XWHG WR WKH ODFN RI IRFXV RQ WKLV LVVXH :LWK OHDGHUVKLS SRVLWLRQV QRZ ILOOHG KRZHYHU WKH
KRVSLWDO QHHGV WR PRYH IRUZDUG TXLFNO\ .H\ DUHDV WKDW QHHG WR EH DGGUHVVHG DUH WKH VL]H RI
OLNHO\ IXWXUH SDWLHQW ORDGV DQG WKH W\SH RI IDFLOLWLHV WKDW ZLOO EH QHHGHG
Unacceptable Facility, Unique
Population Heighten Need
for Long-Term Planning
$6+ IDFHV DQ DFNQRZOHGJHG QHHG IRU D QHZ IDFLOLW\ DQG LWV UROH SUHVHQWV FKDOOHQJHV LQ
SODQQLQJ IRU WKH IXWXUH $6+ QRZ IRFXVHV RQ IRUHQVLF SDWLHQWV DQG RQ FLYLO SDWLHQWV ZLWK
QHHGV WKDW PD\ QRW EH PHW LQ FRPPXQLW\ VHWWLQJV %HFDXVH RI VWDWXWRU\ DQG RWKHU UHTXLUH
PHQWV $6+ KDV OLPLWHG FRQWURO RYHU WKH QXPEHU RI SDWLHQWV LW DGPLWV RU KRZ ORQJ WKH\ VWD\
7KH KRVSLWDO DOVR QHHGV WR SODQ IDFLOLWLHV WKDW ZLOO WDNH LQWR DFFRXQW WKH DGGLWLRQDO VHFXULW\
DQG VDIHW\ FRQFHUQV DVVRFLDWHG ZLWK LWV SDWLHQWV DV ZHOO DV GHYHORSLQJ SURMHFWLRQV WKDW WDNH
LQWR DFFRXQW SDWLHQWV ZKRVH OHQJWKV RI VWD\ YDU\ IURP D IHZ PRQWKV WR PDQ\ \HDUV 7KHVH
DQG RWKHU XQFHUWDLQWLHV KHLJKWHQ WKH QHHG IRU DQ HIIHFWLYH ORQJ WHUP SODQQLQJ SURFHVV
1HZ KRVSLWDO QHHGHG³:KLOH LQH[SHQVLYH HQKDQFHPHQWV DQG LPSURYLQJ PDLQWHQDQFH SUDF
WLFHV ZLOO DOOHYLDWH VRPH RI $6+·V IDFLOLW\ UHODWHG SUREOHPV WKH 6WDWH XOWLPDWHO\ ZLOO QHHG WR
EXLOG D QHZ KRVSLWDO $V GLVFXVVHG LQ )LQGLQJ ,, VHH SDJHV WKURXJK WKH IDFLOLWLHV GR
QRW PHHW FXUUHQW SV\FKLDWULF KRVSLWDO GHVLJQ VWDQGDUGV DQG ODFN VXIILFLHQW VSDFH WR DFFRP
PRGDWH WKH KRVSLWDO·V SDWLHQW SRSXODWLRQ 7KLV QHHG KDV EHHQ DFNQRZOHGJHG E\ ERWK WKH
*RYHUQRU DQG WKH /HJLVODWXUH 6WDII IURP WKH -RLQW /HJLVODWLYH %XGJHW &RPPLWWHH DQG WKH
*RYHUQRU·V 2IILFH RI 6WUDWHJLF 3ODQQLQJ DQG %XGJHWLQJ UHFHQWO\ VWXGLHG $6+ DQG SUHVHQWHG
D QXPEHU RI RSWLRQV IRU D QHZ IDFLOLW\ LQFOXGLQJ VHUYLQJ IRUHQVLF SDWLHQWV H[FOXVLYHO\ (I
IRUWV DUH XQGHUZD\ WR LGHQWLI\ PRQLHV WKDW FDQ EH XVHG WR FRQVWUXFW D QHZ $6+ IDFLOLW\
0DMRU TXHVWLRQV UHPDLQ DERXW ZKDW NLQG RI IDFLOLW\ VKRXOG EH EXLOW $W D PLQLPXP WKH 6WDWH
QHHGV WR EXLOG KRVSLWDO IDFLOLWLHV RI VXIILFLHQW VL]H WR DSSURSULDWHO\ WUHDW LWV H[LVWLQJ SRSXOD
WLRQ RI DERXW SDWLHQWV QRW LQFOXGLQJ LQGLYLGXDOV LQ WKH 693 SURJUDP ,I WKH SDWLHQW
SRSXODWLRQ JURZV EH\RQG WKH FXUUHQW OHYHO D ODUJHU KRVSLWDO ZLOO EH UHTXLUHG 7KHUHIRUH WKH
KRVSLWDO QHHGV WR GHWHUPLQH LWV IXWXUH QHHGV UHJDUGLQJ WKH VL]H DQG GHVLJQ RI D QHZ IDFLOLW\
/LWWOH FRQWURO RYHU VL]H RI SDWLHQW SRSXODWLRQ³$6+·V QHHG WR FDUHIXOO\ VWXG\ WKHVH IXWXUH
QHHGV LV KHLJKWHQHG EHFDXVH XQOLNH RWKHU PHQWDO KHDOWK IDFLOLWLHV LQ WKH 6WDWH LW KDV OLWWOH
FRQWURO RYHU LWV SDWLHQW SRSXODWLRQ 8QOLNH RWKHU IDFLOLWLHV WKDW FDQ WXUQ DZD\ SDWLHQWV ZKHQ
WKHLU EHGV DUH IXOO $6+ FDQQRW UHIXVH WR DGPLW D FRXUW RUGHUHG SDWLHQW 0RUHRYHU $6+ KDV
RQO\ OLPLWHG LPSDFW RQ SDWLHQW GLVFKDUJHV &LYLO SDWLHQWV PXVW UHPDLQ DW $6+ XQWLO WKHLU
WUHDWPHQW WHDP GHWHUPLQHV WKH\ FDQ IXQFWLRQ LQ D FRPPXQLW\ VHWWLQJ DQG WKDW D VXLWDEOH
SODFHPHQW LV DYDLODEOH $FFRUGLQJ WR $6+ FXUUHQW FRPPXQLW\ SODFHPHQWV IRU FLYLO SDWLHQWV
DUH YHU\ OLPLWHG $V D UHVXOW SDWLHQWV PXVW ZDLW DW $6+ XQWLO D SODFHPHQW EHFRPHV DYDLODEOH
6LPLODUO\ LI SDWLHQWV DUH VHQW WR $6+ EHFDXVH WKH\ KDYH UHFHLYHG D YHUGLFW RI JXLOW\ H[FHSW
LQVDQH RU QRW JXLOW\ E\ UHDVRQ RI LQVDQLW\ WKH\ UHPDLQ XQWLO WKH 3V\FKLDWULF 6HFXULW\ 5HYLHZ
%RDUG RU WKH FRXUW GHWHUPLQHV WKH\ DUH UHDG\ IRU GLVFKDUJH DQG D VXLWDEOH SODFHPHQW LV
DYDLODEOH 3ODFHPHQWV FDQ EH GLIILFXOW WR ORFDWH ,Q WKHVH FDVHV SDWLHQWV FDQ ZDLW VHYHUDO
PRQWKV RU ORQJHU IRU DQ RSHQLQJ
&KDUDFWHULVWLFV RI XQLTXH SDWLHQW SRSXODWLRQ DIIHFW IDFLOLW\ UHTXLUHPHQWV³$6+ VKRXOG SODQ
IDFLOLWLHV WKDW FDQ PHHW QHHGV WKDW DUH GLIIHUHQW IURP WKRVH RI PRVW RWKHU PHQWDO KHDOWK IDFLOL
WLHV 7KH IRUHQVLF SURSRUWLRQ RI $6+·V SDWLHQW SRSXODWLRQ QRZ DERXW RI WKH SUHVHQW
SRSXODWLRQ RI WHQGV WR EH \RXQJ DQG DFWLYH DQG KDV YHU\ GLIIHUHQW QHHGV IRU WUHDWPHQW
VXSHUYLVLRQ DQG VHFXULW\ WKDQ WKH FLYLO PHQWDO KHDOWK SDWLHQWV )XUWKHU PDQ\ RI $6+·V
FLYLOO\ FRPPLWWHG SDWLHQWV DOVR UHTXLUH D PRUH VHFXUH HQYLURQPHQW EHFDXVH RI EHKDYLRUDO
SUREOHPV RU EHFDXVH WKH\ QHHG VXEVWDQFH DEXVH WUHDWPHQW
$6+·V SDWLHQW SRSXODWLRQ VL]H LV FRPSOLFDWHG E\ WKH ZLGH YDULDQFH LQ WKH OHQJWK RI WLPH
SDWLHQWV VWD\ DW WKH KRVSLWDO 5HVWRUDWLRQ WR FRPSHWHQF\ SDWLHQWV KDYH VKRUW VWD\V FRPSDUD
EOH WR SDWLHQWV LQ RWKHU SV\FKLDWULF IDFLOLWLHV EXW PDQ\ $6+ SDWLHQWV VWD\ PXFK ORQJHU )RU
H[DPSOH $6+ FLYLO SDWLHQWV VWD\ RQ DYHUDJH GD\V 6RPH SDWLHQWV KDYH EHHQ DW $6+ IRU
RYHU \HDUV 0DQ\ $6+ SDWLHQWV RIWHQ KDYH VHYHUH LPSDLUPHQWV WKDW SUHYHQW WKHP IURP
UHDFKLQJ WKHLU WUHDWPHQW JRDOV ZLWKRXW DQ H[WHQGHG VWD\
2WKHU LVVXHV DOVR PHULW DWWHQWLRQ³,Q DGGLWLRQ WR IDFLOLW\ SODQQLQJ DQG WKH VL]H RI $6+·V
SDWLHQW SRSXODWLRQV VHYHUDO RWKHU LVVXHV VKRXOG EH FRQVLGHUHG LQ ORQJ WHUP SODQQLQJ )RU
H[DPSOH WKH NLQGV RI WUHDWPHQW SURYLGHG WR $6+ SDWLHQWV PXVW FRQWLQXDOO\ FKDQJH LQ DF
FRUGDQFH ZLWK GHYHORSPHQWV LQ SV\FKLDWULF VWDQGDUGV 3DWLHQWV DOUHDG\ EHQHILW IURP LP
SURYHPHQWV LQ SV\FKRWURSLF PHGLFDWLRQV DQG UHFHLYH PRUH DFWLYH WKHUDS\ FRPSDUHG WR
SDWLHQWV LQ WKH SDVW +RZHYHU HIIHFWLYH WUHDWPHQWV KDYH QRW \HW EHHQ LGHQWLILHG IRU VH[XDOO\
YLROHQW SHUVRQV DQG HIIRUWV DUH XQGHUZD\ QDWLRQZLGH WR GHYHORS WUHDWPHQWV WKDW ZLOO
HYHQWXDOO\ DOORZ VXFK SDWLHQWV WR OLYH LQ WKH FRPPXQLW\ 7R HQVXUH WKH KRVSLWDO KDV DSSUR
SULDWH VWDII DQG RWKHU UHVRXUFHV WR SURYLGH DSSURSULDWH WUHDWPHQW IRU DOO LWV SDWLHQWV LQ WKH
IXWXUH $6+ VKRXOG LQFRUSRUDWH WKHVH LVVXHV LQWR LWV ORQJ WHUP SODQV
2WKHU LVVXHV ZLOO DOVR DIIHFW WKH KRVSLWDO·V IXWXUH 7KH GHLQVWLWXWLRQDOL]DWLRQ PRYHPHQW WKDW
EHJDQ LQ WKH V FRQWLQXHV WR KDYH D VLJQLILFDQW LPSDFW RQ WKH KRVSLWDO DQG LWV SDWLHQWV
FUHDWLQJ D QHHG IRU EHWWHU FRRUGLQDWLRQ ZLWK FRPPXQLW\ EDVHG VHUYLFH SURYLGHUV DQG IRU
SUHSDULQJ SDWLHQWV WR OLYH PRUH LQGHSHQGHQWO\ ,Q IDFW VRPH DGYRFDWHV FRQWLQXH WR DVVHUW
WKDW LQ WKH ORQJ UXQ DOO FLYLO SDWLHQWV VKRXOG EH WUHDWHG LQ WKH FRPPXQLW\ DOWKRXJK RWKHUV
HPSKDVL]H WKH QHHG IRU DQ LQVWLWXWLRQ WKDW FDQ SURYLGH ORQJ WHUP FDUH WR VHYHUHO\ LPSDLUHG
LQGLYLGXDOV
ASH Has Not Adequately
Planned for the Future
$6+ GRHV QRW KDYH DQ DGHTXDWH SODQQLQJ SURFHVV IRU PHHWLQJ WKHVH SUHVVLQJ FKDOOHQJHV
7KH KRVSLWDO KDV QRW GHYHORSHG SURMHFWLRQV RI IXWXUH GHPDQG IRU LWV VHUYLFHV HYHQ WKRXJK LW
KDV KDG XQH[SHFWHGO\ KLJK QXPEHUV RI FHUWDLQ W\SHV RI SDWLHQWV DQG KDV H[SHULHQFHG RYHU
FURZGLQJ RI FHUWDLQ SDWLHQW XQLWV ,W KDV UHVSRQGHG ZLWK VWRSJDS PHDVXUHV WKDW GR QRW DG
GUHVV ORQJ WHUP VSDFH VKRUWDJHV DQG RWKHU IDFLOLW\ SUREOHPV WKH KRVSLWDO LV OLNHO\ WR IDFH LQ
WKH IXWXUH $OWKRXJK WKHUH LV ZLGHVSUHDG DJUHHPHQW WKDW D QHZ IDFLOLW\ LV QHHGHG $6+·V
PRVW UHFHQW FDSLWDO PDVWHU SODQ ZDV SUHSDUHG LQ DQG ZDV QRW EDVHG RQ DQ DQDO\VLV RI
IXWXUH QHHGV $6+ KDV RQO\ UHFHQWO\ LQLWLDWHG D SODQQLQJ HIIRUW WKDW PD\ FRQWULEXWH WR SROLF\
PDNHUV· IXWXUH IDFLOLW\ GHFLVLRQV
$6+ GRHV QRW SURMHFW IXWXUH SDWLHQW QXPEHUV³'HVSLWH WKH LPSDFW RI WKH SDWLHQW FHQVXV RQ
$6+·V GD\ WR GD\ RSHUDWLRQV DQG WKH LPSRUWDQFH RI IXWXUH SDWLHQW SRSXODWLRQ VL]H WR SODQ
QLQJ D QHZ IDFLOLW\ WKH KRVSLWDO KDV QRW GHYHORSHG SURMHFWLRQV RI IXWXUH GHPDQG IRU LWV
VHUYLFHV ,WV SURMHFWLRQ HIIRUWV DUH OLPLWHG WR SUHSDULQJ SRSXODWLRQ HVWLPDWHV WR KHOS GHWHU
PLQH FXUUHQW RSHUDWLQJ EXGJHW UHTXHVWV ,Q FRQWUDVW WKH 8WDK 6WDWH +RVSLWDO SUHSDUHV HVWL
PDWHV RI H[SHFWHG SDWLHQWV HYHU\ WLPH VWDWH SRSXODWLRQ SURMHFWLRQV DUH SUHSDUHG 6LPLODUO\
WKH &RORUDGR 0HQWDO +HDOWK ,QVWLWXWH DW 3XHEOR DOVR SURMHFWV IXWXUH SDWLHQW QXPEHUV ZKHQ
HYHU VSHFLDO SURMHFWV VXFK DV EXLOGLQJ UHTXHVWV DUH LQLWLDWHG 8WDK KDV SURMHFWHG IXWXUH SD
WLHQW QXPEHUV XS WR WKH \HDU ZKLOH &RORUDGR·V SURMHFWLRQV JHQHUDOO\ DUH RQH WR WZR
\HDUV LQWR WKH IXWXUH 6LPLODUO\ 0RQWDQD SURMHFWV SDWLHQW SRSXODWLRQ HYHU\ WZR \HDUV LQ
FRQMXQFWLRQ ZLWK WKH VWDWH EXGJHWLQJ SURFHVV
,Q $UL]RQD WKH 'HSDUWPHQW RI &RUUHFWLRQV SUHSDUHV SURMHFWLRQV RI HVWLPDWHG IXWXUH SULVRQ
SRSXODWLRQV DQG LQ IDFW KDV GHYHORSHG SURMHFWLRQV IRU $6+·V XVH UHJDUGLQJ WKH QXPEHU RI
UHVLGHQWV LW H[SHFWV WR VHQG WR WKH 693 SURJUDP
(YHQ LQ WKH VKRUW WHUP WKLV ODFN RI DWWHQWLRQ WR SDWLHQW WUHQGV KDV FDXVHG SUREOHPV DW WKH
KRVSLWDO )RU H[DPSOH
n ,Q $6+ H[SHULHQFHG VHYHUH RYHUFURZGLQJ LQ LWV XQLWV WKDW KRXVH UHVWRUH WR
FRPSHWHQF\ SDWLHQWV 7KH KRVSLWDO KDG GHVLJQDWHG WZR XQLWV :LFN DQG :LFN IRU
PDOH UHVWRUH WR FRPSHWHQF\ SDWLHQWV 7KHVH WZR XQLWV KDG D FDSDFLW\ RI SDWLHQWV EXW
E\ -XQH WKH WZR XQLWV KDG D WRWDO RI SDWLHQWV $IWHU DQ XQVXFFHVVIXO DWWHPSW WR
WXUQ DZD\ SDWLHQWV EHLQJ UHIHUUHG E\ WKH FRXUWV $6+ RSHQHG DQ XQXVHG IDFLOLW\ WR UH
OLHYH RYHUFURZGLQJ (YHQ DQ XQVRSKLVWLFDWHG SODQQLQJ RU SURMHFWLRQ PHWKRG ZRXOG
OLNHO\ KDYH VLJQDOHG WKH HIIHFWV RI WKH XSZDUG WUHQG LQ QXPEHUV RI VXFK SDWLHQWV EXW QR
VXFK SURFHVV ZDV LQ SODFH
n 7R DGMXVW RYHUFURZGHG XQLWV $6+ KDV WUDQVIHUUHG SDWLHQWV IURP XQLW WR XQLW VRPHWLPHV
PRYLQJ WKHP VHYHUDO WLPHV EHIRUH ILQDOO\ VHWWOLQJ WKHP LQ D SHUPDQHQW ORFDWLRQ 7R DF
FRPPRGDWH WKH -XQH RYHUIORZ RI UHVWRUH WR FRPSHWHQF\ SDWLHQWV $6+ WHPSRUDULO\
PRYHG VRPH SDWLHQWV LQWR DQRWKHU EXLOGLQJ LQWHQGHG WR KRXVH VH[XDOO\ YLROHQW SHUVRQV
(YHQWXDOO\ LW PRYHG WKH RYHUIORZ RI PDOH UHVWRUH WR FRPSHWHQF\ SDWLHQWV LQWR DQRWKHU
XQLW WKDW IRUPHUO\ KRXVHG IHPDOH SDWLHQWV
$6+ QHHGV WR GHYHORS SODQV IRU QHZ IDFLOLW\³$OWKRXJK VWDWH SROLF\ PDNHUV LQFOXGLQJ WKH
*RYHUQRU DQG VRPH OHJLVODWRUV KDYH DFNQRZOHGJHG WKDW D QHZ KRVSLWDO IDFLOLW\ LV QHHGHG WR
DGHTXDWHO\ WUHDW DQG KRXVH SDWLHQWV $6+ KDV QRW \HW DGHTXDWHO\ GHYHORSHG RSWLRQV IRU
PHHWLQJ WKLV QHHG ,WV PRVW UHFHQW FDSLWDO PDVWHU SODQ SUHSDUHG LQ LQFOXGHG D QHZ
IDFLOLW\ WKDW ZRXOG KRXVH RQO\ SDWLHQWV ZKLFK ZRXOG EH WRR VPDOO WR DFFRPPRGDWH KDOI
RI $6+·V FXUUHQW SRSXODWLRQ $FFRUGLQJ WR D SHUVRQ SDQHO RI PHQWDO KHDOWK H[SHUWV ZKR
UHYLHZHG $6+·V RSHUDWLRQV LQ 2FWREHU DV SDUW RI WKH DWWHPSW WR DGGUHVV SUREOHPV WKDW
ODWHU OHG WR +&)$·V GHQLDO RI 0HGLFDUH FHUWLILFDWLRQ VHH )LQGLQJ , SDJH $6+·V FXUUHQW
KRVSLWDO IDFLOLW\ GRHV QRW SURYLGH WKH WKHUDSHXWLF HQYLURQPHQW DOO RI LWV SDWLHQWV QHHG $6+
KDV UHFHQWO\ LQLWLDWHG D QHZ SODQQLQJ SURFHVV WR LGHQWLI\ RSWLRQV UHJDUGLQJ IDFLOLW\ QHHGV
2WKHUV VXFK DV VWDII IURP WKH -RLQW /HJLVODWLYH %XGJHW &RPPLWWHH DQG WKH *RYHUQRU·V 2IILFH
RI 6WUDWHJLF 3ODQQLQJ DQG %XGJHWLQJ KDYH DOVR EHJXQ WR LGHQWLI\ DOWHUQDWLYHV IRU WKH QXPEHU
RI EHGV WKH IDFLOLW\ FRXOG KDYH DQG WKH W\SHV RI SDWLHQWV LW FRXOG VHUYH 8QWLO $6+ PDNHV
PRUH SURJUHVV LQ LWV RZQ SODQQLQJ HIIRUWV LW ZLOO EH OLPLWHG LQ LWV DELOLW\ WR SURYLGH QHHGHG
LQIRUPDWLRQ WR VWDWH GHFLVLRQ PDNHUV
$6+ HIIRUWV KDYH EHHQ OLPLWHG LQ VFRSH³$6+ KDV LQLWLDWHG VHYHUDO DG KRF SURMHFWV WR DG
GUHVV SUREOHP DUHDV LGHQWLILHG E\ VWDII DQG RXWVLGH UHYLHZHUV EXW VR IDU QRQH HQFRPSDVV
DQ\ ORQJ WHUP SODQQLQJ )RU H[DPSOH $6+ KDV SXW LQWR SODFH DQ DVVDXOW SUHYHQWLRQ WHDP
DQG D SURJUDP WKDW IRFXVHV RQ WUDLQLQJ VWDII WR SUHYHQW DVVDXOWV IURP RFFXUULQJ $6+ KDV
DOVR LQLWLDWHG VRPH HIIRUWV GLUHFWHG WRZDUG LPSURYLQJ VWDII PRUDOH IRU H[DPSOH E\ UHZDUG
LQJ RXWVWDQGLQJ HPSOR\HHV DQG UDLVLQJ PRQH\ IRU VWDII VRFLDO HYHQWV )LQDOO\ LQ UHVSRQVH WR
LWV ORVV RI +&)$ FHUWLILFDWLRQ $6+ GHYHORSHG VRPH SURMHFWV GLUHFWHG WRZDUG UHVROYLQJ WKH
VSHFLILF GHILFLHQFLHV FLWHG E\ WKH +&)$ LQVSHFWRUV :KLOH LPSRUWDQW QRQH RI WKHVH HIIRUWV
JRHV EH\RQG PHHWLQJ WKH LPPHGLDWH QHHG WR VROYH D VSHFLILF SUREOHP
Past Leadership Challenges
Affected ASH’s Ability to
Develop Long-Term Plans
9DFDQFLHV DQG WXUQRYHU LQ NH\ PDQDJHPHQW SRVLWLRQV DW $6+ DQG WKH 'HSDUWPHQW RI +HDOWK
6HUYLFHV KDYH FRQWULEXWHG WR WKH GLIILFXOW\ LQ GHYHORSLQJ ORQJ WHUP SODQQLQJ HIIRUWV $V RI
WKH PDQDJHPHQW SRVLWLRQV KDYH ODUJHO\ EHHQ ILOOHG
n $6+ ZHQW VL[ PRQWKV ZLWKRXW D &KLHI ([HFXWLYH 2IILFHU ,Q -XQH WKH IRUPHU &KLHI
([HFXWLYH 2IILFHU ZDV LQYROXQWDULO\ GLVPLVVHG &RQWURYHUV\ VXUURXQGLQJ WKLV GLVPLVVDO
OHIW WKH SRVLWLRQ XQILOOHG XQWLO -DQXDU\
n ,Q OHVV WKDQ RQH \HDU WKH KRVSLWDO ORVW VHYHUDO NH\ PDQDJHPHQW SRVLWLRQV LQFOXGLQJ WKH
&KLHI ([HFXWLYH 2IILFHU WKH &KLHI 0HGLFDO 2IILFHU DQG WKH 'LUHFWRU RI 4XDOLW\ 0DQDJH
PHQW 5HVRXUFHV $OWKRXJK WKH KRVSLWDO KDV VLQFH ILOOHG WKHVH SRVLWLRQV WKH UHSODFHPHQWV
ZLOO QHHG WLPH WR EHFRPH DFFXVWRPHG WR WKH KRVSLWDO DQG LWV SURFHVVHV
n $W WKH GHSDUWPHQW OHYHO WKH $VVLVWDQW 'LUHFWRU RI %HKDYLRUDO +HDOWK 6HUYLFHV WKH SRVL
WLRQ WR ZKLFK $6+·V &KLHI ([HFXWLYH 2IILFHU UHSRUWV UHVLJQHG LQ -XQH 7KH SRVLWLRQ
ZDV ILOOHG VRRQ DIWHU 7KH 'LUHFWRU·V SRVLWLRQ ZDV DOVR YDFDQW IURP -XQH WR )HEUXDU\
ASH Should Take Steps
to Plan for the Future
1RZ WKDW WKH KRVSLWDO·V PDQDJHPHQW WHDP LV IXOO\ VWDIIHG $6+·V &KLHI ([HFXWLYH 2IILFHU
VKRXOG LQLWLDWH ORQJ WHUP DFWLRQ WR JXLGH WKH KRVSLWDO·V RSHUDWLRQV LQ WKH IXWXUH $V SDUW RI
WKLV SURFHVV WKH PDQDJHPHQW WHDP VKRXOG HQVXUH WKDW WKH SDWLHQW FHQVXV LV UHJXODUO\ UH
YLHZHG DQG DQDO\]HG DQG WKDW IXWXUH SDWLHQW QXPEHUV DUH SURMHFWHG $GGLWLRQDOO\ WKH
SURFHVV VKRXOG LQFOXGH FRVWV RI WKH KRVSLWDO·V ORQJ WHUP IDFLOLW\ QHHGV
6SHFLILFDOO\ $6+ PDQDJHPHQW VKRXOG
n Project future patient numbers³$6+ VKRXOG DV SDUW RI LWV VWUDWHJLF SODQQLQJ SURFHVV
DQDO\]H WKH QXPEHUV RI SDWLHQWV LW FXUUHQWO\ VHUYHV DQG SURMHFW QXPEHUV RI SDWLHQWV LW
H[SHFWV WR VHUYH DW WKH KRVSLWDO $ WKRURXJK DQDO\VLV RI FXUUHQW DQG H[SHFWHG QXPEHUV RI
SDWLHQWV ZRXOG DVVLVW WKH KRVSLWDO LQ SODQQLQJ DQG HQVXUH WKDW SDWLHQW XQLWV DUH QRW XQ
H[SHFWHGO\ RYHUFURZGHG $GGLWLRQDOO\ VXFK D UHYLHZ FRXOG KHOS WR LGHQWLI\ SDUWLFXODU
SDWLHQW W\SHV WKDW FDQ LQFUHDVH TXLFNO\ VXFK DV WKH UHVWRUH WR FRPSHWHQF\ SRSXODWLRQ
ZKLFK LQFUHDVHG GUDPDWLFDOO\ DQG FRQWULEXWHG WR VHYHUH RYHUFURZGLQJ GXULQJ -XQH
n Plan a new hospital facility³$6+ VKRXOG EHJLQ WKH SODQQLQJ SURFHVV IRU D QHZ KRVSL
WDO IDFLOLW\ WKDW ZRXOG SURYLGH D PRUH WKHUDSHXWLF HQYLURQPHQW IRU SDWLHQWV %HIRUH GH
YHORSLQJ D UHTXHVW IRU SURSRVDOV IURP DUFKLWHFWV RQ GHVLJQLQJ WKH QHZ IDFLOLW\ $6+
VKRXOG FODULI\ LWV QHHGV LQ D FRQFHSWXDO SODQ GRFXPHQW )RU H[DPSOH DV ZHOO DV SURMHFWLQJ
IXWXUH SDWLHQW SRSXODWLRQ QXPEHUV $6+ VKRXOG LGHQWLI\ WKH WUHDWPHQW DQG VHFXULW\
QHHGV IRU ERWK FLYLO DQG IRUHQVLF SDWLHQWV )XUWKHU $6+·V SODQ VKRXOG LQFRUSRUDWH FXU
UHQW EHVW SUDFWLFHV LQ SV\FKLDWULF KRVSLWDO GHVLJQ LQFOXGLQJ GHGLFDWHG WKHUDS\ URRPV
FHQWUDO QXUVLQJ VWDWLRQV DQG SDWLHQW EHGURRPV VL]HG WR EH VKDUHG E\ DQ DSSURSULDWH
QXPEHU RI SDWLHQWV 2QFH WKH FRQFHSWXDO SODQ LV FRPSOHWH $6+ VKRXOG ZRUN ZLWK WKH
*RYHUQRU·V 2IILFH RI 6WUDWHJLF 3ODQQLQJ DQG %XGJHWLQJ DQG WKH -RLQW /HJLVODWLYH %XGJHW
&RPPLWWHH VWDII WR LGHQWLI\ IXQGLQJ VRXUFHV IRU WKH GHVLJQ DQG HYHQWXDO FRQVWUXFWLRQ RI WKH
QHZ IDFLOLW\ $V RI WKH FRQFOXVLRQ RI WKH DXGLW LQ -DQXDU\ WKH *RYHUQRU·V 2IILFH H[
SHFWHG WR GHVLJQDWH D SRUWLRQ RI WKH IXQGV WR EH UHFHLYHG LQ VHWWOHPHQW RI WKH 6WDWH·V ODZ
VXLW DJDLQVW WREDFFR FRPSDQLHV IRU WKLV SXUSRVH )LQDOO\ $6+ VKRXOG FRQVLGHU UHTXHVW
LQJ OHJLVODWLYH DSSURYDO WR KLUH DQ H[SHUW RU FRQYHQH DQ DGYLVRU\ JURXS WR DVVLVW KRVSLWDO FOL
QLFLDQV DQG DGPLQLVWUDWRUV LQ GHYHORSLQJ UHTXHVWV IRU GHVLJQ DQG ODWHU FRQVWUXFWLRQ
SURSRVDOV SUHSDULQJ D GHWDLOHG VFKHGXOH DQG EXGJHW DQG RYHUVHHLQJ WKH DUFKLWHFWXUH
DQG FRQVWUXFWLRQ FRQWUDFWRUV WR HQVXUH WKH QHZ IDFLOLW\ PHHWV WKH FXUUHQW DQG IXWXUH
QHHGV RI $6+ DQG LWV SDWLHQWV
$FFRUGLQJ WR $6+·V &KLHI ([HFXWLYH 2IILFHU D VWUDWHJLF SODQQLQJ SURFHVV LV XQGHUZD\ DQG LV
H[SHFWHG WR EH LPSOHPHQWHG E\ 6HSWHPEHU 7KH SURFHVV LV LQWHQGHG WR SURGXFH D SODQ
GHILQLQJ WKH KRVSLWDO·V JRDOV DV ZHOO DV DQ RSHUDWLRQDO SODQ WR KHOS $6+ DFKLHYH LWV JRDOV
$W WKH DXGLW·V HQG LQ -DQXDU\ WKLV SURFHVV ZDV LQ D SUHOLPLQDU\ VWDJH
Recommendations
7R KHOS HIIHFWLYHO\ SODQ IRU WKH IXWXUH $6+ VKRXOG SURMHFW IXWXUH QXPEHUV RI SDWLHQWV
$6+ PDQDJHPHQW VKRXOG EHJLQ SODQQLQJ D QHZ KRVSLWDO IDFLOLW\ E\ LGHQWLI\LQJ LWV QHHGV
LQ D FRQFHSWXDO SODQ GRFXPHQW )RU H[DPSOH WKH SODQ VKRXOG
n ,GHQWLI\ WKH WUHDWPHQW DQG VHFXULW\ QHHGV IRU FLYLO DQG IRUHQVLF SDWLHQWV
n ,QFRUSRUDWH EHVW SUDFWLFHV LQ SV\FKLDWULF KRVSLWDO GHVLJQ
2QFH LWV FRQFHSWXDO SODQ IRU D QHZ KRVSLWDO IDFLOLW\ LV ILQDOL]HG $6+ VKRXOG ZRUN ZLWK
VWDII IURP RWKHU DJHQFLHV VXFK DV WKH -RLQW /HJLVODWLYH %XGJHW &RPPLWWHH WR LGHQWLI\
IXQGLQJ VRXUFHV IRU WKH QHZ IDFLOLW\
$6+ VKRXOG FRQVLGHU UHTXHVWLQJ OHJLVODWLYH DSSURYDO WR KLUH DQ H[SHUW RU WR LQLWLDWH DQ
DGYLVRU\ ERG\ WR DVVLVW LQ GHYHORSLQJ D UHTXHVW IRU SURSRVDO SUHSDULQJ D GHWDLOHG VFKHG
XOH DQG EXGJHW DQG RYHUVHHLQJ FRQWUDFWRUV WR HQVXUH WKH QHZ IDFLOLW\ ZLOO PHHW WKH KRV
SLWDO·V QHHGV
OTHER PERTINENT INFORMATION
'XULQJ WKH DXGLW DXGLWRUV GHYHORSHG LQIRUPDWLRQ RQ WZR RWKHU LVVXHV 7KH ILUVW $6+·V
6H[XDOO\ 9LROHQW 3HUVRQ 693 SURJUDP LV D UHFHQW DGGLWLRQ WR $6+·V UHVSRQVLELOLWLHV DQG LV
FXUUHQWO\ WKH IRFXV RI FDSLWDO SODQQLQJ GLVFXVVLRQV LQYROYLQJ PLOOLRQV RI GROODUV 7KH VHFRQG
WKH VWDWXV RI $6+·V 0HGLFDUH FHUWLILFDWLRQ LQYROYHV $6+·V SUREOHPV LQ TXDOLI\LQJ IRU IHGHUDO
0HGLFDUH UHLPEXUVHPHQW DPRXQWLQJ WR KXQGUHGV RI WKRXVDQGV RI GROODUV D \HDU
New SVP Program
at the Hospital
$6+ LV UHVSRQVLEOH IRU WKH WUHDWPHQW DQG KRXVLQJ RI 693V XQWLO WKH\ QR ORQJHU SRVH D WKUHDW
WR WKH FRPPXQLW\ 693V DUH KRXVHG LQ WKH $UL]RQD &RPPXQLW\ 3URWHFWLRQ DQG 7UHDWPHQW
&HQWHU ZKLFK LV ORFDWHG LQ WKH &KROOD %XLOGLQJ RQ WKH $6+ JURXQGV $ 5 6
WKURXJK GHILQHV WKH FRPPLWPHQW SURFHVV IRU SHUVRQV DGMXGLFDWHG 693V 7KHVH VWDW
XWHV GHILQH DQ 693 DV D SHUVRQ ZKR KDV EHHQ FRQYLFWHG RI RU IRXQG JXLOW\ EXW LQVDQH RI
FRPPLWWLQJ D VH[XDOO\ YLROHQW RIIHQVH RU ZKR KDV EHHQ FKDUJHG ZLWK VXFK DQ RIIHQVH DQG
IRXQG LQFRPSHWHQW WR VWDQG WULDO DQG ZKR KDV D PHQWDO GLVRUGHU WKDW PDNHV KLP RU KHU
PRUH OLNHO\ WR UH RIIHQG 6H[XDOO\ YLROHQW RIIHQVHV LQFOXGH VH[XDO FRQGXFW ZLWK D PLQRU
VH[XDO DVVDXOW PROHVWDWLRQ RI D FKLOG DQG RWKHU VSHFLILF IHORQLHV LI WKH\ ZHUH VH[XDOO\ PRWL
YDWHG 7KH VWDWXWH EHFDPH HIIHFWLYH -XO\ EXW ZDV QRW DSSOLHG GXH WR FRQFHUQV WKDW WKH
ODZ ZDV XQFRQVWLWXWLRQDO RQ WKH JURXQGV WKDW 693V ZHUH UHTXLUHG WR VHUYH WZR VHQWHQFHV IRU
WKH VDPH FULPH +RZHYHU RQ -XQH WKH 8 6 6XSUHPH &RXUW XSKHOG D FKDOOHQJH WR D
VLPLODU ODZ LQ .DQVDV DQG DV D UHVXOW GXULQJ 6HSWHPEHU WKH ILUVW 693 ZDV FRPPLWWHG
WR $6+
$6+ ZDV DSSURSULDWHG DSSUR[LPDWHO\ PLOOLRQ DQG )7(V IRU WKH 693 SURJUDP IRU
ILVFDO \HDU :KLOH WKH ODUJHVW SURSRUWLRQ RI WKH VWDII FRQVLVWV RI UHVLGHQWLDO FRXQVHORUV
WKH SURJUDP DOVR LQFOXGHV VHFXULW\ RIILFHUV QXUVHV UHFUHDWLRQDO WKHUDSLVWV VRFLDO
ZRUNHU SV\FKRORJLVWV DQG DGPLQLVWUDWLYH VWDII $GGLWLRQDOO\ WKH &KROOD %XLOGLQJ ZDV
UHQRYDWHG DQG D QHZ EXLOGLQJ ZLOO EH FRQVWUXFWHG DGMDFHQW WR &KROOD +DOO )XQGLQJ RI
ZDV SURYLGHG IRU WKH UHQRYDWLRQ DQG QHZ FRQVWUXFWLRQ &XUUHQWO\ &KROOD KDV
EHGV :KHQ WKH QHZ EXLOGLQJ LV FRPSOHWHG LQ -XQH WKH 693 SURJUDP ZLOO KDYH
EHGV
&LYLO FRPPLWPHQW SURFHVV³$ VWDWH SULVRQ LQPDWH QHDULQJ WKH HQG RI KLV RU KHU VHQWHQFH IRU
D VH[XDOO\ YLROHQW RIIHQVH UHFHLYHV D SV\FKRORJLFDO VFUHHQLQJ FRQGXFWHG E\ D SV\FKLDWULVW RU
SV\FKRORJLVW HPSOR\HG ZLWK RU XQGHU FRQWUDFW ZLWK WKH 'HSDUWPHQW RI &RUUHFWLRQV ,I WKH
VFUHHQLQJ VXJJHVWV WKH LQPDWH PD\ EH DQ 693 WKH FRXQW\ DWWRUQH\ PD\ ILOH D SHWLWLRQ DOOHJ
LQJ SUREDEOH FDXVH WKDW WKH SHUVRQ LV DQ 693 ,I D MXGJH GHWHUPLQHV WKDW SUREDEOH FDXVH GRHV
H[LVW WKH SHUVRQ LV GHWDLQHG DW $6+ WR DZDLW D SUREDEOH FDXVH KHDULQJ ,I DW WKH SUREDEOH
FDXVH KHDULQJ WKH FRXUW DIILUPV WKH ILUVW MXGJH·V GHFLVLRQ WKH SHUVRQ UHFHLYHV DQ DGGLWLRQDO
HYDOXDWLRQ DV WR ZKHWKHU KH RU VKH LV D VH[XDOO\ YLROHQW SHUVRQ
:LWKLQ GD\V DIWHU WKH FRXQW\ DWWRUQH\ ILOHV WKH SHWLWLRQ D WULDO PXVW EH KHOG WR GHWHUPLQH
ZKHWKHU WKH SHUVRQ LV D VH[XDOO\ YLROHQW SHUVRQ :KLOH DZDLWLQJ WULDO WKH GHWDLQHH LV KRXVHG
DW $6+·V 693 XQLW EXW GRHV QRW UHFHLYH WUHDWPHQW ,I WKH MXGJH RU MXU\ GHWHUPLQHV EH\RQG D
UHDVRQDEOH GRXEW WKDW WKH SHUVRQ LV DQ 693 WKH FRXUW FDQ RUGHU WKH SHUVRQ WR HLWKHU UHPDLQ
LQ WKH $6+ 693 XQLW RU EH PRYHG WR D OHVV UHVWULFWLYH DOWHUQDWLYH ZKLFK LV ORFDWHG LQ WKH
$ODPR %XLOGLQJ RQ WKH $6+ JURXQGV
$V RI -DQXDU\ WKHUH ZHUH UHVLGHQWV LQ WKH 693 SURJUDP 2I WKHVH ZHUH DZDLWLQJ
WULDO PHDQLQJ WKHUH ZDV SUREDEOH FDXVH WR EHOLHYH WKHVH SHRSOH DUH 693V DQG WKHUHIRUH WKH\
ZHUH XQGHU WKH MXULVGLFWLRQ RI WKH 'HSDUWPHQW RI +HDOWK 6HUYLFHV +RZHYHU VLQFH WKHLU 693
VWDWXV KDG QRW \HW EHHQ GHWHUPLQHG E\ D MXU\ WKH 'HSDUWPHQW FRXOG QRW SURYLGH WUHDWPHQW
IRU WKHP 7KH UHPDLQLQJ UHVLGHQWV ZKR ZHUH UHFHLYLQJ WUHDWPHQW WKURXJK WKH SURJUDP
KDG HLWKHU ZDLYHG WKHLU ULJKW WR D WULDO RU KDG KDG WKHLU WULDO DQG KDG EHHQ GHWHUPLQHG WR EH
693V
7UHDWPHQW DQG UHOHDVH³,I D SHUVRQ HLWKHU ZDLYHV KLV RU KHU ULJKW WR D WULDO RU KDV EHHQ FRP
PLWWHG WKURXJK WKH WULDO SURFHVV WR $6+·V 693 XQLW KH RU VKH XQGHUJRHV D FRPSUHKHQVLYH
HYDOXDWLRQ DQG D WUHDWPHQW SODQ LV GHYHORSHG 7R GHYHORS LWV WUHDWPHQW SURJUDP $6+
UHVHDUFKHG SURJUDPV LQ RWKHU VWDWHV DQG FRQVXOWHG ZLWK DQ H[SHUW IURP WKH 8QLYHUVLW\ RI
$UL]RQD 7KH SURJUDP·V PDLQ JRDO LV WR WHDFK WHFKQLTXHV WR DYRLG HQJDJLQJ LQ VH[XDOO\
YLFWLPL]LQJ EHKDYLRUV )RU H[DPSOH FRXQVHORUV ZRUN ZLWK UHVLGHQWV WR KHOS WKHP OHDUQ WR
UHFRJQL]H DQG DYRLG LQDSSURSULDWH VLWXDWLRQV +RZHYHU DOWKRXJK $6+·V WUHDWPHQW SURJUDP
LV EDVHG RQ EHVW FXUUHQW SUDFWLFHV LQ WKH ILHOG RI WUHDWLQJ VH[XDOO\ YLROHQW SHUVRQV H[SHUWV
EHOLHYH LW PD\ EH LPSRVVLEOH WR IXOO\ UHKDELOLWDWH LQGLYLGXDOV ZLWK WKH PHQWDO GLVRUGHUV WKDW
PDNH WKHP OLNHO\ WR FRPPLW VH[XDOO\ YLROHQW RIIHQVHV
7R REWDLQ XQFRQGLWLRQDO UHOHDVH IURP WKH SURJUDP RU FRQGLWLRQDO UHOHDVH WR D OHVV UHVWULFWLYH
HQYLURQPHQW WKH SHUVRQ PXVW SHWLWLRQ WKH FRXUW +H RU VKH FDQ GR WKLV DQQXDOO\ ZLWKRXW
SHUPLVVLRQ RU DW DQ\ WLPH LI WKH VXSHULQWHQGHQW RI $6+ RU WKH GLUHFWRU RI WKH 'HSDUWPHQW RI
+HDOWK 6HUYLFHV GHWHUPLQHV WKH SHUVRQ·V PHQWDO GLVRUGHU KDV FKDQJHG DQG WKDW KH RU VKH LV
QRW OLNHO\ WR FRPPLW VH[XDOO\ YLROHQW RIIHQVHV $W WKH GLVFKDUJH KHDULQJ WKH 6WDWH PXVW
SURYH WKDW WKH SHUVRQ·V PHQWDO GLVRUGHU KDV QRW FKDQJHG DQG WKDW KH RU VKH UHPDLQV D GDQ
JHU WR RWKHUV DQG LV OLNHO\ WR HQJDJH LQ DFWV RI VH[XDO YLROHQFH DQG LI WKH 6WDWH FDQQRW GR VR
WKH SHUVRQ PXVW EH UHOHDVHG $V RI -DQXDU\ QR SHUVRQV KDYH EHHQ UHOHDVHG DIWHU HQWHU
LQJ WKH SURJUDP
,I D UHVLGHQW VXFFHVVIXOO\ SDVVHV H[WHQVLYH SV\FKRORJLFDO HYDOXDWLRQV KH RU VKH PD\ EH DS
SURYHG WR OLYH LQ WKH SURJUDP·V OHVV UHVWULFWLYH DOWHUQDWLYH HQYLURQPHQW +H RU VKH ZLOO EH
DVVLVWHG LQ ILQGLQJ HPSOR\PHQW GXULQJ WKH GD\ DQG ZLOO EH HOHFWURQLFDOO\ PRQLWRUHG XQWLO
WKH WUHDWPHQW WHDP UHFRPPHQGV WKDW WKH SHUVRQ KDV SURJUHVVHG IDU HQRXJK LQ WUHDWPHQW
WKDW KH RU VKH FDQ VDIHO\ OHDYH WKH IDFLOLWLHV ZLWKRXW WKH QHHG IRU H[WHUQDO PRQLWRULQJ $W WKH
WLPH WKH DXGLW HQGHG LQ -DQXDU\ IRXU UHVLGHQWV KDG EHHQ DSSURYHG WR OLYH LQ WKH SUR
JUDP·V OHVV UHVWULFWLYH DOWHUQDWLYH
2WKHU VWDWHV KDYH VLPLODU SURJUDPV³6HYHUDO RWKHU VWDWHV KDYH VLPLODU SURJUDPV WKDW SUR
YLGH FLYLO FRPPLWPHQW LQ PHQWDO LQVWLWXWLRQV IRU FHUWDLQ W\SHV RI VH[ RIIHQGHUV $FFRUGLQJ WR
D UHFHQW DUWLFOH HLJKW RWKHU VWDWHV KDYH VLPLODU SURJUDPV DQG PDQ\ RWKHU VWDWHV KDYH LQLWL
DWHG VLPLODU OHJLVODWLRQ )RU H[DPSOH :DVKLQJWRQ .DQVDV DQG )ORULGD KDYH VWDWXWHV WKDW
FRQILQH FHUWDLQ W\SHV RI VH[ RIIHQGHUV WR D KRXVLQJ DQG WUHDWPHQW SURJUDP
)XWXUH RI $UL]RQD·V 693 SURJUDP³$6+·V 693 SURJUDP KDV JURZQ UDSLGO\ VLQFH WKH ILUVW
DGPLVVLRQ LQ 6HSWHPEHU ,Q -DQXDU\ WKH SURJUDP KDG JURZQ WR RYHU UHVLGHQWV
$FFRUGLQJ WR WKH $UL]RQD 'HSDUWPHQW RI &RUUHFWLRQV $6+·V 693 SURJUDP VKRXOG FRQWLQXH
UHFHLYLQJ DERXW QHZ DGPLVVLRQV SHU PRQWK 8QOHVV DQ HIIHFWLYH WUHDWPHQW LV IRXQG VR WKDW
UHVLGHQWV FDQ EH UHOHDVHG $6+ SURMHFWV WKDW WKH SURJUDP ZLOO OLNHO\ H[FHHG LWV EHG FD
SDFLW\ GXULQJ 1RYHPEHU 7KH $UL]RQD 'HSDUWPHQW RI $GPLQLVWUDWLRQ UHFHLYHG OHJLVOD
WLYH DSSURYDO LQ $SULO WR EHJLQ GHVLJQLQJ DQ DGGLWLRQDO EHG IDFLOLW\ WR LQFUHDVH WKH
XQLW·V FDSDFLW\ WR EHGV 7KH /HJLVODWXUH DSSURSULDWHG PLOOLRQ LQ WKH ILVFDO \HDU
FDSLWDO RXWOD\ EXGJHW IRU WKLV IDFLOLW\
$ VWXG\ JURXS FDOOHG WKH /RQJ 7HUP +RXVLQJ 2SWLRQV 7HDP ZLWK UHSUHVHQWDWLYHV IURP
$6+ WKH $WWRUQH\ *HQHUDO·V 2IILFH DQG WKH 'HSDUWPHQWV RI +HDOWK 6HUYLFHV DQG &RUUHF
WLRQV ZDV FKDUJHG ZLWK DQDO\]LQJ D YDULHW\ RI RSWLRQV IRU KRXVLQJ SHUVRQV LQ WKH SURJUDP
LQFOXGLQJ NHHSLQJ WKH SURJUDP DW $6+ PRYLQJ LW WR WKH 3HUU\YLOOH 3ULVRQ RU SULYDWL]LQJ LW
7KH VWXG\ JURXS GHYHORSHG D WKUHH SKDVH FDSLWDO FRQVWUXFWLRQ SURFHVV EHJLQQLQJ ZLWK
EXLOGLQJ UHQRYDWLRQV ZKLFK DFFRXQWV IRU EHGV ,W FRQVLVWV RI WKH EHG &KROOD %XLOGLQJ
RQ WKH $6+ FDPSXV DQG WKH EHG DGGLWLRQ WR &KROOD ZKLFK VKRXOG EH FRPSOHWHG LQ -XQH
,Q WKH VHFRQG SKDVH WKH $VSHQ %XLOGLQJ RQ WKH $6+ FDPSXV ZKLFK LV FXUUHQWO\ RFFX
SLHG E\ WKH 'HSDUWPHQW RI &RUUHFWLRQV ZLOO EH YDFDWHG DQG UHQRYDWHG WR SURYLGH DQ DGGL
WLRQDO EHGV E\ $SULO 7KH $VSHQ UHQRYDWLRQ LV SURMHFWHG WR FRVW PLOOLRQ
)RU WKH WKLUG SKDVH WR EULQJ WKH SURJUDP·V FDSDFLW\ XS WR WKH SURMHFWHG E\ 2FWREHU
WKH VWXG\ JURXS SUHSDUHG IRXU RSWLRQV
n Option 1³&RQWLQXH WKH SURJUDP DW $6+ &RQVWUXFW D QHZ EHG EXLOGLQJ UHQRYDWH
%LUFK +DOO DV D WUHDWPHQW DQG VXSSRUW IDFLOLW\ WKLV EXLOGLQJ LV FXUUHQWO\ UHQWHG RXW WR
RWKHU 'HSDUWPHQW RI +HDOWK 6HUYLFHV RIILFHV DQG EXLOG D PRGXODU HGXFDWLRQ EXLOGLQJ
IRU WUHDWPHQW DQG VXSSRUW 7KLV RSWLRQ ZRXOG SURYLGH WRWDO EHGV DW D WRWDO FRVW RI
PLOOLRQ LQFOXGLQJ WKH UHQRYDWLRQV DW &KROOD DQG $VSHQ
n Option 2³6DPH DV 2SWLRQ H[FHSW EXLOG D QHZ VXSSRUW DQG HGXFDWLRQ EXLOGLQJ LQ
VWHDG RI UHQRYDWLQJ %LUFK +DOO DQG EXLOGLQJ D PRGXODU HGXFDWLRQ EXLOGLQJ 7KLV ZRXOG
DOVR SURYLGH WRWDO EHGV DW D WRWDO FRVW RI PLOOLRQ
*RUGRQ 'LDQQD .HHSLQJ 6H[ 2IIHQGHUV 2II WKH 6WUHHWV 6WDWH /HJLVODWXUHV 0DUFK
n Option 3³0RYH WKH SURJUDP WR WKH 3HUU\YLOOH 3ULVRQ LQ :HVW 3KRHQL[ 7KLV ZRXOG
UHTXLUH FRQVWUXFWLRQ RI D QHZ EHG IDFLOLW\ DW WKH SULVRQ 7KH WRWDO FRVW IRU EHGV
ZRXOG EH DSSUR[LPDWHO\ PLOOLRQ VLQFH WKH SURJUDP ZRXOG QRW XVH UHQRYDWHG $6+
EXLOGLQJV
n Option 4³0RYH WKH SURJUDP WR D QHZ EHG IDFLOLW\ WR EH RSHUDWHG E\ D SULYDWH
FRQWUDFWRU 7KH HVWLPDWHG FRVW RI ORFDWLQJ D VLWH DQG EXLOGLQJ D QHZ IDFLOLW\ LV WR
PLOOLRQ $QQXDO RSHUDWLQJ IHHV ZRXOG DOVR EH LQFXUUHG XQGHU WKLV RSWLRQ EXW WKH &RP
PLWWHH GLG QRW HVWLPDWH WKH DPRXQW RI WKHVH IHHV
7KLV VWXG\ JURXS UHFRPPHQGHG 2SWLRQ WR WKH *RYHUQRU 7KH *RYHUQRU·V ILVFDO \HDU
EXGJHW UHFRPPHQGV DOORFDWLQJ DSSUR[LPDWHO\ PLOOLRQ RI WREDFFR VHWWOHPHQW PRQLHV
UHFHLYHG IURP ILVFDO \HDUV WKURXJK IRU $6+ LPSURYHPHQWV DQG FRQVWUXFWLRQ ,Q
DGGLWLRQ OHJLVODWLRQ KDV EHHQ LQWURGXFHG WKDW ZRXOG DSSURSULDWH VRPH WREDFFR VHWWOHPHQW
PRQLHV IRU KRVSLWDO FRQVWUXFWLRQ :KLOH WKH ODUJHVW SRUWLRQ RI WKDW PRQH\ ZRXOG EH IRU D
QHZ KRVSLWDO VRPH RI WKH PRQH\ LV LQWHQGHG WR EXLOG DGGLWLRQDO IDFLOLWLHV WR DFFRPPRGDWH
693 SURJUDP JURZWK
5HJDUGOHVV RI WKH RSWLRQ VHOHFWHG WKH IXWXUH FRVWV RI WKLV SURJUDP ZLOO EH VXEVWDQWLDO
Medicare Certification
7KH +HDOWK &DUH )LQDQFLQJ $GPLQLVWUDWLRQ +&)$ LQ WKH IHGHUDO 'HSDUWPHQW RI +HDOWK
DQG +XPDQ 6HUYLFHV RYHUVHHV KRVSLWDOV WKDW UHFHLYH 0HGLFDUH UHLPEXUVHPHQWV 7R UHFHLYH
UHLPEXUVHPHQW IRU VHUYLFHV WR HOLJLEOH SDWLHQWV DOO KRVSLWDOV PXVW PHHW 0HGLFDUH·V &RQGL
WLRQV RI 3DUWLFLSDWLRQ D FRPSUHKHQVLYH OLVW RI VWDQGDUGV FRYHULQJ PDQDJHPHQW IDFLOLWLHV
TXDOLW\ DVVXUDQFH IRRG VHUYLFHV DQG LQIHFWLRQ FRQWURO SUDFWLFHV ,Q DGGLWLRQ SV\FKLDWULF
KRVSLWDOV PXVW PHHW VSHFLDO FRQGLWLRQV UHJDUGLQJ SDWLHQW WUHDWPHQW UHFRUGV DQG VWDIILQJ 7R
UHFHLYH $+&&&6 7LWOH ;,; UHLPEXUVHPHQWV KRVSLWDOV PXVW EH 0HGLFDUH FHUWLILHG
$6+ LV FXUUHQWO\ LQHOLJLEOH WR UHFHLYH UHLPEXUVHPHQW IRU SURYLGLQJ VHUYLFHV WR SDWLHQWV ZKR
DUH HOLJLEOH IRU 0HGLFDUH DQG $+&&&6 7LWOH ;,; UHLPEXUVHPHQWV $FFRUGLQJ WR $6+ RYHU
SDWLHQWV ZHUH HOLJLEOH IRU 0HGLFDUH UHLPEXUVHPHQW DQG SDWLHQWV ZRXOG KDYH EHHQ
HOLJLEOH IRU $+&&&6 7LWOH ;,; UHLPEXUVHPHQWV ,I $6+ ZHUH FHUWLILHG E\ +&)$ WKH 0HGL
FDUH UHLPEXUVHPHQWV ZRXOG KDYH EHHQ UHPLWWHG WR WKH 6WDWH *HQHUDO )XQG +RZHYHU DV D
UHVXOW RI WKH KRVSLWDO QRW EHLQJ FHUWLILHG WKH 6WDWH *HQHUDO )XQG UHYHQXH LV UHGXFHG E\ WKH
DPRXQW RI WKH UHLPEXUVHPHQWV WKDW WKH KRVSLWDO ZRXOG KDYH EHHQ HOLJLEOH WR UHFHLYH )RU
ILVFDO \HDU UHLPEXUVHPHQWV WRWDOHG DSSUR[LPDWHO\ IRU 0HGLFDUH UHLPEXUVH
PHQW DQG DERXW PLOOLRQ IRU $+&&&6 7LWOH ;,; UHLPEXUVHPHQWV 7KH $+&&&6 7LWOH
;,; UHLPEXUVHPHQWV DUH IXQGHG E\ IHGHUDO VWDWH DQG ORFDO GROODUV 7KH 6WDWH DQG FRXQWLHV
ILQDQFH DERXW RQH WKLUG RI WKH UHLPEXUVHPHQWV DQG WKH UHPDLQLQJ WZR WKLUGV DUH IXQGHG E\
WKH IHGHUDO 0HGLFDLG SURJUDP ,Q DGGLWLRQ VLQFH $6+ LV LQHOLJLEOH WR FROOHFW $+&&&6 7LWOH
;,; UHLPEXUVHPHQWV DGGLWLRQDO 6WDWH *HQHUDO )XQG PRQLHV ZHUH QHHGHG WR IXQG WKH KRV
SLWDO·V RSHUDWLRQV
&HUWLILFDWLRQ YROXQWDULO\ VXVSHQGHG³,Q -DQXDU\ RIILFLDOV IURP +&)$ ZDUQHG WKH
'HSDUWPHQW RI +HDOWK 6HUYLFHV WKDW $6+ ULVNHG ORVLQJ LWV 0HGLFDUH FHUWLILFDWLRQ GXH WR GHIL
FLHQFLHV UHODWLQJ WR LWV PHGLFDO UHFRUGV DQG VWDIILQJ %RWK RI WKHVH GHILFLHQFLHV ZHUH FLWHG
GXULQJ DQ LQVSHFWLRQ WKDW WRRN SODFH 'HFHPEHU 6SHFLILFDOO\ +&)$ VXUYH\RUV GH
WHUPLQHG WKDW $6+ IDLOHG WR DGHTXDWHO\ GRFXPHQW SDWLHQWV· SURJUHVV LQ WKHLU PHGLFDO UHF
RUGV $GGLWLRQDOO\ VXUYH\RUV IRXQG OLWWOH HYLGHQFH WKDW WKH KRVSLWDO ZDV SURYLGLQJ SDWLHQWV
ZLWK DGHTXDWH DFWLYH WUHDWPHQW )LQDOO\ VXUYH\RUV GHWHUPLQHG WKDW $6+ KDG DQ LQDGHTXDWH
QXPEHU RI TXDOLILHG VWDII WR FDUH IRU SDWLHQWV 2Q -XQH WKH 'HSDUWPHQW RI +HDOWK
6HUYLFHV WHPSRUDULO\ ZLWKGUHZ $6+ IURP WKH 0HGLFDUH SURJUDP IRU GD\V UDWKHU WKDQ
ULVN EHLQJ GHFHUWLILHG E\ +&)$ 9ROXQWDU\ VXVSHQVLRQ DOORZHG $6+ WR UHDSSO\ DV VRRQ DV LW
ZDV UHDG\ ,I +&)$ KDG IRUPDOO\ GHFHUWLILHG $6+ WKH KRVSLWDO ZRXOG QRW KDYH EHHQ DO
ORZHG WR UHDSSO\ IRU RQH \HDU
5HDSSOLFDWLRQ GHQLHG³$6+ DSSOLHG IRU UH FHUWLILFDWLRQ RQ 6HSWHPEHU EXW ZDV
XQDEOH WR PHHW +&)$ VWDQGDUGV LQ LQVSHFWLRQV WKDW WRRN SODFH GXULQJ $SULO 7KH $UL
]RQD 'HSDUWPHQW RI +HDOWK 6HUYLFHV +&)$ DQG WKH 6WDWH )LUH 0DUVKDO·V 2IILFH MRLQWO\ FRQ
GXFWHG WKH LQVSHFWLRQ )HGHUDO DQG VWDWH LQVSHFWRUV IRFXV RQ GLIIHUHQW DUHDV ZKHQ UHYLHZLQJ
D KRVSLWDO )HGHUDO UHYLHZHUV LGHQWLI\ SUREOHPV LQYROYLQJ DFWLYH WUHDWPHQW DQG VWDIILQJ DQG
UHO\ XSRQ VWDWH UHYLHZHUV WR GHWHUPLQH D KRVSLWDO·V FRPSOLDQFH ZLWK IDFLOLW\ VWDQGDUGV VXFK
DV FOHDQOLQHVV
$6+ IDLOHG WR PHHW VWDQGDUGV LQ VL[ DUHDV³'HVSLWH $6+·V HIIRUWV WR EULQJ LWV SHUIRUPDQFH
XS WR VWDQGDUGV $6+ IDLOHG LWV $SULO LQVSHFWLRQ LQ VL[ DUHDV DV IROORZV
n Governing Body³+&)$ LQVSHFWRUV GHWHUPLQHG WKDW WKH KRVSLWDO GLG QRW KDYH DQ HI
IHFWLYH JRYHUQLQJ ERG\ UHVSRQVLEOH IRU JHQHUDO RYHUVLJKW RI WKH KRVSLWDO )RU H[DPSOH
+&)$ VWDQGDUGV UHTXLUH KRVSLWDOV WR XSGDWH WKHLU SROLFLHV DQG SURFHGXUHV HYHU\ WZR
\HDUV +RZHYHU $6+·V JRYHUQLQJ ERG\ GLG QRW HQVXUH WKDW WKH SROLFLHV ZHUH XSGDWHG
$GGLWLRQDOO\ WKH LQVSHFWLRQ GHWHUPLQHG WKDW WKH JRYHUQLQJ ERG\ GLG QRW HQVXUH WKDW
FRQWUDFW VWDII ZHUH DGHTXDWHO\ PRQLWRUHG DQG HYDOXDWHG E\ KRVSLWDO VWDII )XUWKHU WKH
LQVSHFWLRQ GHWHUPLQHG WKDW $6+ GLG QRW PDLQWDLQ D OLVW RI DOO FRQWUDFWHG VHUYLFHV DW WKH
KRVSLWDO DV FDOOHG IRU E\ +&)$
n Quality Assurance³6XUYH\ LQVSHFWRUV FRQFOXGHG WKDW $6+ GLG QRW KDYH DQ HIIHFWLYH
TXDOLW\ DVVXUDQFH SURJUDP )LUVW LQVSHFWRUV GHWHUPLQHG WKDW $6+·V JRYHUQLQJ ERG\
IDLOHG WR HQVXUH WKDW $6+ KDG D TXDOLW\ DVVXUDQFH SURJUDP RU D SODQ WR LPSOHPHQW RQH
)RU H[DPSOH DOWKRXJK WKH KRVSLWDO KDG SODQQHG WR GHYHORS D WRRO WR PHDVXUH SDWLHQWV·
GLDEHWHV OHYHOV LWV SODQV ZHUH QRW IROORZHG WKURXJK 6HFRQG LQVSHFWRUV GHWHUPLQHG WKDW
$6+·V JRYHUQLQJ ERG\ IDLOHG WR HYDOXDWH VHUYLFHV SURYLGHG E\ FRQWUDFW SHUVRQQHO 6HY
HUDO FRQWUDFWV UHYLHZHG LQFOXGLQJ QXUVHV D VSHHFK WKHUDSLVW DQG D SV\FKRORJLVW KDG QR
GRFXPHQWDWLRQ WKDW $6+ UHYLHZHG RU HYDOXDWHG WKHLU ZRUN $GGLWLRQDOO\ DOWKRXJK $6+
KDG SODQQHG WR PRQLWRU SURJUHVV DQG WDNH IROORZ XS DFWLRQ LQ DUHDV VXFK DV DVVDXOWV UH
VWUDLQW XVDJH GUXJ XWLOL]DWLRQ DQG RWKHUV WKHUH ZDV QR HYLGHQFH WKDW $6+ KDG LPSOH
PHQWHG DQ\ RI WKHVH DFWLRQV
n Nursing Services³6XUYH\ LQVSHFWRUV FLWHG VHYHUDO GHILFLHQFLHV UHODWHG WR $6+·V QXUV
LQJ SURJUDP )LUVW LQVSHFWRUV IRXQG WKDW $6+ IDLOHG WR SURYLGH DGHTXDWH QXPEHUV RI
QXUVLQJ VWDII WR SDWLHQWV 6XUYH\RUV REVHUYHG VHYHUDO RFFDVLRQV ZKHUH GXWLHV ZHUH QRW
SHUIRUPHG $GGLWLRQDOO\ $6+ GLG QRW HQVXUH WKDW LWV QXUVHV KDG YDOLG FUHGHQWLDOV DQG
WKDW FRQWUDFW SHUVRQQHO IROORZHG KRVSLWDO SROLFLHV DQG SURFHGXUHV UHJDUGLQJ LPPXQL]D
WLRQV DQG ILQJHUSULQWLQJ )RU H[DPSOH VHYHUDO SHUVRQQHO ILOHV UHYLHZHG GLG QRW KDYH
GRFXPHQWDWLRQ RI FXUUHQW OLFHQVXUH FUHGHQWLDOV $OVR LQVSHFWRUV IRXQG WKDW $6+ IDLOHG WR
HQVXUH WKDW GUXJV ZHUH SUHSDUHG DQG DGPLQLVWHUHG LQ DFFRUGDQFH ZLWK SK\VLFLDQV· RU
GHUV 6HYHUDO PHGLFDO UHFRUGV UHYLHZHG ODFNHG GRFXPHQWDWLRQ WKDW SDWLHQWV· PHGLFDWLRQV
ZHUH DGPLQLVWHUHG DFFRUGLQJ WR GRFWRUV· RUGHUV
n Special Staff Requirements for Psychiatric Hospitals³,QVSHFWRUV GHWHUPLQHG WKDW
$6+ GLG QRW KDYH DGHTXDWH VWDIILQJ WR SURYLGH SDWLHQWV ZLWK DGHTXDWH WUHDWPHQW )RU
H[DPSOH LQVSHFWRUV REVHUYHG RQH XQLW WKDW KDG RQO\ VWDII DYDLODEOH WR FDUH IRU SD
WLHQWV $OWKRXJK WKH XQLW ZDV VXSSRVHG WR KDYH VWDII WKDW GD\ VWDII PHPEHUV ZHUH DV
VLJQHG WR RWKHU WDVNV )XUWKHU VXUYH\RUV FLWHG IUHTXHQW VWDII DEVHQFHV LQMXULHV GXH WR SD
WLHQW DVVDXOWV DQG WKH UHDVVLJQPHQW RI VWDII WR RWKHU WDVNV DV IDFWRUV OHDGLQJ WR LQVXIIL
FLHQW VWDII RQ WKH WUHDWPHQW XQLWV
n Food and Dietetic Services³7KLV VWDQGDUG UHTXLUHV WKDW WKH KRVSLWDO·V GLHWDU\ VHUYLFH
EH VWDIIHG E\ DGHTXDWH SHUVRQQHO 7KH VXUYH\ LQVSHFWRUV GHWHUPLQHG WKDW $6+·V GLHWDU\
VHUYLFHV KDG LQDGHTXDWH VWDII DQG WKDW LWV PHDOV GLG QRW DGHTXDWHO\ PHHW SDWLHQWV· GLH
WDU\ DQG QXWULWLRQDO QHHGV ,QVSHFWRUV GHWHUPLQHG WKDW $6+·V GLHWDU\ GHSDUWPHQW KDG
VHYHUDO YDFDQFLHV RQ HDFK VKLIW $GGLWLRQDOO\ VRPH SDWLHQWV ZKR ZHUH VXSSRVHG WR UH
FHLYH VSHFLDO GLHWV VXFK DV ORZ VRGLXP RU ORZ FDORULH ZHUH QRW UHFHLYLQJ WKHP ,QVWHDG
SDWLHQWV LQ FHUWDLQ XQLWV IUHTXHQWO\ UHFHLYHG WKH VDPH IRRG
n Infection Control³7KLV VWDQGDUG UHTXLUHV WKH KRVSLWDO WR SURYLGH D VDQLWDU\ HQYLURQ
PHQW WR DYRLG WUDQVPLWW
Arizona State Government Publications
