A Sad Day Indeed; A Rant About the System

It's a sad day today in more ways than one.  Our sister program, CDT (Continued Day Treatment) is closing.  We've worked side-by-side for the five years I've been with the organization, and I will miss all the staff who have been a part of my life for five years.  Thankfully, they have not lost jobs.  The organization is the largest in the city with 28 programs so all staff will be placed elsewhere.  I can't blame the organization for the closing.  There is no money to be made in day treatment programs anymore.  They fought to keep it open, but finally had to give in just like all the others here in the city.  Medicaid has decided that there is no merit in such places, and they will no longer pay.

I will miss the workers, yes, but they will be okay.  For some, their new position is a step up with a hefty raise.  It is the clients who I am feeling for.  Continued Day Treatment is/was a program for mentally ill clients.  They spend their day at the program coming for breakfast in the morning, then attending various groups throughout the day.  And unlike my program in which groups are geared toward substance abuse, their groups are designed  to teach them how to survive in the community, how to take care of themselves--cooking classes, daily living skills, making a budget, hygiene, dealing with mental illness, etc.  So, it not only gets them off the streets, it also teaches them how to live.

And, although they are being referred to other places, it is not the same.  Clubhouses are just that...a clubhouse.  Oh, there are some that offer some kind of life skills training, but not to the point where the client learns to become self-sufficient.  Other clients are being referred to the programs Medicaid WILL pay for...a program where the client meets with the psychiatrist, gets his/her prescriptions, and whoosh, they are back on the streets.   

Where does it all end?  I mean, it's not the clients faults that Medicaid has been mismanaged for so many years.  I remember back in time when addicts would spend all their money on drugs, check themselves into a detox, check out when their money arrived, and then do the same thing when their money ran out....over and over again...at a cost of over $1500 a day. When patients are discharged — typically after about five days — the needed transition to an outpatient treatment program rarely or never occurs. And, rather than encourage clients to enter long-term treatment, Medicaid continued to pay the hospital's exorbitant fees.  Addicts know this and take full advantage.

That's only one way Medicaid has been mismanaged over the years.  There are far more, but this is one I know of personally as I work in the field. And all of us are going to end up paying for it.  Not only will the mentally ill get the care they deserve, but homelessness and crime is already on the rise.  Why close down programs that help to prepare  the mentally ill and homeless to survive in this challenging world while Medicaid quacks are out there charging a small fortune to write out scripts?

And, it's not only the mentally ill who are suffering.  It is happening to the elderly, as well.  Senior centers are shutting down all over the city, and despite the fact that we 'baby boomers'  are producing the largest generation of elderly folk ever, housing and other services for the oldsters is down to a minimum.  As a woman nearing retirement age, it truly frightens me.  


Where does it all end?  By 2018 Medicaid is requiring that all people who work in my field will need a Master's Degree, or they will not be able to find a job.  My question is, who is going to pay for it?  That is six years from now.  By then I will be 70.  Let's hope I can retire by then.


Thanks for letting me rant.