New house rules

Earlier this month, Cindy Crippen returned from a lengthy vacation with her parents to an unwelcome surprise: She had been discharged from her Spokane group home by the county’s public mental health system.

Crippen, a 41-year-old woman who has schizophrenia, ran afoul of a new county policy that strictly limits when people with mental illness can leave the homes.

Under the policy, the group homes cannot hold a bed for a patient – regardless of whether they are visiting family, or have been hospitalized or placed in jail – unless the homes are willing to absorb the cost.

United Behavioral Health, which manages the county’s mental health system, discharged Crippen despite the fact that she continued to pay $540.16 a month out of her disability check to the home, according to her family.

“We wouldn’t have left if we had known,” said Barbara Crippen, Cindy’s mother. “We certainly don’t try to take advantage of the system.”

The county pays $39 a day for people who need continuous supervision because of the seriousness of their mental illness. But the county will no longer pay for days when the patient is not at the home, and will discharge patients gone for extended periods of time, according to county officials.

The county policy, which went into place Jan. 1, did not set a limit on how many days a patient can leave the home before being discharged.

Kasey Kramer, the county’s director of community services, said state guidelines require that “the person’s head has to be on the pillow” for the group homes to be paid with public money. He said Crippen was on vacation for 72 days, which her family confirmed.

“We can’t pay for services for a person who is not here,” Kramer said. “From a public stewardship position, I think it’s an appropriate policy to have.”

The policy is part of a controversial contract between Spokane’s regional support network, which is tasked with overseeing the public mental health system, and a handful of the city’s group homes. In the past year, the county reduced the number of beds for the mentally ill in the homes, required better training for staff and restructured the homes’ payment system.

As a result, one home stopped accepting people with mental illness, choosing to focus exclusively on people with developmental disabilities. Another home closed its doors in January, citing a decrease in referrals from the mental health system and the county’s new reimbursement plan.

Donald Crippen said his daughter has flourished during her two years at Grande Manor, a 12-bed home for women on a leafy street in a quiet South Hill neighborhood.

Crippen, a retired biology teacher, said the county previously allowed his daughter to go on extended vacations with them to visit family in California – as long as she returned within 90 days.

Edie Rice-Sauer, the county’s administrator for mental-health programs, said that extended vacations may indicate that a client does not need the high-level of a care provided by the homes.

“If someone can leave the facility for many days without mental health staff available, they are able to live in a lower level of care,” Rice-Sauer wrote in an e-mail on Thursday.

The Crippens said Cindy has had schizophrenia since she was a teenager. She lived at home until moving to Grande Manor in 2003. Donald Crippen said he and his wife provide constant supervision of their daughter when she goes on family trips.

This week, Kramer said he intervened to reinstate Crippen in the home. Kramer said he did not have knowledge that UBH had discharged other mental health clients under the new policy.

Margaret Cureton, UBH’s residential care manager, did not return phone calls this week seeking comment.

In January, a Spokane man asserted he was not allowed to live in a group home after he was sent to jail for stealing his roommate’s CDs and selling them to a pawn shop. In that case, as well as the Crippen case, UBH did not provide written notification of the decision to discharge the client from the home, according to both families.

“You don’t get anything in writing,” Crippen said. “You are just told after the fact. We would like something in writing so we know where we stand.”

Last week, Donald Crippen sent a letter to county commissioners and the media, stating the policy transformed the group homes into “an institutionalized setting of incarceration.”

The policy also prevents the homes from holding a bed for a patient who must be briefly hospitalized. Previously, homes could hold a bed for 17 days to ensure the patients had stable housing when they were released.

“What’s happened in the past is clients can come and go as they please,” said Penny Rodriguez, owner of Grande Manor. “They have every right that you and I have.”

But questions remain.

Weekend visits with family would probably be allowed, if they are noted as part of the patient’s treatment plan, Kramer said. The decision to discharge the person, he said, could be left to the discretion of the group home, which can fill the empty bed with a new client.

Kramer said he was not certain whether people arrested or involuntarily hospitalized would be automatically discharged.

“Is this an isolated incident? This is the first time we’ve heard of it,” Kramer said. “I don’t think this is the last time we’ll hear of it.”