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It remains to be seen whether Medicaid or Medicare or private health insurance will pay for peer-run respite care instead of a hospital. My guess is that thhose traditional forms of payment would resist at first. Should respite care not be covered by insurance the burden of payment is on the consumer. $250 per day is a steep out-of-pocket expense for most of us. Perhaps the individual respite care centers would work out a payment plan based on a sliding fee scale.
Christina
Good food for thought. Since I have been hospitalized many times at many different facilities, I can say that the ones that helped the most were where there was an excellent staff of caring persons. Feeling their humanity, their concern, and yes, their love, was vital to my return to the road to recovery.
I would have second thoughts, though, about going to a peer-staffed respite center. But I guess that is because I was never just mildly relapsed -- it was often an all or nothing proposition. I was usually suicidal and tried to commit suicide various ways even while hospitalized.
Now, though, I can see that there are days when I am totally stressed out so that I am to the point of being mentally and physically ill. I just need to talk to someone who understands, someone who has "been there." But I would have to have help from my insurance company to pay for it. And I can't see them getting involved without a lot of red tape, certification, site inspections, etc. A hospital I went to several times offered a kind of half-way house for their mental patients to ease back into the community after a course of hospitalization. But it was only for people who really had no other place to go. And they offered group therapy for everyone once a week, for 1 year after hospitalization. I found that helpful.
I know one thing we need more of is meeting places that can be peer-run and peer-established. I would like to get with others who have schizophrenia just to talk. I don't think there is anything like that in my area. But I could be the one to start it, right?
Carolyn
I say Dr. Fisher has the greatest compassionate, yet knows where to draw the line. His vision of a 720-bed respite sounds wonderfully affordable; & with a great percent of comparision; it would be idealistic to places like the few that are EBP's///Just like Peer-supported Specialists; (now state certificationed like in WI) certifying exams that are finding that when working with a small staff of "professionals" (wrapped in sheepskin) A peer-supported, consumer-run agency would cut costs SO WELL versus inpatient hospital by staff clinical staff. I was born into a dysfunction family. I started into a ward of the State at age 15 in an AODA ctr. With ALL the money the State doled out for my "correctional ass" I could have my own, not-for-profit 800 bed respite in the Caribbean Islands. When I heard the truth that spun my beancounters into young graves; that 1 day in a State-owned hospital like the one I was in, could send enough money to save Haiti; Hurricane Katrina & 9/11 in NY within lightening tenacity. And, I became extremely upset that it spent billions of dollars of THEM (not person-centered-planning) to drug me out & ECT my ass out of 5 years of life's memories & that was their excuse "It was last resort". If I had a CPS way back in my 20's, not hospital-dependent & could have enjoyed all those good times that ppl are suppose to enjoy BEFORE turning 50 yrs. old. I started as a peer support in the youth state facilities, just when I thought my my life was actually happy & gave hope to some of my institutionaled peers, until THEY called me a danger to myself & "saved my life" AWAY from me. Now I am 48 yrs. old. I haven't felt so alive as when I do advocacy work w/ others who are trying to get out of the Nazi-centered psych wards. Ask the United States Budget whether IF they forked out the small amount that could empower thousand lives--we'll let them keep spendiing multi-billion of dollars to run their machines of WAR....wonder what they'd say...don't you? WHY spend SO MUCH MONEY to keep our species that only kind that kill each other, with masses of national dollars? It saddens my heart so much when I live during these times. It should be "Our Voice, Our Choice"; empowerment w/i societal parameters........not go to disruptive haters of nothing but bean-counting "victories."
LAW's Theory 2010
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OK: when the word "crisis" is used to describe a peer-run center, I do not think of a vacation. The last time I was hospitalized-in the summer of 1992-I had gone off my meds and relapsed. I needed medication as well as hand-holding and staff qualified to measure whether I'd gotten better.
Left to my own devices, I would have refused the meds-and did so for the first two days I was back on the ward. If I'm in crisis, I don't want just anyone treating me: ideally that peer would have the CPRP designation [certified psychiatric rehabilitation professional]. T
The second time I was on the ward, as soon as I began taking the meds, I quickly became embarrassed I landed in the hospital again. So I marched up to the nurses station one night to talk to the woman about this. She wouldn't listen and told me, "Talk to your therapist about it in the morning."
Though that certainly wasn't unethical behavior, her comment showed a lack of compassion and her unwillingness to give comfort. I was on the ward for a total of two weeks that summer and most likely discharged right away because I had no health insurance. Plus I had to return to my job which my boss lobbied to keep open for me although management wanted to boot me out.
I will refer back to Ms. Dolan's vacation analogy. I could see the benefit of respite care if the word crisis was not used as a modifier in the same sentence. All of us, whether diagnosed with a mental illness or not, experience times of stress to a greater degree than is routine. So if a peer couldn't afford a vacation to Bermuda and needed a place to chill out for awhile, respite care makes sense.
In my own life, I have the option of traveling to Virginia to visit a friend who wants to show me Old Town and various historic sites. The cost: free lodging in his spare bedroom and money for the train, restaurants and souvenirs.
Lastly, respite care might be an alternative if a psychiatrist in the community had instituted a cross-titer from one drug to another for a patient. As long as you have been stable on the outside, there is often no reason to be admitted to a hospital to execute a medication change. So respite care woulc smooth out the bumps while a patient adjusts to the new medication.
As for me, I'm getting on that train to Virginia in April.