LINCOLN — Nebraska officials want $8.8 million this year to help keep patients from killing themselves at the state psychiatric hospital in Lincoln.
The Department of Health and Human Services submitted the budget request after a September inspection found numerous “ligature risks” at the Lincoln Regional Center.
Ligature risks are objects or fixtures that patients could use to hang or choke themselves, said Karen Harker, deputy director of finance for the HHS Behavioral Health Division.
Such risks could include things like the casing around a fire extinguisher or the corner of a door frame, an unprotected light fixture or a sturdy doorknob. Some may not be obvious to the untrained observer.
“In an older building, you can imagine,” she said.
Reducing such dangers has become a major focus for the Joint Commission, a major private body that accredits hospitals, and the federal Centers for Medicare and Medicaid Services. In a 2017 statement announcing the new emphasis, the Joint Commission pointed to national concerns about the number of suicides in hospitals.
The Lincoln Regional Center has not been spared from patient suicides. According to HHS records, the hospital has had 17 deaths in the past two decades, of which 12 were by suicide. Some of the 12 were deaths by hanging.
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Harker said many obvious strangulation dangers were addressed long ago. Shower heads, for example, were replaced with fixtures that would break off with more than 40 pounds of weight. That change was made in the mid-1990s, after some patients used shower heads to hang themselves.
The latest risks were identified during a routine survey by the Joint Commission. The commission renewed the regional center’s accreditation but is requiring the hospital to address the problems in order to keep that accreditation. Losing accreditation could jeopardize the state’s ability to get federal Medicare payments for care at the regional center.
HHS officials had to put together a risk reduction plan before the Joint Commission surveyors left.
In the short term, officials increased staff at the regional center to keep a better eye on patients and ensure their safety. Harker said about eight to 10 additional patient care workers have been added to each shift.
The budget request includes $3.6 million for the extra coverage. Harker said the funds will pay for additional overtime hours and additional employees from temporary agencies.
The regional center already has a sizable overtime budget because of ongoing struggles in hiring and keeping staff.
Overtime for the fiscal year that ended June 30 reached $3.2 million, compared to $16.4 million for regular hours. Overtime for the first four months of the current fiscal year topped $1 million, with $5.8 million spent on regular staff hours.
In the longer term, HHS is seeking $5.6 million to make structural changes in the regional center buildings that would reduce strangulation dangers. Harker said the cost could be less, depending on how the bidding process turns out.
Plans are to start on the changes once the funds are approved, with a goal of wrapping up the work by June 30, 2021.
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