Visiting Hours make visiting impossible
guest post by Elizabeth Richter
Recently, I drove for two and a half hours to visit a friend in a psychiatric hospital arriving at 4:00p.m.. I had heard from a staff member the night before that visiting hours were from 6:15am to 7:15pm, but I must have heard her incorrectly, because as it turned out visiting hours were from 6:15 pm to 7:15pm--only for a single hour.
Desperately trying to salvage the situation, because I couldn't wait, I explained how far I had driven and I asked whether staff could give me a break. "No." was the answer. I shifted my ground. "Would it be possible to ask the nurse in charge and see if, as hospital policy stated was possible, she would authorize a visit outside of the standard visiting hours. "No." was the answer. I
shifted again. "Granted my lengthy trip there and anticipated lengthy trip back, would it be possible to say "hi" to my friend at the door of the ward and just give her the presents I'd brought along. "No." was the answer.
My insistence alone was so unpleasant to the receptionist that by now she had called in two additional staff members down from the ward to deal with recalcitrant me, and their faces were frozen into expressions of stony disapproval.
At a time when we are so aware of the central importance of family and friends in assisting the recovery process for people labeled with psychiatric diagnoses, what can account for this rigid response to my request?
Also, what could account for visiting hours limited to a single hour per day, in contrast to medical hospitals that have visiting hours of at least 12 hours per day and often 24 hours per day given the medical condition?
In 1978 when I was also an inpatient on a psych ward visiting hours were from 10:00am to 10:00pm. This was considered an enlightened policy and was in place as a part of a substantial reform movement on the part of the hospital. It would never occur to me that psychiatric hospitals would regressively return to restrictive policies that a prior generation of mental health professionals had deemed poorly conceived.
After my failed adventure visiting my friend at the psychiatric hospital where she was staying, I conducted a survey of hospital visiting hours at approximately 26 psychiatric hospitals in the state of CT. Three other people assisted me in this endeavor.
We determined that out of the 26 psychiatric facilities and hospital psychiatric wards that we called, during the weekday 3 had only 1 hour a day available, 12 had only 2 hours, 9 had only 3, 1 had 4, and 2 had more than 4.
During the weekends, hours were more generous, often expanding up to 4 hours per day and sometimes extending up to 7. Alice Russ Cochran Psychiatric Clinic in Derby was particularly generous in providing expanded visiting hours for family and friends, whereas Natchaug Hospital in Mansfield Center offered substantially limited visiting hours.
It is worth noting that if we tried to get visiting hour policies, in addition to information on visiting hours, staff were often reluctant to answer questions. One of my callers found the problem so difficult, he gave up the job. Often, the price of getting any information turned out to be the extent of my willingness to respond to intrusive questions about who I was, why I was asking, who I was intending to visit, for what purpose, and when. Yet when I asked one receptionist what her name was, she told me it was hospital policy not to give that information out.
Across the board, several hospitals had brochures detailing their psychiatric ward visiting policies. However, some just outright refused to send those brochures to me, while others said they would, but only one did. Some told me that they limited information regarding the conduct of hospital visits to an orientation with the patient upon his or her arrival.
But what is most important here is what I discovered-that hospital visiting hour policies appear to be constructed in order to restrict the access of friends and families to psychiatric patients. This is unfortunate recognizing how essential the support of family and friends is to recovery for those labeled with mental illness. According to one New York study, upon returning to the community those diagnosed with schizophrenia have relapse rates of 5% when supported by family whereas those who don't have family support relapse at rates of more like 40-45%. In addition, a Washington Post July 27, 2005 article by Shankar Vedantam again centrally stressed the results of a three decade long study by the World Health Organization that emphasized the vital importance of family and friends in supporting the recovery process. Shouldn't visiting hour policies reflect such insights?
I spoke to three psychiatrists regarding this issue, including Dr. Harold Schwartz of the Institute of Living, and all concurred in saying that the rationale for limited visiting hours was that patients nowadays only stay
in hospitals for very brief periods--8-10 days--and during that time they are nvolved in structured therapeutic programs that take up all of their time. As Harold Schwartz put it, "the single most compelling issue here is that the inpatient psychiatric unit has a structured therapeutic program all during the day and patients need to focus in on their participation in such groups."
Yet these kinds of statements were not backed up by patients. I spoke to one person who said that there were perhaps two or three hours of therapy groups, but after that she spent much of her time resting. Another former patient in response to the question of what she did all day in the hospital said,
"I complained, bitched and moaned and walked around in circles. At one point I got involved in an argument over which television channel to watch and another patient hit me over the head." Another sixteen year old who was in a juvenile facility for two weeks said, "I did nothing all day."
Some would speculate that restricted visiting hours is a vestige of attitudes that blame families for the onset and continual progression of mental illness. As one staff person who did not wish to be named explained, "Families and friends are still viewed with suspicion, though no one will ever say that officially."
In hospital wards treating dual diagnoses, which were the most restrictive, such policies are based upon the assumption that family is most likely centrally involved with the condition, and that friends are most likely drinking or drug buddies. To me, this points out where treating dual diagnosis in the
same hospital wards with those who are psychiatrially labeled leads to substandard conditions for the latter, and is a strong argument for discontinuing such practices.
Dr. Jim Murray, Director of Behavioral Health at St. Francis Hospital stressed additional points, i.e. the importance of keeping a person safe who is undergoing an acute crisis, the difficulty for staff of managing their resources in the face of extended visiting hours, the problems associated with confidentiality. And, of course, there are situations where family and friends can exacerbate a person's symptoms.
However, using these concerns to restrict visiting hours to a mere one or two hours a day seems like an extreme response conveying the impression that mental health professionals are defensive and suspicious of family and friends whom they see as outsiders.
The greater good of incorporating family and community support into the lives of people in crisis is a persuasive argument for extending visiting hours and adding more flexibility into the picture.
wildlife census project
August Goose Surveys
will be conducted in Connecticut by the Department of Environmental Conservation | They are looking for volunteers to report sightings of geese | There will be 2 [two] separate sampling periods to assess population size of our resident geese. The 2 survey periods are August 10-12, and August 24-26. As in past years, DEP is looking for all observations of geese (collared and non-collared) during this period, anywhere in the state of Connecticut. Even if it is a "group" of only 1 [one]!
The information that needed is:
Location of flock
# of collared birds (with codes if possible)
# of uncollared birds
This information is vital towards an accurate population estimate, and in the past 3 years, over 6000 geese have been observed during the sample periods, and have some very good population estimates with tight confidence intervals. Contact:
Min T. Huang
Migratory Gamebird Program Leader
391 RT 32
N. Franklin CT 06254
860-642-7239, ext 118 (p)
health insurance fraud?? part 2
After a number of days and several phone calls
it seems that the Anthem Blue Shield rep was not completely accurate on some things but correct on others. The good news part of "...not completely accurate...
" is that Bruce's hospital bills shall be covered under Blue Shield. So it turns out that for the moment at least, it may have been resolved.
Here's what happened.
The Blue Shield rep called me back and over ther remaining days of the week she and I walked through other messy bureacuracies.
First she said the hospital submitted the bill to provider/vendors in the wrong sequence. Hospital stays, for Medicare Part A eligibles, must be sent to Medicare first. Medicare then sorts out the actual hospital charges [room stay, ER visits, direct care staff hours, those five dollar aspirins, etc] THEN leaves the remaining costs to be borne by the secondary vendor; in this case, Anthem Blue Shield.
The "secondary costs" include physician consults [our local hospital ~ for example ~ noted to me that none of the docs are employees. They are, instead, independent contractors "privileged" to serve their clients at the hospital], diagnostic tests, X-rays, CT Scans, MRIs etceteras, and the secondary provider picks up these costs AFTER direct hospital costs are shaken out.
So where did the denial by virtue of us being domestic partners [whatever] come from? Well, that got complicated. When she first called Medicare and alerted them of our same-sex spousal "condition" [emphasis was hers]she got a lecture from the Medicare rep who told her that since they are a Federal program, and since the Feds define "spousal" as only male/female, that Medicare has subsequently interpreted their regs to apply the same way. She mentioned that he also stressed that "this means for pensions, too". She told me that Medicare was just trying to make sure I knew that if one of us dies, then the other doesn't get the Social Security pension of the other. Doh! I guess the stranger at Medicare thinks I never read the papers.
When she'd gotten that info, she called me back. Fresh from the phone conference with him [she did say the Medicare consultant was male] she came right back to me to tell me, with a tone of authority, [tho' first skirting specifics] that since Medicare wouldn't pay the bill, then neither was Anthem Blue Shield obliged to.
That was when I asked her if this was just because we were "a couple of queers" and questioned her about Anthem possibly engaging in contractual fraud with the State of Connecticut.
That gave her enough to think about so that by Friday, and four conversations later, she announced the problem solved and that we no longer had to worry about non-payment of medical expenses.
She also provided a backhanded verbal flow chart describing how the hospital has to bill for services. In our case, BC/BS was sent the whole bill first. Some lower functionary at Anthem spotted that Medicare didn't get the bill first. This supposedly triggered the process whereby both service providers [...wait, they are VENDORS ...purveyors of money nothing more...] denied the claim. I'm still uncertain whether or not I follow this, but she says the bill's getting paid, the bill's getting paid. She cautioned, however, that I needed to do a direct conversation with the hospital's billing department about the SEQUENCE of billing out. I thanked her.
The explanation got revised to clarify that Medicare Part A covers the actual hospital visit. Any other medical expenses [physician consults, diagnostic exams, other] that would have been covered under Medicare Part B [Bruce doesn't have this coverage right now] gets picked up by Anthem Blue Shield, as it ought to.
Somehow, since I had constant and incessant problems with Blue Shield Dental [they kept saying there was no way to "code in" domestic partnership arrangements in their computer system. Could the fact that their tech support people are based in Utah have anything else to do with this?] I remain uncertain. Until I actually see the bill as paid I'll remain wary and shall stay at it until there's a zero balance on the hospital's ledger sheet.
This then still remains a battle with the Feds, with the Shrub, Karl Rove, and Dubya's Shadow Cabinet [Ann Coulter, Donald Wildmon the whole caboodle of hateful bigots] that run and/or influence the doling out of equity these days which needs to be addressed.
We may have to wait of the day when election rights are once again restored before THAT gets corrected.