Western State Hospital dementia units decertified

Regan Bailey
Director of Legal Advocacy

DRW successfully advocated for individualized admission and discharge of dementia patients at Western State Hospital, and a prior policy that resulted in discrimination against dementia patients has been abandoned.

The policy was initiated after two hospital units, home to elderly patients who receive inpatient care at Western's Center for Older Adult Services (COAS), were recently decertified by the Center for Medicare and Medicaid Services (CMS).  Decertification means that the hospital can no longer bill CMS, the Federal arm that runs the entire Medicaid program, for the costs of operating these two units. 

Most patients in these units have some form of advanced dementia, including Alzheimer’s disease.  They experience significant behavioral challenges as a result of their disability and have been involuntarily committed to WSH.  Many formerly lived in nursing facilities, but were sent to the hospital when they began to exhibit loud outbursts, disinhibited behavior, wandering or other common dementia related behaviors. 

In the weeks following decertification, WSH developed a plan to address the issues cited by CMS.  CMS determined patients with dementia did not have the “cognitive reserves” to benefit from active psychiatric treatment and declined to pay for their inpatient care.  WSH planned to stop dementia patients from entering the hospital by denying them admission, while quickly discharging current dementia patients. 

DRW initiated an investigation and worked closely with senior advocacy groups, including the Alzheimer’s Association and the National Senior Citizen’s Law Center.  The investigation unveiled serious concerns with the blanket approach being taken by the hospital.  Specifically, some of the patients on these units had dual diagnosis and had benefited from their inpatient care.  The WSH approach would eliminate inpatient care as an option.  Also, a blanket policy of excluding people with dementia would remove the safety net that prevented those with advanced dementia, who could not find a nursing facility willing to take them, from being homeless.  DRW was also concerned that a rush to discharge could result in poor outcomes for some dementia patients; particularly those whose treatment teams did not feel were ready for discharge.

DRW has been successful in advocating for the admission and discharge of patients with dementia to be individualized.  The prior policy that resulted in discrimination against dementia patients has been abandoned. WSH is working with DRW to address the serious discharge issues that stem from a lack of community options and is committed to maintaining the two units at their prior staffing levels.

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