Continuity of Care A Personal Voyage

by Bob Osenenko Ed.D.
(Neptune,New Jersey US)

Carol Stickney and Opal Bristow published a book (let) entitled "Discharge Planning and Continuity of Care". Carol had gotten sick later in life and needed the continuity of care she so struggled with as a nurse professor in Virginia. As living tribute to them I did a dissertation then encouraged by the US Army Medical Department which is available at Argosy University, Argosy University-Sarasota in Sarasota. Continuity of care research throughout hospitals in New Jersey at the time (1991) was a two part issue; education and the desire for community to care. In that environment it was relatively easy to approach continuity of care issues, especially in pediatrics. Since then discharge planning became more of a "mechanical process" connected to lawsuits that were being waged in its name. But outside of dramatic deaths and their accounts continuity of care had problems gaining traction with lawmakers. It was and is always a personal issue, but in legislature it was never assumed to be a real need for people. To tell the honest truth we have grown as a society technologically but rarely do I see concern for continuity of care as a community issue. But it was always a community care issue for nursing and social work as a professional function only. We've somehow advanced much beyond caring for one another as we once did as a society. But I would wager that just as I pursued continuity of care and later taught it there would be personal opportunity for someone to pursue it again.

Dr.Bob Osenenko
www.medicareservices.us

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Jul 03, 2010
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Hagedorn State Hospital Bill Creating Mental Health Facilities Evaluation Task Force Advances
by: Dr. Bob Osenenko

Below is the repeat of a historical fact that led to the closure of Marlboro State Hospital Marlboro,NJ 07746.New Jersey's Legislature often does the opposite of logic and this is no exception.They use inverse logic.That is, to study the feasibility of closure it is logical to study where the people would go, and the cost to pay for the infrastructure to support them since they could be placed only in geriatric or nursing homes.Instead the State Legislature will investigate the State Hospitals for efficiencies and probably recommend budget cuts that will slowly expel patients from State Hospitals.That's the equivalent of looking up a horse's butt to find a veterinarian.Below is an article published summary. Please read it.
TRENTON – Legislation sponsored by Assembly members Patrick J. Diegnan, Jr., Ruben J. Ramos, Jr., and Valerie Vainieri Huttle that would establish to create an evaluation task force for mental health facilities was released Thursday from the Assembly Budget Committee.

The legislators sponsored the bill in response to a line item in Gov. Christie’s proposed budget that would have closed the Senator Garret W. Hagedorn Gero-Psychiatric Hospital – the only geriatric psychiatric facility in New Jersey – at the end of the 2011 fiscal year. Thanks to a budget compromise reached on the 21st, Hagedorn Psychiatric Hospital is no longer slated for closure.
Read the entire article at.http://njtoday.net/2010/06/25/bill-creating-mental-health-facilities-evaluation-task-force-advances/
By Dr. Bob Osenenko
www.medicareservices.us

Jun 27, 2010
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The Fault In The Theoretical -react to Anthony Lucibello - NEW JERSEY PSYCHIATRIC REHABILITATION ASSOCIATION NJPRA Testimony, Budget Hearings, FY2011
by: Dr. Bob Osenenko

Deinstitutionalization is a test to the health and mental care system on how well it performs its continuity of care.All eyes are on New Jersey to see if it can pass the muster while it considers closing yet another State Hospital.In the 1970'2 when closing state hospitals there was a series of deaths, mismanaged boarding homes; The New York Times wrote about it and first coined the term psychiatric ghetto pointing to the haphazard manner New Jersey is characteristic of.In those years I worked with Dr. James Farnell a researcher with the Monmouth County Board of Social Services whereby the Monmouth Workshop would employ former state hospital patients.How did we get from this ideal in practice to the present theory of dumping patients into boarding homes without extensive follow up? Reference using this trail as a Google search string: Anthony Lucibello - NEW JERSEY PSYCHIATRIC REHABILITATION ASSOCIATION File Format: PDF/Adobe Acrobat - Quick ViewNJPRA Testimony, Budget Hearings, FY2011

Dr. Bob Osenenko
www.medicareservices.us

May 11, 2010
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Assemblyman Lou Greenwald and Continuity of Care
by: Anonymous

Asbury Park Press Monday May 3,2010. Housing options sought for disabled. Trenton."Assemblyman Lou Greenwald has long proposed closing some state developmental centers and refocusing funds to community based housing and related options."
As stated in the article,"THE CORRECTIONAL OFFICER STOCKHOLM SYNDROME: MANAGEMENT IMPLICATIONS The Effects of Psychiatric Deinstitutionalization on Community Policing By KEVIN M. GILMARTIN, Ph.D.Published in Police Chief Magazine - December 1986" Dr. Gilmartin summed it up like this,"Over the past two decades, the streets of America's cities have become home for an increasing number of chronically mentally ill individuals, and the special problems they pose have exacerbated the traditional burdens of' the American law enforcement officer. During this period, the belief that mentally ill individuals should be released from the nation's state hospitals and returned to local communities-labeled "deinstitutionalization"-became the goal of institutional psychiatry.

Deinstitutionalization Costs

The prevailing theory behind deinstitutionalization was that the system of 647 mental health centers created by the 1963 Community Mental Health Act-in combination with breakthroughs in the development of anti-psychotic medications would adequately meet the needs of tile deinstitutiorialized psychiatric subpopulation. The predictions, however, were grossly inaccurate. Tens of thousands of psychiatrically disturbed persons were dumped into communities across the country, filtering downward from voluntary programs of community-based treatment to lives of transience and vagrancy. "
Possibly one of the greatest injustices for the developmentally disabled are the growing numbers being pushed into the estblished New Jersey psychiatric day program and adult homes in New Jersey.But for both populations the original idea in the 1970's for us who worked on the community research was to integrate them into the life of the community. Either thru basic employment and independent housing.That 1960s dream is still unfounded.
Most of the developmentally disabled who are not severe behavioral problems will be discharged thru the normal channels of New Jersey State Developmental Centers. Assemblyman Lou Greenwald is talking about those not able to meet the standard.
Bob Osenenko,Ed.D.
www.medicareservices.us


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