From court orders to staff and bed shortages, the woes of Washington state’s mental-health system are well-documented.
But the dispute in court over whether to admit a man with dementia into the state’s largest psychiatric facility, Western State Hospital, highlights the state’s particular shortcomings in caring for a growing number of dementia patients.
Right now, more than 107,000 Washingtonians have Alzheimer’s disease or other dementias, according to a state report released this year. In 25 years, that number is expected to more than double.
To be sure, not all dementia patients will need the level of care provided by a state hospital or a bed in a special facility.
But as the numbers increase, Washington lags behind other states in preparing to care for dementia patients, according to Kristoffer Rhoads, a clinical neuropsychologist and associate professor at the University of Washington School of Medicine.
“We were the 42nd state to come up with a plan,” said Rhoads, who was involved in drafting the state plan, adding later: “We’re pretty far behind.”
Bob Le Roy, executive director of the Washington chapter of the Alzheimer’s Association, calls it “a public-health epidemic.”
While death rates for stroke, cancer and heart disease have gone down, the death rate for Alzheimer’s is rising, according to the state report.
Dementia is an umbrella term for symptoms like loss of memory, speech and problem-solving capabilities, and the onset of behavioral problems such as delusions, hallucinations and agitation. Le Roy says there are maybe 70 types of dementias.
The issue has reached the point of high drama in a standoff between Pierce County Court Commissioner Craig Adams and new Western State Hospital CEO Cheryl Strange.
In April, a court ordered a dementia patient to go to Western State, which has 800 beds hospital in Lakewood. Because of the facility’s bed and staff shortage, the man hasn’t been admitted and instead has been held in a general hospital.
Pierce County Court Commissioner Craig Adams ordered the hospital’s CEO and another mental-health executive to jail if the patient wasn’t admitted.
A judge last week granted a stay to that order.
Strange won’t override the hospital’s waiting list, saying other patients who are possibly in worse condition have priority over the dementia patient.
Of the approximately 550 civilly committed patients at Western State, 32 are diagnosed with dementia, according to the state Department of Social and Health Services, which oversees the hospital. That’s more than an entire standard-sized patient ward.
Meanwhile, about 70 patients being cared for in other facilities remain on a waitlist to get into Western State.
Carla Reyes, an assistant secretary with DSHS, argues that some dementia patients don’t need to be in Western State.
“If there was a community place for them to go, we probably wouldn’t have put them in the hospital in the first place,” she added later.
Reyes said half the patients waiting to get into Western State are older adults.
The agency couldn’t say, however, if they are diagnosed with dementia.
The Legislature has commissioned 30 geriatric beds around the state to move some dementia patients out of Western State. But that project has lagged, and those beds aren’t yet available.
Menta health officials in the community see dementia patients sometimes coming through their system.
Dementia patients can have additional challenges, such as bipolar disorder, that require psychiatric care, according to Joe Valentine, executive director of the North Sound Mental Health Administration.
“At least some of them don’t actually need that level of care,” said Valentine.
North Sound Mental Health Administration is one of several regional organizations that, among other things, provides short-term psychiatric beds.
These regional providers, along with community hospitals, are where psychiatric patients stay while awaiting a bed at Western State.
Rhoads points to several things Washington must do to improve dementia care.
People working in nursing and adult-family homes, as well as emergency responders, need more training in how to handle behavioral health incidents, he said.
Better preventive care is needed, he said, which could slow down the number of people progressing to late-stage dementia, when behavioral problems can become worse.
The state will also need more facilities for dementia patients, said Le Roy.
In the state’s January report, which included Washington’s first long-term plan to address Alzheimer’s and other dementias, there were a slew of recommendations related to raising awareness and finding less expensive ways to provide dementia care.
The recommendations and the clash over the admission of the dementia patient at Western State come as state lawmakers must figure out how to tackle other long-term challenges, such as continuing to invest in the mental health system and funding court-ordered education costs.
When it comes to preparing for dementia patients of the future, Rhoads said, “The challenges come from who’s going to pay for it.”