Pay In Advance To Retreat
While we're on the topic of the Worried Well, you might be interested in seeing what kind of inpatient care the worried well can get by paying $1700 per day out of pocket (that would be $34,000 up front for the first 20 days of inpatient diagnostic assessment):
Private rooms include a bath, television with cable access, bedside telephones and internet connection. (Do they have a turn-down service with chocolates on the pillows?) It is for the longterm (months) treatment of mood disorders, anxiety disorders and "disabling adjustment disorders". (Translation: if you're paying enough we won't stigmatize you by diagnosing you with a personality disorder.) In addition to standard treatment modalities they also use "Eastern movement and meditative practices" (I wonder how you give informed consent for treatment for an unproven therapy?).
Now, as long as it's not being paid for by my tax money or supported by my insurance premiums then I suppose I can't legitimately beef about this. But it's still mind-boggling.
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[Edit: see also No Retreat, Still Stewing, and My Planned Nervous Breakdown for more on this. Also, listen to our podcast.]
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16 comments:
I don't quite know what to say. All I know is that I can stay at home, and save myself $1700 (no turndown service, but you know...).
Wait, I get it completely (that doesn't mean I'm checking in). You're psychiatrically ill and you want to optimize your chances of getting better fastest with an inpatient stay (does that work? no clue, but daily therapy, faster med management then you'd get with outpatient sessions, weekly or less), life is feeling awful or at a standstill, and you're deperate, at the same time, you don't want to be in a big inpatient unit with cigarette smoke and all those (see Clink's former post) sexual offenders and unbathed. schizophrenics (please forgive me) or the fear of being put in a seclusion room, you're looking for treatment and hope, this place offers it without the constraints of "your insurance says we have to do x.." and you, like many many folks out there are forking over $50,000/yr to send your kid to college, what's another $40 grand for your sanity? In other words, you need treatment, but you're fearful of losing control, and you want what you perceive to be the finest of care.
I've never met anyone who's been treated on one of these units, so I don't know what to say about efficacy. I can talk myself into a way this might make sense.
I do know some of the folks who work on this particular unit (The Retreat at Sheppard Pratt), my sense is that they are well-trained, main stream psychiatrists, that this is a good level of care, Eastern healing gook aside, so don't dis them just cause you think "That's not how I'd spend my money?" And also, I'm not happy with the entire concept that you'd imply that because someone is willing to pay for creature comforts during an episode of mental illness, it means they are part of The Worried Well (you said it, not I). Do you really think mentally healthy folks are checking in here? Spas are cheaper, and when I'm at the end of my rope...well, let's just say I can generate a list of luxury hotels that run much cheaper AND have room service and that turndown service you're so fond of.
Are you the person who was going to call your insurance company to find a doctor? Let's be real, the top docs don't have to hassle with insurance, and so they don't. My internist isn't in my insurance network, and for the record, if you go nuts (technical terminology here) and want to sign yourself into the top show in town-- I think that's how Johns Hopkins views their psychiatry department-- you'll get a double room to share with a mentally ill stranger, a shared bathroom, treatment by a second year resident, and while the hospital will take your Blue Cross, the physican services don't, so you'll be asked to show up with a check for a few grand at the door.
Face it, Clink, treatment is free in jail, if you don't mind that you're doc time is split by 3000 patients/year and no chocolate turn downs.
you pushed a few buttons...
Glad your feeling better.
Dinah, I think that if someone is organized enough to use and enjoy Internet service and safe enough to have telephone (with cords) et al in their room, they're probably not that seriously mentally ill. The web page itself specifically spells out the diagnoses/people/behavior they're not willing to take. That rules out a heck of a lot of folks even if they had the money. Like I said at the end of my post, if they're paying for it themselves I'm not going to begrudge them what they want. I'm just not sure it's a good idea. Look at what happened with the VA system---we had all these months-long inpatient programs for PTSD, only to discover that when the outcome studies were done people came out worse than when they went in. I just don't think months and months of inpatient care is a good idea. It sounds like another variation of the MPD service. On the good side, the revenue brought in by these folks is probably underwriting the care provided to four or five others who don't get private suites.
Well this is a new and interesting standard for inpatient care: You made a phone call without hanging yourself, or you're organized enough to Google, Go Home! I can see insurers latching on to that and I thought it was bad when then asked an ER psychiatrist (I believe it was Camel) if the patient's gun had bullets in it (?We only let you admit if the patient is pointing a LOADED gun to their head and only if it's positioned in such a way to cause fatal injuries).
Many psychiatric patients are allowed to leave inpatient units, it's never been a standard that if you can get a soda from the cafeteria, you're good to go. Most allow trial trips home for a few hours before discharge. Your standard for needing inpatient care is no one else's standard.
I believe there was a suicide at The Retreat and for whatever reasons, they reserve the right to transfer patients to their regular hospital beds on sight. It's sort of like saying you can only be in the the Hotel Unit if you meet criteria for an unlocked ward (Do they still have those?). Most of the hospitals I've ever worked at have had suicides on the units while I was there, including a patient on a locked ward who hanged himself from the ceiling in the hallway, one who jumped out the window, one who shot himself with a gun brought back while on a pass. Should I go on?
I believe this is a cushy hospital unit trying to play down the hospital aspect of it---face it on a regular inpatient unit, you see a doc for a few minutes a day, go to OT and PT, maybe have a group session, get meds (monitored by that doc you saw for a few minutes a day), gets some check ins with nurses, and the many remaining hours are spent watching TV, smoking, unorganized. If these folks want to pay for a full daily session with a psychoanalyst, a Harvard-trained expert on psychopharmacology to make their med decisions, and a little yoga, I don't think it's any less therapeutic.
You twice called these patients the Worried Well. I don't believe that the Worried Well are spending $1700/day on care (the well are out shopping or washing their yachts). These are, simply, the Rich Mentally Ill.
Begrudge them their wealth if you want. I've yet to see wealth protect anyone from suffering.
I'd be happy to ask the unit director to comment if you'd like...
Oy. I think probably I'll just leave things as they stand. I'm sorry if I pushed your buttons. Should we talk about jail release planning instead? :)
Whoa! I'm on Dinah's side here. Use of a phone and internet does not indicate you are too well to be in the hospital.
I think you have been successfully brainwashed by managed care into thinking that only imminently dangerous people require hospitalization. Add to that the inability to function at home, work, OR school; non-response to lower levels of treatment, such as outpatient, IOP, or PHP; and need to closely monitor and manage one's response to treatment.
Now, Mangled Care has been good at continuously raising the bar that defines the cut-off for whether your collection of symptoms are hospital-worthy or not. That is because insurance companies have to pay off its shareholders, and spending it on frivolous things like treatment don't fit in with that agenda.
That being said, without insurers or others to watch over these decisions, providers have historically lowered the bar so far down that anyone with a positive wallet biopsy met criteria. So, there needs to be a balance.
I have treated patients who have been at the Retreat, at Hopkins, at Father Martin's Ashley, Sierra Tucson, and other high-end treatment facilities. I have yet to see any of these as being what some would call "worried well" (though this depends on one's perspective -- if I had a chronic mental illness and was in jail, these well-off "patients" would appear to be worried well to me).
Some of the frills seem a bit hokey to me (like the holistic crap and the Sushi chef). [No flames... holistic crap can be very helpful... I'm just being ornery.] But, if I was spending these big bucks, then I would expect great food, great service, internet access, and maybe even a massage from a hot chick (ok, maybe that's going too far).
But there should be two bills. One, for the medical treatment (doctors, group therapy, tests, meds, maybe the therapeutic massage). The other bill would be for the frills (food, lodging, highballs). Even if you are paying cool cash for it all, it shouldn't all be tax-deductible (IMO).
It's good we have each other to talk to here.
Is psychiatric inpatient care tax deductible?
I asked Hubby, the business type, and he says: if your total medical expenses are more than a certain percentage of your income (maybe 7%?) you can tax deduct it, he doesn't know if there's a cap. I would guess that many of the bills are paid by a concerned relative and therefore wouldn't be tax deductible.
I will agree, I don't think one should tax deduct sushi expenses. I don't even think one should tax deduct a therapeutic massage for psychiatric treatment (no known efficacy), I might feel differently about therapeutic massage for muscle strain.
I'm still left to say that I don't think anyone is checking into expensive treatment facilities for R&R and that being rich doesn't protect you from mental illness.
If both of you say there are people with serious mental illnesses at the Retreat then I will take your word for it. Obviously, my patients don't go there and so far I don't think I've ever had any Retreat patients in jail. I'm going by what I read on the web site and I had a hard time reconciling a weeks-to-months long hospitalization with their listed eligible diagnoses of "anxiety disorders and adjustment disorders". The patients I know who need hospitalizations that long are psychotic folks who are resistent to most meds. Just on the face of it adjustment problems and anxiety are not something that usually warrants extended hospitalization. Again, I'll take both of your words on who actually goes there.
Are we podcasting today?
Reading this last night made me very very sad. I want to go here;
http://www.lawlispeavey.com/
but can't afford it.
There are always going to be rich people that can afford to get whatever they want or think they need. There will always be those that do without. At least I do have some resources and I am grateful for those.
I have a bone to pick with this statement; '"Eastern movement and meditative practices" (I wonder how you give informed consent for treatment for an unproven therapy?).'
Now, I was under the impression that the "mindfulness" aspect of DBT (Dialectical Behavioral Therapy for Borderline Personality Disorder), inspired by Eastern practices (Buddhism, I believe), has been proven effective in studies, so is it so much of a stretch to think it could help with other issues too?
I never got informed consent for Haldol in hospital and it gave me dystonia. I had no idea what was happening.
Psychiatry doesn't help everyone and it seems presumptive to insist that anything outside that box is mumbo jumbo. I think I'm fairly intelligent and I have considered trying accupressure, ritual cleansing and other alternatives. I admit, OK, they freak me out a little and I have yet to try any.
There is something reassuring about white coats and diplomas on the wall...but is that just conditioning?
Anyway...what kinds of psychiatrists work in those places, anyway? Do they feel they are doing a service? Are they?
Maybe being 'mentally ill' will be the next 'cool' thing, like going to rehad seems to be today.
There is still a demographic for those seeking treatment from a private doc, right? White, female, educated, with $$$$$$.
I wonder. How many African-American homeless men are in psychoanalysis? Hmmmmmmmmmm
Revision:
DBT as a whole has been proven an effective treatment for borderline, but I am not aware that the part of it relating to "Eastern philosophies" has been singled out for effectiveness.
see http://www.dbtselfhelp.com
Wow. Is this the sort of place celebrities go when they are "hospitalized for exhaustion"?
Hmmm... It saddens me that there are such stereotypes against people who are rich sometimes. Just because a person is rich doesn't make them happy - and we still live in a capitalist environment, so I don't see that being rich is some sort of moral crime, although the masses would have you think that. Am I rich? No - I don't have enough money to pay next month's rent until I get paid on Thursday. But my aunt is - and my aunt recently was hospitalized for a suicide attempt on New Year's.
She left the hospital as quickly as possible because it was not an appropriate environment for her. My aunt is someone who, while she is currently taking cymbalta, does not have depression or any major mental illness. However, she has been going through a very very rough several months now, and well....can't say she made the wisest choice in dealing with it, but she's doing better now.
The hospital was completely pointless. On the first day there, she saw a doctor for like <5 minutes...and the rest of the day was full of nothing. The day after that she asked to leave, and they told her she couldn't leave for another 24 hours. In the meantime, was any helpful therapy or med changes going on? No. It was like she was just being baby-sat, IMHO. Then on the last day, before she was allowed to leave, the nurses were taking the "patients" outside for a walk, and my aunt asked to go with them and they told her she didn't have any priveleges. Heh.... That about sent her over the edge.
When she left, nobody in my family knew what she was required to do for follow up. I asked several people, including my brother who took her out to dinner the night she got out. Nobody could tell me if she was supposed to see or call her therapist every day for a week - or if there was any follow up plan at all. I would assume that if someone is hospitalized for a suicide attempt, that upon release they would stipulate some sort of follow up care plan. The whole thing seemed positively ridiculous to me.
So what's wrong with her going to a place like The Retreat? She probably would have gotten a lot better care. She would have been in, most likely, a much more appropriate environment, frankly. One of the things about those who are hospitalized without some serious mental illness like psychosis or schizophrenia is that in reality, you just don't fit in all that well. So in some ways, it can be pretty good to have a place where they treat some of the serious yet less severe mental illnesses like anxiety, adjustment disorders, and depression. Maybe she would have stayed a week or two and really gotten the help she needed if she went somewhere like that. Instead of today, as my parents were up there helping her move some of her stuff from her old house to her new apartment, me sitting here worrying about whether or not this event is going to make her so upset as to try something again.
I've looked at the websites of places like this before, and frankly, if I was rich, I'd try them. I would want to see that a qualified professional was on staff, but frankly it just seems like a more appropriate place for some.
One of the biggest things I've always said to my psychiatrist is that part of the reason I never wanted to admit to suicidal thoughts was because if that resulted in hospitalization, then I guarantee that would be a worse outcome. Going into the hospital at any point for a psych stay would have made things so much worse that it wouldn't have even been funny. And then if you're put in an environment that isn't appropriate, where a doc sees you for a quick visit (not saying this happens everywhere) and then you're left to the rest of the day to spend group time with people you cannot relate to whatsoever, well....how is that going to help you get better?
I guess I just see these places as, while maybe a little over the top, a good alternative for those who can afford them. I have looked at those websites when I have been in the depths of my own crises and despair, and sometimes I just look at things online just to try to make myself feel like options are out there. Crazy really - I will never afford anything like this.
So in the meantime, with respect to insurance. Magellan doesn't really pay for much, as those of you in the know are aware. I have blue cross personal choice, which pays for the moon and stars when it comes to medical, but it is coupled with magellan, which pays for peanuts when it comes to mental health care. No providers take it. Everywhere I've checked into has not taken it. With my insurance, I have a $2000 out-of-pocket deductible before I get reimbursed for a percentage. I am just very fortunate that when in nursing school, I went to the resident's clinic and saw my psychiatrist on a sliding scale of $25/appt....no insurance attached. I had paid about $125 an appt for a previous psychiatrist - and that was his discounted rate. So there isn't a day I don't count my blessings about my reduced rate. My doctor allowed me to keep coming once I became a nurse...same rate. And now that I see him at Penn and he's a fellow, he has still arranged for me to see him at the same rate. This is extremely necessary for me since I'm thousands of dollars in debt (and not just educational debt....my credit card debt is ridiculous......) and with every appt also comes parking/transportation costs.
And yes - tax deductible.....you can itemize your medical costs if they go over a certain amount. I sort of wonder if that includes parking costs for when you go to your appts, but I'm not sure. I wasn't so good about saving receipts from the pharmacy and from physical therapy, but I do have every single receipt from doctor's appts. I should start getting them out and giving them to my father. I must say that my salary is really good - better than I would have ever expected to make, but I am unable to make any kind of savings or barely keep my head above water because of medical costs. So I'm certain I should be able to itemize this year.
Sorry to ramble on!! Lots of thoughts, as usual!! I could write stuff on my blog, but lately I just don't feel like it.
Take care!
Carrie :)
Carrie,
I don't know your aunt, but in psychiatrist's terms, anyone taking an antidepressant who has a suicide attempt and is psychiatrically hospitalized, has a major mental illness. The term doesn't just apply to Schizophrenia and Bipolar Disorder, or illnesses with psychosis. Anything might kill you cuts the call for me.
Dinah - I'm going to send you a private email...
Carrie
Carrie, My best to your aunt and I hope she gets good care. I imagine The Retreat would be happy to have her if she comes with the cash. I hope you feel better soon, sounds like you've all been through a lot.
Dinah - Thanks for the response here. Yes - it's been trying times lately. We have other things going on, too, but it's just too much to get into it all right now. And now I'm stressed out about my dumb blog and who is reading it. I just want to have one place where I don't have to worry about everyone and everything! LOL...
Ah well - I think my aunt is doing okay. I haven't asked my mom or dad for an update in the past few days. Have been having a harder time myself with a few things, so I just didn't have the energy to ask for info on anybody else at the moment!
Take care,
Carrie :)
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