Serving the medical needs of an aging population civilly committed to the Special Commitment Center on McNeil Island means more doctor appointments and costs. The off-island trips for care, for a time, were starting to mean a decline in actual sex-offender treatment.
The sexually violent predators of Washington state are getting older.
And serving the medical needs of that aging population, civilly committed to the Special Commitment Center on McNeil Island, means more doctor appointments and the costs.
“They’re growing old with us,” said Sjan Talbot, CEO of the facility, which recently had 218 residents, 130 of them 50 or older. “The average age of offenders right now is 51.6 years.”
The law allowing civil commitment of sex offenders, enacted in 1990, led to an influx of people committed to state custody. Under the law, offenders found to be “sexually violent predators” are sent to the commitment center after finishing their prison sentences.
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The facility handles general medical care for offenders, but specialty care — such as cardiology and urology appointments or appointments for MRI and CT scans — happens elsewhere.
That means taking residents to appointments off the island, which lies about 10 miles from the landing near Point Defiance Park.
In July, Talbot said, there were 43 off-campus scheduled medical visits.
As the population ages, the number of off-island trips is increasing. Last year, there were 557 planned medical trips; so far this year there have been 271.
In addition, there are emergency trips, in which a speed boat takes patients from the island to meet an ambulance that gets the resident to an emergency room. In 2017, there were 49 emergency trips; there have been 32 so far this year.
“If we keep up at this pace, we’ll top last year,” Talbot said of the emergency trips.
As off-island medical trips increase, so has the average annual cost to the state for housing residents. It was $153,488 for the 2017 fiscal year, and projected to be $185,136 for the 2018 fiscal year.
Talbot says that increase is due, at least in part, to rising medical costs.
The budget for the 2018 fiscal year is nearly $48.8 million. For the 2019 fiscal year, it’s nearly $49.5 million.
Security staff pulled
A budget request in 2016 asked for more nursing staff, and more security to help with the off-island appointments.
At the time, security staff were being pulled from the facility to make the trips, which the request said was affecting rehabilitative and habilitative services on the island.
For example, participation in sex-offender treatment was starting to decline in 2016, “in part due to services not being available due to limited security staffing,” the request said.
And in April and May 2016, residents got 65.5 fewer hours in the yard and recreation center than scheduled, because of the limited security staff.
“This reduced access is becoming the norm for residents and is counter therapeutic to their motivation for treatment,” the request said.
A sort of footnote in the request noted that a shortage of security staff also led to increased pilfering of food from the cafeteria, and a subsequent increase in incidents of homemade alcohol from stolen fruit, sugar and bread.
The facility didn’t get the funding it asked for, but Talbot said it’s fixed the problems, by filling vacancies, hiring a pool of on-call staff members and by designating a team of security staff to make the off-island trips.
“We have a crew of (six) guys now that just take residents on and off island for these appointments,” she said.
That means residents aren’t seeing cuts, such as a locked recreation center or yard, Talbot said.
One of the residents taken to appointments off the island is Richard Scott, 71. He made several trips last year and is expecting to make another trip soon.
One trip was for a CT scan to determine why he was having trouble breathing, Scott said. Another was for a test to figure out why he was coughing and having difficulty eating.
Between waiting for the boat and driving to the appointment, the trips make for long days in chains, Scott said.
“They hate it,” he said. “They really do.”
Rachael Seevers, an attorney with Disability Rights Washington, says she’s investigated some of the island’s medical emergencies, and found it can take about an hour to get someone from the facility to a hospital.
“It’s always a challenge getting people medical care in a remote location,” she said. “The island location makes it hard. They’re isolated there.”
Asked about the medical needs of the island, Seevers said the aging residents might see an increased need for nursing assistants to help with daily care — something approaching the level of nursing-home care.
Talbot said one of the facility’s budget requests this year is for additional nursing staff for the unit that houses the most medically needy residents, “to help support our aging population and end-of-life care.”
Seevers seemed wary about the idea of the island being a place for end-of-life care.
“To the extent that they have people in hospice care, I think it’s useful to remember why this facility exists, and what people are supposed to be there,” she said. “ … That there are people on hospice care, to what extent is that what the facility is designed for or intended to be doing?”
Residents can be reviewed annually by the court to check their progress in sex- offender treatment, and the court can order them released to a less restrictive living arrangement.
Seevers said she’d like to see social-worker positions on the island, to help residents plan for release.
“Having someone whose job is to know those resources and be able to work with people on developing discharge plans that are helpful and realistic,” she said.
A social-worker position is also one of the facility’s budget requests this year, Talbot said, to help aging residents with guardianship and power of attorney matters — to clarify who makes medical decisions for them.
They’ve also asked for funding for a medical database.
The island’s medical records system, still done on paper, is also aging.