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Thursday, May 5, 2016

Ross Rambles: Cost ineffectiveness

Monday, November 21, 2005

Government doesn't always operate in the most cost effective manner and the reasons are not always the most logic effective.

Some insight into this was provided last month during a citizens advisory meeting at the Cherokee Mental Health Institute.

There was discussion on why the institution is not being used to its potential by the state. A program that seems not to be getting anywhere is a geriatric unit at the CMHI for inmates in the Iowa penal system.

It would be a natural fit with all of the support services and the facilities available at the CMHI.

The minimum security units in the state are primarily designed for work release type programs so an older or disabled inmate tends to be in medium or even maximum security facility.

A geriatric unit at CMHI would operate at a fraction of the cost per inmate as is spent at a medium or minimum security facility.

There is resistance to getting rid of the older inmates from higher security facilities because the beds would immediately get filled by young, potentially violent offenders. This is perhaps not the only reason preventing the proposed geriatric unit and it certainly will never be officially recognized as a reason at all, but such behind the scenes attitudes prevent needed changes from happening.

The CMHI staff provided a program for county sheriff's departments providing transportation for inmates at about a third of the cost that the counties could do it themselves. It worked well for awhile, providing a service for 26 counties.

However usage dropped below the critical number at which the CMHI could make the service available 24 hours a day, seven days a week. When it couldn't be made available consistently, all the time, usage slipped further until it was no longer viable at all.

At least one of the reasons that usage went down was that deputies in a few counties (not this one) didn't like the program denying them the opportunity to make overtime.

A program that never started at CMHI was a social detox program for those addicted to alcohol or drugs. It involves monitoring by a nurse and is far less costly than medical detox which is emergency room care of a person facing potentially fatal complications.

The catch with providing social detox is that a hospital where medical detox can be provided must be less than a mile away. You can't blame the Cherokee Regional Medical Center for not wanting to commit to providing this service to people from a multi-county area, mostly indigent people.

It just seems symptomatic of what is wrong with our whole system of public service that we give $3,000 a day care to a person who requires $100 a day care because of some technicality.