Retreat, state offer sustainability plan

An administrative building at the Brattleboro Retreat.

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BRATTLEBORO — The Brattleboro Retreat could be getting $10.2 million from the state in financial relief as it starts tackling items on a "sustainability plan" developed with the Vermont Agency of Human Services.

A proposal from the agency would provide the psychiatric and addictions hospital with weekly contributions of $600,000 for 17 weeks from federal funds aimed at helping states get through the coronavirus pandemic. Approval from the Vermont Legislature is needed.

The sustainability plan calls for restructuring the organization, reconfiguring space, expanding services including telehealth programming, exploring alternative payment models to provide more certainty around Medicaid budgeting from the state, renegotiating or putting an end to Medicaid payments from New Hampshire and Massachusetts, "rightsizing" inpatient social work and caseloads for psychiatrists, and forming a senior strategy team to improve and engage with the union.

Konstantin von Krusenstiern, vice president of development and communications at the Retreat, described the plan as "the result of many weeks of hard work on the part of state officials and Retreat leadership."

"Creation of the plan has further aligned the goals for patient care of the Retreat and AHS, and we are grateful to have had the opportunity to collaborate with them in the process," he said in a statement. "Implementation of parts of the plan have already begun, and we look forward to what lies ahead as we continue to fulfill our mission to meet the psychiatric and addiction treatment needs of some of Vermont's most vulnerable citizens."

The agency and Retreat began looking at "sustainability challenges" in January, according to a narrative about the process. At the agency's request, the Retreat hired independent consultants at Osner/Deutch LLC to evaluate operations and recommend strategies to improve its financial situation. The group submitted its report shortly after the beginning of the coronavirus pandemic in the United States.

In mid-April, the agency and Retreat agreed to a financial package that would provide the hospital $3.5 million in grant funding and a $3.8 million advance on Medicaid payments to help with a decline in revenue associated with the pandemic. Their agreement also involved "an intensive collaborative process" to come up with a sustainability plan for the Retreat and "ensure the continuity of care for Vermonters in need," according to the narrative.

The Retreat is the state's only provider of mental health inpatient services to Vermont's children and adolescents, the narrative states. More than 5,000 people are said to be served annually by the hospital.

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The report from Osner states two of the challenges the mental health facility faces are "organizational provincialism" and a "hostile and obstructing union culture." Some of the suggestions from the consultants included restructuring the organization, retitling positions, resizing senior teams, reorganizing the nursing department and creating a business plan.

The United Nurses & Allied Professionals, which represents two groups at the hospital, said neither the plan nor the report address management issues at the Retreat "in part exhibited by years of extraordinary high turnover due to a toxic work environment created and condoned by the current administration."

"Note that turnover is not only in the front line staff ranks but also includes managers, executives, doctors and others," the union said. "There is an obvious need for the Retreat to change its business model, but unless and until the Retreat addresses its core employee relations problems no amount of additional money or different business model will help secure a future for the Brattleboro Retreat."

The union takes issue with Osner not meeting "with a single employee representative" before issuing its report and the redaction of information under what the union called "the pretense of 'union negotiations.'"

"There have been no negotiations going on nor are any scheduled," the union said. "Because of its entirely one-sided investigation, the Osner report can make no claim to objectivity or neutral analysis and as such should be considered tainted."

Union members recently began picketing on Mondays in protest of the firing of two union officials and management issues.

Reach staff writer Chris Mays at cmays@reformer.com and at @CMaysBR on Twitter.