The community-impact of consolidating long-term inpatient care at a singlestate hospital

Objective: A community impact model was used to estimate how consolidation of all long-term inpatient care at one state mental hospital affected the t own in which the hospital was located. Methods: Qualitative and quantitativ e methods were used to measure objective and subjective impacts of the hosp ital's expanded role. Objective impacts included employment, retail sales, and use of local services such as police, welfare, and education. Subjectiv e impacts included residents' perceptions of safety. Data were obtained fro m hospital records, service providers, merchants, residents, and persons li ving on the streets or in shelters. Results: Overall, the policy had a posi tive net impact on the community, estimated at roughly $4 million during th e 18 months after implementation. Nearly $1 million was a direct payment fr om the state in lieu of taxes for the property occupied by the hospital, Th e hospital's payments to businesses in the town increased 10 percent. The n umber of hospital employees increased by 61 percent, to 1,336. The number o f local residents working in the hospital grew from 200 to 320, and the pro portion of the hospital's annual payroll paid to local residents increased from 14 to 24 percent. Local service use did not increase, and no change wa s noted in the crime rate. More patients were discharged to other towns tha n were admitted fi-om the host town. Eighty percent of the residents survey ed said the town had either improved or had not changed, Conclusions: The b enefits brought by the consolidation are likely to be sustained in the long run if the state continues the current rate of payments to the community a nd the hospital continues its policy of discharging patients to the town wh ere they resided before hospitalization.