Memorial Epworth accepts patients regardless of their ability to pay, McCahill said, adding, "We take all comers."
But, once it gets patients as stable as an acute care hospital like Memorial Epworth can get them, it has trouble finding new, permanent homes for them.
Memorial Epworth has provided more than $1 million in care so far -- none of it reimbursed -- just for patients who are waiting for beds at state mental health facilities, McCahill said. Memorial has to eat that cost because the patients didn't have Medicaid or other
This doesn't include others who, for example, are waiting for beds at private group homes.
"We have patients who've waited three months for a state bed," McCahill said.
Sometimes the patients' behavior is so explosive that they can no longer participate in group therapy at Memorial Epworth. That ends up drawing more of the staff's time.
Patients qualify for state beds according to their clinical needs -- if they're severely mentally ill but no longer suitable for inpatient, acute care and if they're not appropriate for a nursing home.
"Sometimes we believe the patient needs a state bed but the state doesn't," she said.
Less room for slack
Parts of Madison Center's operations went elsewhere. For example, Portage Manor took 25 residents from West Park, a home on Western Avenue that Madison Center had run, said Portage Manor's facility director, Louann Becker.
At first, Madison Center's closure sent a rush of clients to the nonprofit Family & Children's Center Counseling and Developmental Services. It created a wait list there for the range of counseling and therapy. Since then, other forces have limited how much slack the Family & Children's Center can pick up.
Over the past two years, said CEO Bruce Greenberg, the agency has dropped from about 50 therapists to 15, mostly because of a large cut in reimbursements from Indiana's Department of Child Services and from Medicaid.
In 2011, the agency lost about $800,000 in reimbursements, even though it still provided the outpatient care, Greenberg said. In recent weeks, the state announced that it will restore some of the funding. The Family & Children's Center calculates that it would mean a boost of about $40,000 in a year -- and likely an increase in services -- but still a fraction of its $4 million in total income for outpatient services, Greenberg said.
Meanwhile, he pointed out, insurance providers are going to higher deductibles, meaning that clients pay more upfront. Because of that, he said, his staff observes that people are delaying care. They also may be seeking alternatives, such as talking with their pastor, he added.
Not knowing exactly where clients have moved on to, he said: "I worry for the kids who are victims of trauma and neglect. If they don't get services, those problems are just going to magnify."
Staff writer Joseph Dits: