Ten years ago, I was diagnosed with AML (Acute Myeloid Leukemia). This was devastating news for my family; I was a healthy 26-year old woman, on the verge of going to Harvard Business School and my life was turned upside down. At the same time, my brother fought the battle of his life against heroin addiction. Needless to say, the O’Connor household was grim. Interestingly, while both Chris and I struggled with diseases, our courses of treatment were very different. I was given two options for medical care and the side effects and survival statistics were explained clearly. With Chris, the thirty professionals my mom called all had different opinions about what our family should do to help him and there “were no guarantees”. While my $500,000 in medical bills was covered through insurance, my brother’s bill of $500,000 for addiction treatment was paid out of pocket by my parents. While I stayed the course in one hospital system, my brother jumped from one residential treatment facility to the next, without any long-term plan.
For professionals in the field, this is not an unusual story. Many of our clients come to us after their fifth or twenty-fifth inpatient stay at a residential treatment facility. By that time, families will often ask, “What will my loved one get at this facility that the others didn’t offer?”
It’s not a surprise that families question that cost. With most facilities ranging between $10,000 and $100,000 per month, families are often paying close to a full year of college tuition for one month of treatment, without much information as to why this facility is better than another or what outcomes they can expect. In some circumstances, families develop unrealistic expectations for what the facility can offer in the long term – i.e. “I want the “best” treatment center so that my son will only have to go through this once”. In other situations, particularly when the loved one is resistant around getting help, families may agree to a minimal level of care to avoid rocking the boat.
There is no question that residential treatment is an essential part of the continuum. Whether an eating disorder patient rises to the level of medical necessity, an addict lives in a community with too many negative influences or a bi-polar individual has failed out of multiple outpatient programs, residential treatment can provide numerous benefits – time for diagnostic assessment, clinical and medical stabilization, exposure to positive coping tools and the establishment of healthy routines. The loved one’s time in residential treatment also gives families a respite, time to refocus on self-care and most important, to develop a long-term plan for services.
So how can families ensure that they receive the maximum benefit for their financial investment? Consider the following:
Matching: Internet research can be confusing and often misleading. Families should try to get a customized recommendation for treatment, if at all possible. Educational consultants, some therapists, and companies like ours offer services like this. If a family is going to do independent research, there are resources such as Anne Fletcher’s book Inside Rehab or websites like Partnership for Drug Free Kids that offer tools to consider when weighing a variety of factors.
Budget: While talking about money may not be comfortable, it is essential for families to know their financial capacity to pay for treatment. This should be judged on what they can comfortably pay out of pocket (as opposed to taking a second mortgage). Because behavioral health issues are chronic, it is important for families to look at the age and acuity of their loved one and know that they may need to stretch their budget to cover a few years. It is tragic when families overspend for the first stay in residential treatment, only to struggle later to get financial support for outpatient services.
Release of Information: When an individual feels forced into treatment, he or she may be reluctant to allow a therapist or case manager to update family members. It can be very difficult to assess progress or determine effective aftercare services if family members are left without information. There are various ways for families to strongly encourage that an individual sign a release of information. Please see articles in our resource section about the use of leverage.
Timing: Most facilities are created on a 30 day model, which is routed in what insurance companies were willing to cover. Research suggests that it takes 90 days for the brain to heal. Families often benefit from asking outside professionals how long they would recommend their loved one stay in a facility (not necessarily those who work at the treatment center they are considering). If the individual has been through treatment multiple times before, he or she would often benefit from a longer-term stay.
Family Support: Family members often need support getting a loved one to accept treatment and to keep him or her there when they are resistant. We regularly receive calls from a parent who wants to pick up a complaining child despite the fact that it took all of their persuasive powers to get him or her there in the first place. An objective resource can be a voice of reason encouraging parents to pause before jumping to the rescue.
Aftercare: In-patient treatment centers often provide a safe and necessary structured experience while a patient is in residence. It is the next step – when they leave – that is most daunting. It is important for families to have clear expectations for what their loved one will do when they get home. While some facilities offer virtual aftercare services (ex. phone monitoring), individuals often need concrete plans, accountability and intensive services as they transition into the community.