I worked in a trio of facilities that were established to provide care to people who no longer were eligible for long-term state hospital care but too sick to live independently or in group homes. Many of them had lived a lot of their lives in state hospitals before coming to us. I loved the job and the patients but it was hard to watch some of what they went through. It was a confusing at times mess trying to adhere to Medicare/Medicaid rules while providing appropriate psych care. For example I sometimes had to provide physical restraints and we used more and more involved restraints than in normal nursing homes. I had a hard time with that at first. When I was there things were actually better than 10-20 years before; once I was searching storage for something and found a straight-jacket. We most definitely did not use those. I was there a few years after the last patient with a frontal lobotomy had died. We provided good care but it was sad in that most people had very little family contact. At Christmas the staff brought tons of dollar store gifts (body wash was a huge favorite for the women who otherwise had to use body wash/shampoo combined and it was nasty stuff) and those small gifts were divided up and were most of what most people got. I once was there Christmas Eve and there were so few families.

Some people said they preferred the state hospital. Others still cycled back there occasionally or (more often) to long-term VA IP stays. Most people were pretty happy. Many, maybe most, had at least some symptoms of TD. Most people considered it home.

It was a good place to work and a place I felt I could and did make a difference. It was also sad because of the harm done in the state hospital years.