COEUR d'ALENE - The road to recovery from drug and alcohol addiction often requires intensive treatment, but for many of the uninsured and impoverished in Kootenai County who want to recover, accessing that treatment is often nearly impossible.

Justine Graybeal, director of Fresh Start in Coeur d'Alene - a nonprofit drop-in center that offers homeless and mentally ill adults a place to shower, find food, wash laundry and look online for jobs - said that seven out of 10 people that come through their doors are in need of treatment that, due to a lack of local resources, is unavailable.

"I have so many people that come in and say 'I need help' 'I need help,'" Graybeal said. "All we can do is say 'That's great that you acknowledge it.'"

Albert Mahoney, 51, was 14 when he started drinking alcohol.

Mahoney said he makes money by "holding a piece of cardboard" and recently the seizures that have come as a result of his addiction have made even that challenging.

"I was shaking uncontrollably, I couldn't talk," Mahoney said of his most recent seizure. "It was pretty bad."

Through Fresh Start, Mahoney has been connected with a 12-step recovery program and other organizations that provide him with meals and aid. He has been sober for a "short while" but being homeless means the temptation to drink is everywhere.

"I live on the streets," Mahoney said. "It's been a really long, hard road but I've got a really strong support system. I'm trying to stay sober but it's hard when you're living outside."

Fresh Start rarely sees individuals with insurance or the financial means to get treatment. Graybeal said the center can help them find support through 12-step recovery programs like Alcoholics Anonymous and Narcotics Anonymous. She said physicians from Heritage Health, a Coeur d'Alene community health center, visit Fresh Start and can prescribe medication to those dealing with "hard-core withdrawal symptoms."

"But that only takes care of the physical need," Graybeal said. "It's the mindset and thought patterns that really have to change."

The largest group of addicts that come through the doors of Fresh Start are alcoholics. It's a population that Graybeal said seems to get lost in the shuffle when it comes to state and federal funding for inpatient services.

"The best thing that inpatient treatment can do is hold them accountable," Graybeal said. "Out here they can just leave the AA meeting and then they are free to do whatever they want."

If there is any state and federal funding available for addiction treatment, Graybeal said it's still hard for most people to access.

"Literally it's down to, if they do have funding, you have to be female and pregnant, and a needle has to be in your arm," she said. "Other than that, unfortunately, you don't qualify."

Without intensive inpatient treatment, Graybeal said her clients often continue on the same path they were on when they approached Fresh Start for help.

"Especially our older clients who don't have housing and don't have insurance," Graybeal said. "It can lead to death and it's really sad."

Available Resources

Kootenai Behavioral Health Center, a branch of Kootenai Health, has 15 beds available for adults in need of inpatient treatment for alcohol or drug addiction.

Potential patients are able to pay for the treatment using most major insurance companies, Idaho Medicaid and Medicare. Those that are uninsured, or have other financial issues, are directed to the hospital's business center where, according to staff at Kootenai Behavioral Health, they are consulted "on an individualized, case-by-case basis."

Kootenai Behavioral Health Center does not take patients that qualify for state funding and has no "scholarship funding" available.

Heritage Health struggles when it comes to finding inpatient care for potential patients without insurance and financial means.

"Our providers find this issue very difficult as resources are very limited in our area," said Luke Malek, Heritage Health's director of legal affairs and program development. "Some (individuals in need of inpatient treatment) have to travel as far as Seattle."

Port of Hope - a private, inpatient drug and alcohol treatment provider in Coeur d'Alene - charges $5,250 for roughly 35 days of inpatient treatment. That cost is lower than most other treatment options, said Jake Danible, controller for the facility. With one counselor on site, Port of Hope can, under state law, only provide inpatient treatment services to up to 10 people.

"Truly most people in this situation, if they have money, they are going to the ritzier centers where they have their own rooms and a lot of activities," Danible said. "With us, we are pretty bare-boned. We're going to focus on what's triggering you to do what you're doing."

Funding

Most people who are referred to Port of Hope do not have insurance. They have the option of paying privately and, depending on the individual, may also qualify for a scholarship program that pays for treatment.

"People without the income level to afford the treatment can get approval through the BPA," Danible said. "Sometimes, when the funding level is high, they approve a lot of people. However, the lower the funds the higher the bar."

BPA is Business Psychology Associates, a Boise-based health care management network with which the Idaho Department of Health and Welfare contracts. BPA assesses potential qualifiers for primarily federal funding. If approved, the qualified candidate is given the doctor-recommended treatment.

In the case of inpatient treatment for alcohol and drug addiction being recommended, pregnant women, women with children, and intravenous drug users have been prioritized for subsidized treatment.

"We have about seven or eight priority populations," Rosie Andueza, an operations manager with the Idaho Department of Health and Welfare, said. "Once somebody screens in financially and in terms of meeting a population requirement, BPA will give them some options of treatment providers in their area."

Once a treatment provider is selected, Andueza said the patient gets an assessment. BPA uses the results of the assessment to determine the level of care the person needs and whether or not funding for that treatment will be authorized.

"If you're an individual that doesn't have insurance or has low income and you don't qualify for BPA you're on your own," Danible said.

"We do have a gap in our system whereby individuals who don't meet one of our priority populations, or they're not involved in the legal system, they just want help," Andueza acknowledged. "It's a gap that we know exists, we just don't have the funding. I wish we did."

Lack of funding is leaving small providers fending for themselves as well. Danible said in the past, when state and federal funding was more readily available, Port of Hope was consistently full.

The inpatient treatment facility operates with a "very fixed cost" and, according to Danible, the lack of government funding for potential patients has left Port of Hope in search of alternative methods to generate the necessary overhead.

"A lot of nonprofits have organizations or individuals that act as benefactors and fund them. But there are a lot of centers all fighting for the same money," Danible said.

Recently, the counselor at Port of Hope's Coeur d'Alene location left. The six patients at the center were transported to the organization's Boise location until a new counselor is hired.

This instance has left Port of Hope considering whether or not to reduce its coverage to one location.

"If we have five patients in Coeur d'Alene and five in Boise, it doesn't make sense to duplicate the costs like that when one counselor can have up to 10 patients," Danible said. "We could provide 10 beds to anybody that came to us if we could find a benefactor to cover our overhead cost. That would make it a true community resource."

Future Needs

Access to Recovery, a federal grant that will begin its fourth funding cycle in October, will allow BPA in Idaho to begin targeting additional priority populations.

The grant process, according to Andueza, was competitive and only five states received the funds. States that were previously awarded Access to Recovery funds like Idaho were told that they would not be prioritized to once again receive the grant.

"We thought we really had no chance whatsoever," Andueza said.

But during the next three years, the Idaho Department of Health and Welfare will receive $7 million in federal funding. This includes administrative costs and will allow BPA to approve new populations.

"For the first time we will be serving homeless, veterans involved in the court system, and families involved with child protection and the court system," Andueza said.

Andueza added that they broadened the definition of homelessness as much as possible.

"It's sheltered and unsheltered homeless," Andueza said. "So it's not like you have to be living under a bridge. It could be you've been staying with your sister for the last three months because you're homeless."

Others, like Graybeal, advocate for a larger facility in the county that could be well-staffed and accommodate those in need of inpatient care.

"It would cut down on emergency room visits, ambulance usage, cop calls and things of that nature," Graybeal said. "Instead of taking up beds in the hospital, which costs everybody money, they could detox them at a care center or actually get them the help they need rather than just put a Band-Aid over it."

Mahoney agreed with Graybeal.

"So many people would take advantage of it," Mahoney said. "Especially people that are my age or maybe a little older and have a problem with it. It removes all the temptation and as time goes on you start to change mentally. It's all mental."

Danible said that when it comes to funding for places like Port of Hope, his boss often says "people don't want to fund a bunch of drunks."

When Mahoney heard that statement, he paused before stating that people should care about those with alcohol and drug addiction because they're also a part of the community.

"You can turn a blind eye to it but then you're going to have people on the street corners holding signs, or panhandling and all this other kind of stuff," Mahoney said.