David: Dr. Weltzin, is inpatient eating disorders treatment covered by insurance and/or Medicare, or do parents have to pay for it out of pocket?
Dr. Weltzin: This really varies in terms of the policy. Some policies have unlimited coverage; however, this is rare. Often times, families do have to pay, and this is the reason why it is often not possible for people to receive inpatient care. Historically, this change occurred in the mid to late 80's, and at that time, most inpatient units were not able to continue to provide as high quality of care and alternative treatment models were developed that were less costly but effective.
David: The Rogers Memorial Hospital website is here.
Let's get to some more audience questions:
brendajoy: What if your child is over 18. Is there any legal way to force them into treatment?
Dr. Weltzin: They can be forced into eating disorders treatment, depending on state mental health statutes, if their symptoms are so severe as to be life threatening. This generally occurs when they have had the problem for a while. This is the main reason why children tend to have a better chance at recovery. There is more pressure for them to get into or stay in treatment even if they do not want to recover. For patients over 18, it is very important for families to support the eating disorders treatment as much as they can to keep them in treatment. This often boils down to the patient having to make a choice to stay in treatment because of someone else, initially. For those patients who make this choice, they often are able to see the need for treatment after a period of time in treatment.
Jem42: My daughter is getting better in some ways but still holds on to pretty rigid food rituals. She also does not eat any of the food we fix for dinner. Since she is gaining weight slowly by doing it her way, should we press the issue? Also, my daughter was at Rogers. One year ago, we were putting her into the inpatient facility.
Dr. Weltzin: If your daughter is gaining weight, then I would not push the issue of the rigid thinking and some ritualistic eating behavior. If she is gaining weight, then it may take a while for the anorexic thinking to change. Parents often get frustrated that the thinking does not change even with behavior changes, such as weight gain. You need to tolerate this. I encourage you to focus on a few important changes. It sounds like your daughter needs to gain weight. As her weight gets higher, the thinking will change. Also, good luck with your daughter's treatment.
David: Here's the next question:
jerrym: David, our daughter just left Rogers about 6 weeks ago. Great staff and people! She's doing well overall and we're adjusting. What can parents expect to see after treatment?
Dr. Weltzin: The main thing that I emphasize to parents is that they need to try to remove barriers to recovery. This initially means to let go of blaming yourself for the problem and attend therapy sessions, even though they may be difficult. Being able to change how you approach your son or daughter with the help of the treatment team can make a big difference in how things go when they are home. At Rogers, we strongly encourage family involvement for this very reason. Jerry, I am glad to hear that this seems to be going well thus far.
LilstElf: What is the general length of stay for residential treatment?
Dr. Weltzin: It really depends on the problems. For bulimia, in which weight gain is not needed, the stays tend to be 30 to 60 days, while with anorexia it may be 3-4 months, depending on weight. This tends to seem like a long time but usually patients and families have had to experience years of the problem and the sacrifice for what is generally a short period of time, if we look at effective treatment leading to a healthy long life, is justified if possible.
rkhamlett: After hospitalization and being in an institution, what is there left to do for a 13 year old?
Dr. Weltzin: The main thing is whether she was able to function in terms of her eating in the hospital. If she was able to gain healthy eating habits and be motivated to try and recover then setting up a structured treatment (including close monitoring of weight in addition to intensive therapy) is important. The reason for weight monitoring is so that if things are not going wel,l she can be readmitted without a major loss of ground in terms of recovery. Not letting things get to the point of being as bad as they were before intervening is critical.
David: I'm getting a few comments that fall along this line: If you spend $21K-45K per month for 1-4 months (depending on the seriousness of your child's eating disorder) and then your child comes home and you see the disordered eating behaviors start all over again, it is extremely frustrating and causes a lot of anger. How is a parent supposed to handle that? One parent says she followed her daughter to the bathroom and the child started screaming at her.
Dr. Weltzin: This is very frustrating for parents, as it is often a major sacrifice that effects the whole family when this type of treatment is decided upon. I can say that we are very aware of this. For this reason, when I was the medical director of the inpatient program at Pittsburgh, we followed up our patients and had less than a 10% rehospitalization rate after one year.
As I have been the medical director at Rogers since February of this year, one of my main initiatives is to reduce relapse after treatment so that this story becomes less common for the patients that we treat. It is important to emphasize that planning after an intensive treatment should focus, to a large extent, on what types of things should be done (depending on how the patient is doing at the time of discharge) and how to give parents guidelines to improve the chances that relapse does not occur. Finally, sometimes going back inpatient or residential is needed. Having a discussion with the treaters at the beginning of treatment about this concern and what you, the parent, thinks could have been done differently often helps to avoid this happening again.
David: So are you saying that the inpatient treatment is just the very beginning of the eating disorders treatment process? Do you think a parent shouldn't expect their child to be "healed" or "cured" of the eating disorder, even if they spent $21-200,000 dollars?