Nurse Marie Marsh, left, and Teresa Buonaiuto, right, walk Teresa’s brother Eddie down the hall of the Virks Building at Eleanor Slater Hospital in Cranston on their way to a community room during a visit. Below, the exterior of the Virks Building.

The Providence Journal / Kris Craig

CRANSTON Whenever Eddie has to relocate, he goes to pieces.

Eddie is 70 years old and suffers from schizophrenia and mental retardation. Any disruption of his routine sends him into a tailspin. He lashes out, hitting other people.

“He has an impulse-control issue,” says his nurse, Marie Marsh.

That’s why Eddie’s sister, Teresa Buonaiuto, 77, of Providence, is worried about what will happen when the state closes Eddie’s current home, the Virks Building at Eleanor Slater Hospital, and moves him into another building at the hospital. The shutdown is expected within the next two weeks.

“We really don’t want to see him move,” says Buonaiuto. “They need a place for these kinds of people.”

The closing of Virks is part of the Carcieri administration’s little-noticed effort to shrink the only state-owned hospital in Rhode Island, which serves many types of chronically ill people. In the past year, the hospital’s census has fallen from 360 to 300 patients, and 95 workers have been laid off.

More than a year ago, the hospital stopped admitting patients like Eddie — elderly, mentally ill people who also have behavioral or medical problems –– who were kept at Virks. Gradually the rest are being moved out of Virks, some to nursing homes, some to other buildings at the state hospital.

Ellen R. Nelson, director of the state Department of Mental Health, Retardation and Hospitals, says the change springs from “a positive convergence” of fiscal and clinical needs. In her view, patients who don’t need hospital care are finding more comfortable digs in nursing homes, saving taxpayers about $825 per day, while patients such as Eddie are moving from a decrepit building into more practical quarters.

But people who work at the hospital say the effort has been driven chiefly by financial and administrative concerns, rather than patients’ needs. They lament that a hospital they describe as a forgotten treasure –– the last haven for the state’s most vulnerable citizens –– is being whittled away.

Eddie exemplifies the type of person that the state has long taken responsibility for –– because no one else can. Asked what would have happened to him if it weren’t for Eleanor Slater Hospital, his sister, Buonaiuto, widens her eyes and slumps back in her chair. “He’d be back on the street,” she says. “I couldn’t take care of him.”

Eddie was always mildly retarded, Buonaiuto explains, but he didn’t need institutional care until he started showing symptoms of schizophrenia and paranoia in his 20s. He lived at the state hospital for 25 years and then at a group home for 12 years. But when he developed diabetes and heart disease, he needed more medical attention than the group home could provide.

No nursing home could handle him –– Eddie went through three in two years. He’s aggressive when upset. He touches women inappropriately. He invades other patients’ rooms and gets into their possessions. So he came back to Eleanor Slater and made the Virks Building his home. There, the nurses have expertise in dealing with vexatious old people like him.

“He was difficult when he got here,” says Marsh, nurse coordinator at Virks. “Little by little, we got him at a good level. It takes time.”

Now, Eddie is one of nine people remaining at Virks, which has 60 beds. Worn and dingy, several decades old, with imposing columns at its front entrance, the Virks Building is no one’s idea of a glamorous retirement home. Eddie’s room is furnished only with a bed, a night table and a cabinet. A curtain dangles from a bent rod in the window.

Virks is also a distance from other hospital services, so that food has to be trucked in, and patients who need medical care have to go in an ambulance to a nearby building. Nelson says it makes sense to close Virks and consolidate hospital services in and near the six-story Regan Building, one of several hospital buildings on the Cranston campus.

But Virks features a long, wide corridor on each floor, big activity rooms at each end, flowers painted on the walls, and porches where patients can grow vegetables in the summer. Regan is a more cramped, hospital-style setting, with little opportunity to go outside.

“It’s got to be like jail for them,” says Marsh.

“The unit they’re being moved to was not designed for long-term care,” says Dr. Scott Allen, the attending physician on Virks. “In terms of general humaneness, in longer-term care you don’t want to crowd people in a smaller space. It’s important to have not only ample space to walk around but a good size day room, and easy access to outdoor spaces, whether they’re porches or courtyards.”

The move is also a concern to H. Reed Cosper, the state’s mental health advocate. Cosper says it violates the state Mental Health Law to put mentally ill patients in a hospital for the medically ill, which is how Regan is defined. He has filed suit to block Virks’ closure. “Patients who are moving out of Virks are being subject to patient abuse,” Cosper says.

Since the state began moving people from Virks to Regan, a mental patient broke a $5,000 piece of equipment at Regan and another broke a fellow patient’s hip, according to nurses who work there. They say the psychiatric patients are difficult to manage in the small space.

Such incidents are bound to happen once in a while with this population, even at Virks, says Dr. Edward W. Martin, the hospital’s medical director. “I’m not sure that I’d say that any of our buildings are the ideal design for long-term psychiatric care,” he says. “Reagan is the best –– it’s a brighter, nicer building. Virks was a pretty sort of drab and depressing building.”

Roberta Hawkins, the state’s long-term-care ombudsman, says she’s always favored shutting down Virks and doesn’t see any problem with moving patients to Regan.

Hawkins’ agency, the Alliance for Better Long-Term Care, has an $85,000 contract with the state to coordinate the transfer of patients from Eleanor Slater to nursing homes. Cosper says that contract undercuts Hawkins’ role as patient advocate; Hawkins insists she always puts patients’ needs first.

Over the past five years, the Alliance has helped 200 patients leave Eleanor Slater and move to nursing homes, including 12 who lived at Virks. The Alliance helps select the nursing homes best suited to each patient, and trains the nursing home staff in handling Slater patients. Only two or three have had to return, Hawkins said.

“I’ve been really amazed at how satisfied everyone has been with the transitions,” says Nelson, MHRH director. “All the transitions were smooth.” They also save money. The state Medicaid program pays $1,000 a day for each patient in Eleanor Slater; the rate in a nursing home is $175.

Paul Rossignol, 49, of Cranston, was pleased with the way his wife’s discharge from Slater was handled. Ann Rossignol, 49, suffers from a hereditary form of Alzheimer’s disease that strikes early in life. After she had spent five years in the Zambarano unit of Eleanor Slater, in Burrillville, Rossignol learned that his wife was on a list of people who would eventually have to leave. He acknowledged that she no longer needed hospital-level of care.

The Alliance recommended the Brentwood Nursing Home in Warwick, and when a bed opened in February, Ann Rossignol moved there. “It’s been a very easy transition for her,” he says. “It’s a smaller place, a nicer-looking place, more of a homey-type look.”

Elaine Anderson, of Narragansett, says she had a rockier time when her 74-year-old husband was discharged from Eleanor Slater last year. Two strokes had left Ronald W. Anderson almost completely paralyzed and dependent on a ventilator. The attentive staff at Eleanor Slater, she says, kept him smiling and comfortable. “At Eleanor Slater they took care of you. I mean care and caring,” she says.

But at the nursing home, Anderson says, she has to fight to get anyone to respond to problems, and her husband has needed many trips to an acute-care hospital. Once he fell out of bed when a nursing assistant positioned him on his side too close to the edge.

As with many disturbed by the changes at Eleanor Slater, Elaine Anderson focuses her anger on Governor Carcieri. “Blindfold him. Put him in a bed in one of these nursing homes where no one knows who he is. Lock him in and then ask him two days later what he thought,” she says. “If they did that, maybe he’d think twice about moving all these patients.”

Many people wonder whether the ultimate goal is to shut the hospital. Nelson denies there are any such plans “at this point.” Her vision calls for a flexible, responsive institution that is easy to get into and easy to leave, with fewer patients remaining there for decades. The state will always need a safety net, she says, but the form of that safety net may change.

Asked whether she thinks Eleanor Slater will close, Hawkins, the long-term-care ombudsman, declares: “I will never let it happen. This community won’t let it happen. This whole state needs that hospital.”

ffreyer@projo.com