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Kyle Potter, Published September 21 2013

Fargo detox, shelter seek to recoup cost of care

FARGO – They come to Fargo in buses, trains and cop cars from across the state to sober up at detox or spend the night at the homeless shelter.

Or at least that’s what Fargo police and health officials hear.

City leaders are gearing up to tackle what they believe is a growing problem: people from outside the metro area being sent to be cared for in Fargo. If it’s happening – city officials are sure it is, but they say it’s hard to verify or quantify – it’s adding an extra burden to the city’s already-stressed homeless shelters and detox center.

Fargo police as well as public health and clinic officials are looking into how to recoup some of the costs of serving people from outside the metro area. But at this point, there are more questions than answers.

How often does it happen? Where do admissions from out-of-town come from, and how do they get here? What’s the total cost to Fargo taxpayers?

And crucially, how can the city claw back money from the towns, counties and nonprofits sending people here when it’s unclear where they’re coming from? Or if it’s happening at all?

“We have to try to get a handle on what’s happening and why,” said Jan Eliassen, director of the Gladys Ray Emergency Homeless Shelter.

Officials say they don’t think other communities are maliciously handing off their problems to Fargo-Moorhead. As the largest population hub for hundreds of miles in every direction, it comes with the territory.

Homeless people, or those suffering from substance abuse or mental health issues, end up in the metro area “because we have the resources and other smaller communities don’t,” Fargo police Chief Keith Ternes said. For example, the Gladys Ray shelter is the only shelter in the region that allows homeless people who have been drinking to stay the night.Regardless of intent, it imposes a cost on city resources Ternes said were never meant to cater to the entire state of North Dakota.

“If they are utilizing those resources, it’s coming exclusively at the expense of Fargo taxpayers,” he said. “We can’t continue to provide the financial support for a resource like the emergency shelter for anybody.”

Detox expenses in 2012 were about $460,000, and Gladys Ray Shelter costs were $363,000, according to city figures.

Fargo city commissioners last week approved having the city’s public health department manage both the detox center and Gladys Ray, which was already a city program. The emerging effort to recoup costs of out-of-town admissions came up during that discussion.

Ruth Bachmeier, director of Fargo Cass Public Health, said the first step is to better understand the problem and how large – or small – it may be.

After that, Bachmeier said Centre Inc., which the city contracts to run its detox facility, could implement a contract with other cities and counties across North Dakota, like it does with West Fargo, Cass County and others.

“We just have to really open up those lines of communications with those other jurisdictions,” Bachmeier said, so that Fargo doesn’t have to “carry the financial burden of those individuals.”

The number of homeless people in the Fargo-Moorhead area increased 15 percent from 2009 to 2012, according to a survey recently released by Wilder Research. Homelessness in the metro area has more than doubled since 2003.

Officials attribute the sharp rise in homelessness – and a perceived rise in the number of people from outside the metro coming to the area to stay in a shelter or seek treatment in detox – to North Dakota’s booming economy, driven largely by oil production in the west.

“It’s the land of opportunity, that’s what so many people believe,” Eliassen said. “People come here, run into challenges and end up in Fargo.”

It could help explain why the number of people admitted to detox annually has tripled in the past 10 years, a trend that inevitably increases the cost of those services. City Administrator Pat Zavoral said last week that by 2015, Fargo may need to seek state assistance to help pay for its detox center.

Getting a better picture of how often non-area residents wind up in Fargo detox or homeless shelters may pose the biggest challenge in recouping costs.

Ternes, like many others, said he’s heard anecdotally about people from across the state being shuttled to Fargo with instructions to seek out the city’s detox center or homeless shelters.

According to Centre’s admissions records at the Fargo detox center from the last six months, 47 people told detox staff they were from outside the Fargo-Moorhead area. That’s one in every 33 admissions.

But Centre’s intake forms rely on a patient’s honesty, and it’s difficult, if not impossible, to verify where that person came from and how they got there. Gladys Ray keeps similar intake records, but Eliassen said the shelter hasn’t analyzed records to see how frequent out-of-town admissions are.

Christopher Shotley, Centre’s director of operations, said detox staff have fielded a few calls over the years from outside the metro area about bringing a patient into Fargo’s detox. Each conversation stopped as soon as it came to payment, he said.

Shotley called the possibility of contracting with “the other communities [that] don’t have the services we do,” a fantastic idea.

Ternes said whether or not they can set up an effective mechanism to recapture some of the costs, it may be effective to just send a message: Fargo can’t pay for this on its own.

“If you need or have to send somebody to Fargo, we can understand that, he said. “If you’re going to send somebody here … then you should understand and expect to at least pick up some of the expense associated with that.”

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Readers can reach Forum reporter Kyle Potter at (701) 241-5502