Admissions at Washburn House

Admission to Washburn House starts with a call, a benefits check and a clinical assessment. The house is a historic residence in Worcester, Massachusetts. It was built in 1896 and once owned by Ichabod Washburn, and it now takes both men and women in treatment for drug or alcohol addiction [11].

Its page lists these levels of care: medical detox, Residential Recovery Services for co-occurring disorders, full-day outpatient, half-day outpatient and aftercare planning [11]. Two of those names throw people from out of state. The campus explains them itself. Full-day outpatient is “also called partial hospitalization in some states”. Half-day outpatient is “also called intensive outpatient care in some states” [11].

The campus calls itself a continuum for adults. It runs from medically supported withdrawal management through structured treatment, extended recovery services and outpatient care [7].

Below: the call, the assessment, the money, packing, getting to Worcester, the first day, work, and the fit question.

What Happens on the First Call

Screening. Nothing is decided by the end of it, and nothing is owed.

You will be asked what is being used, and how much. How long that has been true. Whether there has been treatment before. What is prescribed now. What else is going on with your health. There will also be a question about paying for care, and one about where you are right now.

Be exact about amounts. That is the number a withdrawal plan is built from. Rounding it down is the one answer with a clinical price attached.

The caller does not have to be the patient. Parents, partners and clinicians ring for people who are not ready to ring themselves. There are limits on what staff can say back, and those come lower down.

Washburn says the team builds plans that are unique to the individual [11]. Clients may take part in cognitive behavioral therapy, dialectical behavioral therapy, music therapy, art therapy, motivational interviewing and family counseling [11]. The campus adds that patients struggling with opioids also have access to medication for opioid use disorder as medically appropriate [11]. Our guides to how to get into rehab and what the rehab process is like describe the sequence across every campus.

The Clinical Assessment and How the Level of Care Is Decided

A clinician decides the starting level, working from published criteria.

SAMHSA’s consensus panel calls detox a broad process with three essential components that may take place concurrently or as a series of steps [1]. The first is evaluation. The panel spells it out: testing for substances and measuring their concentration, then screening for co-occurring mental and physical conditions [1]. It also means a full look at medical and psychological conditions and at social situation, to settle the right level of treatment after detox [1].

Placement is a separate craft. TIP 45’s placement chapter lays out the treatment settings and the five adult detox levels the field works with [2]. It is frank about the limits, too. The ASAM criteria are only guidelines, and there are no uniform protocols for determining which patients are placed in which level of care [2].

Medical risk is the urgent part, and it is not the same risk for every drug. TIP 45 names seizures and delirium tremens among outcomes in severe alcohol dependence that can lead to fatal consequences [3]. For alcohol, sedative-hypnotic and opioid withdrawal syndromes, it says hospitalization or some form of 24-hour medical care is generally the preferred setting [3]. Opioids flip the timing. MedlinePlus states that withdrawal reduces tolerance, so people who have just gone through withdrawal can overdose on a much smaller dose [4].

If someone is having a seizure, is unresponsive or has trouble breathing, call 911. For a mental-health crisis call or text 988.

Washburn says treatment is individualized to each patient’s clinical needs, progress and insurance coverage [7]. Not everyone takes part in every level of care [7]. It offers medication-assisted treatment when clinically appropriate, with the treatment team deciding case by case [7]. For background, see our explainer on levels of care, which covers the five treatment levels, and on the rehab intake process.

Insurance, Verification and What Patient Responsibility Means in MA

Coverage gets checked while the clinical assessment runs, and admissions usually handles it.

The carrier line here reads differently from most of our campuses. Washburn says it is in network with most major insurance carriers including Aetna, Blue Cross Blue Shield, Cigna, United and Medicaid [11]. It adds that it offers private pay options where someone has no insurance or limited coverage [11]. Medicaid in that list is worth noticing if you live in Massachusetts. It is still the campus’s general statement, not a ruling on your policy, so the check happens anyway.

MassHealth publishes what it pays for. The state says it pays for many important health-care services including doctor visits, hospital stays, rehabilitation and therapeutic services, and behavioral health and substance use disorder services [8]. It also says members, including those in managed care plans, do not have to pay copayments for prescription drugs or other MassHealth covered services [8]. Who runs that benefit is a thing to ask, not to assume. The state tells members in a private health plan through MassHealth to call that plan’s member services for the names of participating providers [8].

The campus has its own billing language as well. Many plans require out-of-pocket costs before benefits apply. Those may include deductibles, co-pays, coinsurance and maximum out-of-pocket expenses, all gathered under the heading Patient Responsibility [7]. A staff member reviews yours at the time of admission, or as soon as possible once you are medically stable [7].

Federal law puts two floors under a commercial policy. A Marketplace plan must include substance use disorder treatment as an essential health benefit. It cannot refuse enrollment over a pre-existing condition, and it cannot cap that benefit in dollars annually or for a lifetime [5].

The second floor is parity. Under the Mental Health Parity and Addiction Equity Act, a plan that covers mental health and substance use care may not apply harsher limits to it than it applies to medical and surgical care, and that reaches prior authorization and step therapy as well as visit and day caps [6]. The scope is worth knowing: it applies to non-federal governmental plans with more than 50 employees, to group health plans of private employers with more than 50 employees, and to the individual market [6]. Plans from small employers are not covered directly; they get comparable protection through the Affordable Care Act’s essential health benefits requirement.

Our guide to insurance coverage for rehab sets out how a benefits check runs. What rehab costs lists our own price ranges for each level.

What to Bring and What to Leave at Home

Two suitcases, because storage is limited, and the campus wants its full packing list read before you travel [7].

Three cards do the most work: a picture ID, an insurance card, and a prescription or pharmacy benefits card [7]. Keep cash small. Prepaid debit cards are preferred, and the campus suggests letting your bank know you will be away [7].

Medications arrive with you and then move into the nursing department’s keeping. Everything must stay in its original, labeled prescription bottle [7]. Your physician decides what continues during treatment, and the campus says directly that it may not include everything you were taking before admission [7]. Raise anything you are anxious about on the call, not on the day. Our page on medication-assisted treatment explains how medication for opioid use disorder fits into a plan.

One line in the clothing list is easy to miss. The campus asks for two pairs of comfortable shoes without strings, such as sandals, slides or slippers [7]. Sheer or revealing clothing, expensive jewelry and other valuables stay at home [7].

Toiletries follow their own rules. Products should be alcohol-free [7]. Anything listing alcohol among its first five ingredients is refused, along with glass containers, personal mirrors and mirrored compacts [7]. Items with cords, plus razors and tweezers, sit in locked storage and are signed out from staff [7].

Nicotine wants planning. Tobacco products must arrive unopened, and vapes must be disposable and not require charging [7]. Bring enough for at least the first 10 days after admission [7]. A staff member does a store run for necessities and tobacco once a week [7]. Staff cannot buy tobacco for patients under 21, so the campus asks people aged 18 to 20 to plan ahead [7].

Leave bedding behind. The program provides bed linens and towels [7]. Laundry rooms are open during designated times and basic supplies are provided [7]. Personal linens and pillows are not permitted [7].

Getting Here: Travel, Arrival and Who Can Come With You

This campus publishes more travel help than most, so ask for it.

Washburn says transportation assistance is available for patients traveling to the facility [7]. It can provide transportation from Worcester, from Boston Logan International Airport, and from Rhode Island T. F. Green International Airport in Providence [7]. Patient pickup may also be available within about 50 to 75 miles of the facility [7]. Arrange it with the admissions team before arrival, not on the day [7].

Visiting works differently at each stage here, which is unusual. The campus says visitation varies by level of care [7]. In-person visitation is not normally available during inpatient treatment [7]. Patients in structured sober living may receive visitors on Sundays [7]. The campus also holds Family Access Nights on Monday evenings, run by clinical staff for family engagement and support [7]. So a family that cannot visit in week one is not shut out. There is an evening with their name on it.

Belongings move separately from people. Family and friends may drop off necessary items, such as clothing or unopened permitted tobacco products, during designated times [7]. Confirm those times with the facility first, and a staff member takes the bag in on arrival [7]. The campus’s what to expect page on this site covers daily life rather than the admission.

The First 24 Hours on the Worcester Campus

Arrival means an intake, a medication review, and a room whose shape depends on the program you are entering.

The campus says sleeping arrangements vary by program and level of care [7]. Patients may stay in single or shared rooms, depending on the program and on availability [7]. Bathroom arrangements vary between levels too [7]. That follows from how the place is built. Different programs run with their own schedules, accommodations and privileges, so the structure shifts as a person moves through care [7].

Meals at Washburn House are prepared in-house by facility chefs [7]. The facility can accommodate dietary restrictions and food allergies [7]. Tell the treatment team early. Outside food and drink are not permitted [7].

Phones change hands at the door during inpatient treatment. Personal cell phones, smartwatches and other electronic devices are securely stored, and patients may use a facility house phone as needed, generally with clinical staff supervision [7]. Patients in extended care may have different privileges, including access to their own phones [7]. Bring a written list of numbers; nobody remembers them.

What fills the rest of a day depends on the program. The published list runs to fitness and exercise facilities, yoga, basketball and other recreation, mindfulness and meditation groups, mindfulness walks, animal-assisted activities, off-site community activities, recovery meetings and on-site laundry [7].

For anyone whose withdrawal needs supervision, medical detox comes first. It is the stage carrying real medical risk. Our inpatient rehab page describes residential care in general terms.

Telling Work and Family

Two questions, and they have different answers.

Job protection comes first, because it has a deadline. The Family and Medical Leave Act lets eligible employees of a covered employer take job-protected, unpaid leave for up to a total of 12 workweeks in any 12 months [10]. The request goes to whoever handles leave where you work. Starting it before admission beats starting it from a treatment center.

Confidentiality is the other question, and the answer is stronger than most people expect. Under federal rules on the confidentiality of substance use disorder patient records, the presence of an identified patient in a facility publicly identified as a place where only substance use disorder treatment is provided may be acknowledged only with the patient’s written consent, or under an authorizing court order [9]. A program answering an inquiry may not affirmatively reveal that an identified person has been or is being treated for a substance use disorder [9]. An inquirer may be told that the regulations restrict disclosure generally, but not that they restrict the records of an identified patient [9]. Somebody ringing to ask whether you are there does not get an answer.

For a family, the practical plan is a named point of contact agreed at admission, plus Monday’s Family Access Night in the calendar [7].

If This Campus Is Not the Right Fit

An assessment that recommends somewhere else has done its job rather than closed a door.

Clinically, the picture may fit a different setting, and only an assessment can establish that. Financially, an insurer may decline to authorize this site, which is what the benefits check surfaces early. Practically, the journey may be wrong for the person or for the household around them.

Washburn’s structure is worth grasping first. It offers several stages of substance use treatment, using terms the state uses [7]. Acute Treatment Services covers medically supported withdrawal management. Clinical Stabilization Services covers continued structured treatment. Residential Recovery Services covers ongoing residential support. Then come full-day outpatient, half-day outpatient, structured sober living, and aftercare and discharge planning [7]. Not everyone takes part in every stage. The campus says the path and the length of stay are set by the treatment team [7].

That is why this page gives no total number of days. The campus publishes none. It says the length of treatment varies by level of care, clinical needs and insurance coverage [7]. Your team sets it and reviews it.

If a lighter level is recommended, our page on outpatient rehab explains what that involves. Our treatment centers page leads with a US map you click by state, and the campus site itself lists its programs.

One thing stays true either way. TIP 45’s consensus panel took special care to note that detoxification is not substance abuse treatment and rehabilitation [1], and most people need long-term treatment after detox [4]. Aftercare and discharge planning are on this campus’s published list for that reason.

Frequently Asked Questions

Sources

1. Center for Substance Abuse Treatment. (2006). Detoxification and Substance Abuse Treatment, Chapter 1: Overview, Essential Concepts, and Definitions in Detoxification. Treatment Improvement Protocol (TIP) Series No. 45. Substance Abuse and Mental Health Services Administration. https://www.ncbi.nlm.nih.gov/books/NBK64119/
2. Center for Substance Abuse Treatment. (2006). Detoxification and Substance Abuse Treatment, Chapter 2: Settings, Levels of Care, and Patient Placement. Treatment Improvement Protocol (TIP) Series No. 45. Substance Abuse and Mental Health Services Administration. https://www.ncbi.nlm.nih.gov/books/NBK64109/
3. Center for Substance Abuse Treatment. (2006). Detoxification and Substance Abuse Treatment, Chapter 4: Physical Detoxification Services for Withdrawal From Specific Substances. Treatment Improvement Protocol (TIP) Series No. 45. Substance Abuse and Mental Health Services Administration. https://www.ncbi.nlm.nih.gov/books/NBK64116/
4. MedlinePlus Medical Encyclopedia. Opiate and Opioid Withdrawal. National Library of Medicine. https://medlineplus.gov/ency/article/000949.htm
5. HealthCare.gov. Mental Health and Substance Abuse Health Coverage Options. Centers for Medicare and Medicaid Services. https://www.healthcare.gov/coverage/mental-health-substance-abuse-coverage/
6. Centers for Medicare and Medicaid Services. The Mental Health Parity and Addiction Equity Act (MHPAEA). https://www.cms.gov/marketplace/private-health-insurance/mental-health-parity-addiction-equity
7. Washburn House. What to Expect at Washburn House. The Recovery Village. https://www.therecoveryvillage.com/facilities/what-to-expect-washburn-house/
8. Commonwealth of Massachusetts. MassHealth Covered Services. Massachusetts Executive Office of Health and Human Services. https://www.mass.gov/info-details/masshealth-covered-services
9. Legal Information Institute, Cornell Law School. 42 CFR § 2.13 — Confidentiality restrictions and safeguards. https://www.law.cornell.edu/cfr/text/42/2.13
10. Legal Information Institute, Cornell Law School. 29 CFR § 825.100 — The Family and Medical Leave Act. https://www.law.cornell.edu/cfr/text/29/825.100
11. Washburn House. Washburn House. The Recovery Village. https://www.therecoveryvillage.com/locations/washburn-house/

This page is for general information and is not medical advice. Only a licensed clinician who knows your history can tell you what is right for you. If you or someone you know is in immediate danger, call 911. For free, confidential support 24/7, call or text 988.

Author

Kevin Wandler, MD

Chief Medical Officer, The Recovery Village