Separating elderly from the mentally ill will take time, money

Bills aim $10 million to shift mentally ill people out of rest homes June 12, 2012 


Former state president for AARP, Diana Hatch, and her husband Richard Hatch, left, speak with Senator Martin Nesbitt, Jr., after the public comment session during a Senate Appropriations/Base Budget Committee meeting in the Legislative Office Building in Raleigh on Tuesday, June 12, 2012. The committee agreed to recommend a $20.1 billion spending plan, which spends $127 million less than a House budget proposal approved two weeks ago.


Thousands of frail elderly people in North Carolina live in assisted-living facilities alongside people with mental illness, who are often younger and stronger than the traditional rest-home residents.

Federal authorities want states to separate the populations whenever possible, and have promised to withhold Medicaid money to make that happen. State officials agree that housing the two groups together is undesirable, but finding a solution has been a headache of long standing.

The legislature’s temporary solution, laid out in budget proposals, is to set aside $10 million to provide homelike community settings for people with mental illness. As much as $39 million would allow assisted-living centers to house both populations without help from Medicaid, which pays about a third of the cost.

Voices representing North Carolina’s more than 1 million older people spoke up on the issues at a Senate budget hearing Tuesday, saying the proposals will shortchange seniors.

The levels of funding proposed by state leaders won’t meet the need, said Lou Wilson, who advocates for the N.C. Association of Long-Term Care Facilities.

“I believe there are few consumers in adult care homes who could transition to community living,” Wilson said at a packed public hearing Tuesday. “A lot of them are elderly, widowed females. To believe that they could do it in one year is a fairy tale.”

The federal Medicaid program won’t reimburse homes for any residents if more than half have mental illness as primary diagnoses. But because there aren’t enough other facilities to take in people with mental illness, the state is stepping in to supplant Medicaid payments with state dollars over the next six months.

Budgets in both houses of the state legislature propose $10 million for finding transitional homes for people with mental illness who are now in adult care homes. The House budget includes nearly $40 million, and the Senate has budgeted $25 million to pay centers for the care of people who lose Medicaid funding until new arrangements are worked out.

“The Feds don’t like adult care homes at all,” Sen. Richard Stevens, a Cary Republican, said after a public hearing. “They are giving us a lot of trouble.”

Overall payments to Medicaid, the federal health-care program for low-income and disabled people, will increase by more than $200 million, Stevens said.

What led to change

A complex series of events has led to the changes in funding for the centers the state calls adult care homes, also known as assisted-living facilities. Sometimes confused with nursing homes – which are more medically intensive – adult care homes in North Carolina house about 35,000 people who are elderly or have disabilities.

In 2010, the advocacy group Disability Rights NC filed a complaint with the federal Justice Department over the state’s practice of housing people with mental illness in adult care homes, alleging that the practice violates the Americans With Disabilities Act. The state has been in negotiation with federal regulators over how to resolve the issue, and the $10 million set aside by legislators is likely intended to help settle the complaint, said Vicki Smith, executive director of Disability Rights NC.

Staff writer Lynn Bonner contributed.

Goldsmith: 919-829-8929

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