State reaches agreement with feds over treatment of mentally ill

N.C.-U.S. plan obligates state on housing, job training and services

lbonner@newsobserver.comAugust 23, 2012 

  • What is adult care? Adult care homes: Also known as assisted living facilities. The care comes from the State-County Special Assistance Program and from the federal Medicaid program. These centers, which in past years were known as rest homes, are regulated by the state and are generally less expensive than nursing homes. Nursing homes: Provide more medically intensive care and are regulated by the federal government. Medicare typically only pays for nursing home care when a patient is recovering from surgery and needs rehabilitation. Medicaid pays for nursing home care only if the resident has exhausted all or almost his or her resources.

The state and the federal government reached a landmark agreement Thursday that will require North Carolina to provide thousands of people with mental illnesses a way out of adult care homes and hospitals, by paying for housing, job training and mental health treatment.

With the agreement, the state avoids having to defend itself against charges in a federal lawsuit that it is violating the Americans with Disabilities Act by improperly putting people with mental illnesses in adult care homes, when they are capable of living independently.

The state Department of Health and Human Services estimates that the plan for housing, jobs and treatment will cost $287 million over eight years.

The state and the U.S. Department of Justice agreed to expand community housing and treatment after more than a year of negotiations. A federal investigation found the state was violating federal law by wrongly confining thousands of people to adult care homes and institutions. Disability Rights North Carolina, a nonprofit advocacy group, filed a federal complaint over housing for mentally ill people in 2010.

Advocates for people with mental illness hailed the plan as long overdue. Adult care home operators, however, said the plan would force people who cannot care for themselves to leave secure housing.

The settlement is not binding on the state legislature, which is responsible for setting aside the money. The agreement says only that the Department of Health and Human Services will seek the funds.

Best interests

As required by the settlement, the state has hired an independent reviewer who will monitor compliance. The state has to meet housing goals every year. If it falls short and cannot explain the deficiency to the federal government, the U.S. Department of Justice will be able to revive its lawsuit.

“This is really an agreement that is in the best interest of the people in North Carolina who need these services and in the best interest of the state,” said Al Delia, the acting health and human services secretary, who signed the agreement for the state.

The settlement allows North Carolina to spend money to support people with mental illnesses rather than spending it on a lawsuit it could lose, Delia said. Losing could have resulted in a court order putting greater demands on the state.

The state has relied on adult care homes as default housing for mentally ill people for years. State officials have acknowledged problems that come with mixing mentally ill people with elderly people, but they have not taken decisive steps to correct the problems.

Concerns typically peaked with news reports about frail elderly people in adult cares homes being abused by mentally ill residents. Mentally ill people face problems in adult care homes, too, because many go without necessary treatment.

Under the settlement announced Thursday, the state must be able to house 3,000 people within eight years, using rental subsidies or government vouchers. The legislature set aside about $10 million to house 100 to 300 people this year.

The Justice Department’s report last year on its investigation was scathing. It said mentally ill people are isolated in adult care homes with no useful way to pass their days and little chance to control when they eat, sleep, or shop for necessities.

Vicki Smith, executive director of Disability Rights, called the agreement “a measured response.” Legislators had a hand in the settlement, which is evidence of the state’s commitment to it, she said.

“There really is an opportunity to finally get it right,” Smith said.

Dollar dissents

Adult care home operators were disappointed with the agreement, and a key legislator said he did not like it.

Rep. Nelson Dollar, a Cary Republican and House budget writer, said the agreement put too many restrictions on the state when it was already moving to address the housing issue. With the state’s recent progress, it would have been on firm footing defending a lawsuit, he said.

“Why should the Obama administration go after the state of North Carolina when we were already moving substantially in the direction the Department of Justice was requesting?” Dollar said.

This is just one of a wave of changes hitting the state’s adult care industry. The homes are undergoing a separate review that will result in their losing federal money if they house too many mentally ill residents. Residents of these homes will be the first to get information about community living from special teams.

Amy Hart, who runs two adult care homes near Charlotte, said residents who don’t want to leave adult care homes will be forced out if a home is over the limit. The housing the state agreed to provide in the first year won’t begin to take care of the need, she said.

“They’re going to be given all these choices, but not the choice to stay in the adult care home,” Hart said.

The agreement says residents will have the choice to stay in the adult care home or live on their own, but they’ll be visited by education teams telling them of their options. Lou Wilson, lobbyist for the N.C. Association (of) Long Term Care Facilities, said repeated visits by such teams can amount to coercion.

Wilson said she pushed the legislature unsuccessfully for years to provide mental health services to adult care residents.

“We will still have the hard-core mentally ill people in adult care homes with no support and no dollars to do it,” Wilson said.

Deby Dihoff, executive director of the National Alliance on Mental Illness – North Carolina, had a different concern. She said the settlement is a good outline for progress, but she worried that as legislators come and go, support for it will weaken.

“I’m afraid we won’t stay the course,” Dihoff said. “I’m afraid we won’t stick with it.”

Bonner: 919-829-4821

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