Administrators blame budget cuts for closing mental facilities all over North Carolina. The mental patients who now live in these places will be evicted to their families and the streets. It’s about to get Carolina Gone Wild. Details after the jump!
Emma Rabid
For years, North Carolina has been warned to take better care of its mentally ill residents. This summer, federal officials have declared they’re tired of waiting.
Federal agencies that provide substantial funding for services to people with mental illness say that far too many of them are living in adult care homes, and the agencies are threatening to stop paying the bills. Last month, the federal Department of Justice stepped in, saying the state has violated the Americans With Disabilities Act by failing to provide housing for mentally ill people other than institutions such as mental hospitals and adult care homes.
The Justice Department says it will sue the state if it doesn’t agree to find alternative housing.
The seemingly sudden standoff is a result of years of failed state mental health policy. And within months, it could force as many as 1,200 mentally ill people out of adult care homes. Those people live in 38 such homes that federal regulators say may be acting as mental institutions because more than half of their residents are there because of mental illnesses.
People with mental illnesses could be scattered to the streets, to homeless shelters and into emergency rooms as social workers and relatives scramble to find scarce beds in mental hospitals or in group homes.
Thousands more could join the exodus in years to come as the federal government forces the state to stop relying on adult care homes to house them.
State leaders are begging the feds for more time to sort through the crisis.
“It’s the perfect storm,” said Lanier Cansler, state secretary of health and human services. “We’re trying to figure out how not to have a catastrophe here.”
Cansler said he needs to meet with legislators when they reconvene in September to find money and get changes in the law to allow more flexibility in housing options.
Advocates for people with mental illness are worried that counties aren’t prepared to care for those who are displaced. Relatives of some residents in adult care homes fear the return of an instability they have battled for years. Adult care facility operators are panicked that their businesses will be forced to close.
And politicians are blaming their counterparts across the aisle for letting down a fragile population.
No one seems to have a solution that can roll out as quickly as it’s needed.
“This is the result of a decade of neglect,” said Vicki Smith, executive director of Disability Rights North Carolina, which has pushed the federal government to pressure state officials. “It’s all coming together right now, and it couldn’t be a worse time.”
Federal law requires that states ensure these citizens get the care they need locally, in the least restrictive setting possible. The state must now challenge the federal government’s findings or work furiously under federal supervision to create a community-based system of care.
This is a familiar story for North Carolina. In 2001, the state passed a broad reform bill aimed at providing more treatment in the community. But it forced county providers out of the business and turned the work over to for-profit companies, some of which charged far more and provided inferior care.
A News & Observer investigation and a resulting audit showed the state had wasted more than $400 million. And mental-health treatment deteriorated.
Now, the state is being forced to reconsider how it cares for the mentally ill. The most immediate issue involves the percentage of residents in adult care homes who are there because they are mentally ill.
Under federal guidelines, Medicaid can’t be used to fund institutions in which a majority of residents are ages 22 to 64 and are there because of mental illness. So far, the state has identified 38 facilities that may be in jeopardy; those homes are housing as many as 1,200 mentally ill residents aged 22 to 64.
The state will be visiting these residents and reviewing case files to determine whether they are there for a mental illness or some other medical issue. The feds will stop paying Medicaid to the residents at facilities found to be in violation, even for prescriptions and doctor visits.
And if the facilities don’t get in line, they could lose all Medicaid funding, even for residents who are elderly and have other disabilities.
Lou Wilson, a lobbyist for the North Carolina Associations of Long-Term Care Facilities, said this will be the financial ruin of many facilities.
“They don’t know where to go and what to do,” Wilson said. “They feel like they’ve taken care of these people when no one else would and that they’ve been good partners in North Carolina. They don’t like the way the state is treating them now.”
Rep. Nelson Dollar, a Wake County Republican, blamed Gov. Bev Perdue and other Democrats for letting the problem persist for years.
“It’s fair to say these issues have been out there for years, and the Democrats have been in charge,” said Dollar, who was chairman of the House appropriations committee that wrote the budget for the state Department of Health and Human Services.
“The governor kicked this can down the road, and the federal government won’t let us get away with it much longer.”
Perdue, however, had allocated $75 million in the budget she submitted to the Republican-controlled General Assembly this year to boost community based support, including housing, for the mentally ill. Legislators removed it from the budget as they tried to reconcile a $2.7 billion shortfall.
As politicians swapped blame, Jim Glenn of Charlotte drove each week to an adult care home in Mooresville to visit his 47-year-old son, oblivious to the brewing problem that could force his son back into the streets.
For more than two decades, Glenn, 73, had watched his son, James, struggle to find his place in the world.
James Glenn had his first break with reality in his mid-20s. Doctors diagnosed him with schizophrenia.
Ever since, the Glenns have been on a roller coaster. James spent time in psych wards. He lived on the streets and in jail cells.
Years ago, Jim Glenn found a place for his son in a group home near Charlotte, a smaller facility for people who need help but don’t require 24-hour supervision. But James vanished.
It took a year before a retired FBI agent hired by Glenn located James in Utah. Police had found him sleeping in an empty classroom on a college campus and locked him up. James Glenn couldn’t tell officers who he was and how he came to be there.
When Glenn got his son back home, he found a place for him in an adult care home, where aides are available around the clock. That was 15 years ago.
“These places fill a gap,” Glenn said. “My son is a step above being in a mental hospital and a step below being able to be in normal society.”
Aides give James Glenn his daily medicine and three meals a day. Glenn said he takes his son out to lunch once a week and brings him home for occasional weekend visits. He had stopped worrying about what would happen to his son when he dies.
Then, this summer, Glenn got a call from Amy Hart, administrator at Crown Colony, the adult care home where James lives. She called a meeting with relatives of her residents to warn them of the trouble stirring in Raleigh.
Both Crown Colony and another facility Hart runs, Hunters Village, are among the 38 adult care homes with substantial populations of mentally ill residents.
Hart didn’t want the residents and their families to be caught flat-footed. She told them to call their legislators and urged them to get on waiting lists at group homes.
As a girl, more than 30 years ago, when her parents ran an adult care home, Hart remembers talking to residents who had been sent there after being discharged from mental hospitals. Over the years, their numbers grew. Some never left.
“We are their home,” Hart said.
The state never asked for a count of residents with mental illnesses at these facilities.
If Hart’s mentally ill residents are evicted, she said, she will be forced to cut her staff by half. Even with that she’s not sure how long she can keep her doors open.
Advocates for the mentally ill say that even though some facilities are well-run and clean, it’s not the right place for people with mental illness. They receive no psychiatric care in the facility and no one is working to help them become more independent, said Smith of Disability Rights.
When Smith’s group visited facilities across the state last year, it found many residents with mental illnesses desperate to go home. Smith’s group said these residents are warehoused and often forgotten.
Now, state officials are being forced to see them, and find a place for them to go.
The state is asking Medicaid officials for more time to make the transition. Officials are coordinating with local mental health organizations and social workers to explore other placements. They know it will be difficult.
Glenn is just hoping it will all blow over and the state and feds will leave him and his son alone.
“They are playing poker with people’s lives,” he said. “They have no business.”
