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By
Jeff Keller
Last
May, an adult home workgroup was established by Department
of Health Commissioner Dr. Antonia Novello at the direction
of Governor Pataki. The workgroup was prompted by a series
of articles in the New York Times documenting the abuse
and neglect of persons with mental illness in adult homes
in the New York City area. The three major components
of the workgroup were staff members from Health Department,
the Office of Mental Health, the Commission of Quality
of Care and the Office for the Aging, representatives
of the adult home industry, and adult home reform advocates,
including NAMI-NYS board members Florence Weil and Sherry
Grenz.
Last September, the workgroup made recommendations on
how to improve the care and quality of life of adult home
residents.
On November 26th, the heads of the four state agencies
involved in the workgroup presented the state’s
official response to the recommendations, outlining what
it intends to do. The state’s response indicated
a willingness to implement several of the major recommendations,
at least in principle. The agency heads gave absolutely
no indication of how much funding the state would commit
to accomplishing this, however. Nor did they indicate
any timeframes beyond a few preliminary deadlines. On
what NAMI believes to be the most vital issue, housing,
there was only a vague promise to form a task force.
Following are the workgroup’s major recommendations
and how the state responded to them.
Assessment
Providing adult home residents with the types of services
and housing they actually need depends, of course, on
knowing what those needs are. The workgroup estimates
that about half of the residents with mental illness should
be in other types of housing, for example, but a verifiable
number has yet to be determined.
The workgroup called for a needs assessment as a “critical
first step” in improving residents’ care and
quality of life.
Dr. Novello said the Department of Health is working with
the New York Presbyterian Health Care Network to design
an appropriate assessment tool, which should be ready
for use in “impacted homes” (where more than
25 percent of the residents are diagnosed with mental
illness) in December.
A Request for Applications from agencies interested in
conducting the assessment will be ready in January. The
plan is to start assessments in the impacted homes as
soon as possible and eventually assess all 36,000 of the
state’s adult home residents.
Medication Management
Poor medication management is ubiquitous in adult home
inspection reports. Horror stories about janitors trying
to hand out complex and powerful combinations of psychotropic
medications abound.
The workgroup outlined three different options to deal
with this serious problem. The preferred option relies
on licensed nursing staff to directly administer all medications.
Dr. Novello apparently has endorsed this option. She said
“nursing personnel” will be recruited to directly
administer medications (although it is unclear whether
that means all medications). She also said the deans of
state nursing schools have assured they can deliver the
number of nurses this will require. She also said that
a Request for Proposals form Home Care Agencies to carry
out such a program will be sent out in March. She did
not mention any other timeframe for the program.
Case Management
Unscrupulous adult home operators have been able to take
advantage of a very fragmented system of care for their
own benefit, providing an inordinate number of services
that profitable them, and not providing those that don’t,
to the great harm of the residents who need them.
The workgroup recommended that Independent Service Coordinator/Case
Managers are needed to ensure that residents with mental
illness get the services they need. The group endorsed
the Office of Mental Health’s “blended”
case management model, which uses both Intensive Case
Managers and Supportive Case Managers.
OMH Commissioner James Stone said both “professional
and peer case managers” will be put in impacted
homes. He said a Request for Proposals for the case managers
will go out “early next year.” He did not
give a timeframe for the introduction of the case managers,
say what type of case managers they would be or the caseload
each would be expected to handle. He said the contents
of the RFPs will depend upon the assessments.
Appropriate Housing
The adult home scandals are a direct result of deinstitutionalization.
Many thousands of current adult home residents were shunted
out the back door of psychiatric centers as they were
closed. The people were transferred, but not the care.
Proper housing with proper care is at the heart of the
matter. Estimating that about half of New York’s
adult home residents with mental illness are housed inappropriately,
the workgroup calls for the creation of 6,000 supported
and supportive housing units for these persons. As for
the remaining half, the workgroup recommended that adult
homes be allowed to have no more than 120 residents and
that they be reconfigured to provide better service.
Commissioner Stone said adult home residents with mental
illness do have housing at present, in the adult homes,
and it is difficult for the OMH to obtain housing (for
persons with mental illness) in New York City. He said
an inter-agency housing task force is being formed to
study the housing situation.
The housing task force will consider not only the needs
of adult residents but all persons with mental illness.
Members of the task force include the state Dormitory
Authority, Division of Housing and Community Renewal,
State Of New York Mortgage Agency, Housing Finance Agency,
Office of Temporary and Disability Assistance, Office
of Alcoholism and Substance Abuse Services, Department
Of Health, Office of Mental Health, Office of Mental Retardation
and Developmental Disabilities, Commission on Quality
of Care and the Office for the Aging. At present, there
is no information on who will head this task force, where
it will be housed, and what opportunities, if any, there
will be for advocates to participate in it.
Commissioner Novello said all new adult homes will not
be allowed to have more than 120 residents.
Legal Services
The role of legal services attorneys has been vital. They
can take adult home operators to court, which in several
cases has been the only way to correct egregious neglect
and exploitation. At present, only 2.5 legal services
attorneys advocate for the residents of 146 adult homes
in New York City and Long Island. NAMI-NYS has advocated
for at least 10 legal services attorneys dedicated to
adult homes statewide. Members of the workgroup have recommended
more legal services attorneys, even though the workgroup
itself was not given the responsibility to look at enforcement
issues.
Commission on Quality of Care Chairman Gary O’Brien
said “additional funding” will be available
for such legal services attorneys. He did not say how
much.
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