Weekly Briefing

Time for the Governor to do the right thing with “adult care homes”

She should work with advocates for persons with disabilities; not fight them

As was discussed at length in this space in 2010 and again this past summer, North Carolina has reached an important moment in the decades-old battle to end the warehousing of people with mental illness and other mental disabilities.

Here is a brief refresher on the problem as it stands:

Federal law has long commanded states to deinstitutionalize persons with mental illness; it’s illegal to use federal money to gather up such individuals and lock them away in big hospitals as was the favored practice during the last century. According to the law, persons with mental illness must be provided with services that allow them to live as normal lives as possible in community-based settings.

Not surprisingly, pulling off such a feat is challenging. Mental illness is complicated and every individual and family is different. Resources and housing are scarce– especially in this era of shrinking public budgets.

Unfortunately, rather than tackling the problem head-on in a systematic fashion, the state of North Carolina has generally looked for quick fixes. For some time, the state has housed as many as 8,000 individuals in “adult care homes” or “rest homes.” This industry originally arose to provide a basic place to live for elderly adults of modest income. The facilities are typically of moderate size and located in rural, out-of-the-way places in which land costs are lower. Though the facilities don’t provide much in the way of services, they do give people a place in out of the rain and food to eat. They’re also generally good at getting people to take their medications regularly.

While these facilities can be somewhat less institutional than giant, centralized state hospitals, they clearly fall way short of what federal law requires. By any honest assessment, they are little more than warehouses in which people are “dealt with” – i.e. kept out of sight and mind as virtual inmates.

Where things stand

Thanks to the emergence of a tough and independent advocacy group known as Disability Rights NC and the welcome assistance of the federal government, it’s increasingly clear that North Carolina will simply no longer be permitted to get away with this practice.

In recent months, as a result of a DRNC complaint, federal officials have informed the state that it must, once and for all, move decisively to create a new and positive direction in its treatment of these vulnerable populations. This is from a WRAL.com story in late July:

“Adult care homes are institutional settings that segregate residents from the community and impede residents’ interactions with people who do not have disabilities,” Assistant Attorney General Thomas E. Perez says the letter, dated July 28 and sent to Attorney General Roy Cooper.

Keeping the mentally ill in adult care homes violates the Americans with Disabilities Act, Perez said. The state not only places the mentally ill in such homes, but encourages them financially to stay there instead of going to communities by providing about $550 to those who live in adult care centers, the letter said

As the close of 2011 draws near, the state of North Carolina is faced with simple and straightforward choice: fight the federal government and disability rights advocates in court in an ill-conceived and almost assuredly doomed effort to preserve the flawed status quo OR work with the same parties to move aggressively to create a new and better system of housing and services.

According to reports percolating through state government, Governor Perdue is currently mulling this very question – should she fight or work things out? A decision could come this week.

Settlement” does not mean “surrender”

Let’s hope fervently that the Governor opts to work with advocates rather than fight them. Making such a choice does not mean that she would be committing the state to some kind of mysterious and ruinously expensive bureaucratic program. To the contrary, there are plenty of examples of how to provide lawful and appropriate housing to the people in question and ample evidence that such a move could save the state money in the long run.

As we noted this past summer:

“Other states (Delaware for example) have entered into step-by-step, court-supervised plans of action to transition away from the practice of warehousing people unlawfully.

Though certainly formidable in its size and scope, North Carolina’s problem is subject to similar treatment. Think about it: If there are roughly 8,000 individuals in need of improved services, that’s less than one for every 1,000 North Carolinians. Times are tight, but North Carolina can clearly do what’s necessary to help 8,000 people.

With a concrete plan and determined action, the state is certainly capable of whittling away at this number – maybe not tomorrow, but certainly within 12 to 24 months. It’s mostly a matter of putting some people in charge of the process and giving them a mandate, the staff and funding to get the job done.

And certainly, no one has to be discharged to ‘the street.’

Some people could graduate to smaller, community-based group homes. With the right subsidies and services, (lots of which already exist) many could actually live independently. The key is to develop a mechanism for assuring the individualized care that people require.”

It should be noted further that North Carolina already has mechanisms at its disposal for subsidizing rents in (and even constructing) affordable, community-based homes for people with special needs. The North Carolina Housing Finance Agency, for instance, has a record of great success in this area. There are other such programs and models. It’s just a matter of getting pointed in the right direction and shoving off

Put simply, it boils down to this: Governor Perdue is approaching another important crossroads moment in the history of her administration. With this single decision she can: a) improve the lives of thousands of people by sounding the death knell for decades of failed policy and further establish herself as an innovative and forward-looking political leader or, b) stick her head in the sand and drag out an unnecessary court battle that will put the state of North Carolina at odds with the Obama Administration and on the wrong side of history.

The choice ought to be obvious.