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July 30, 2019; ProPublica

Not long ago, NPQ noted that the failure to commit to care for residents with mental illness has helped make homelessness in Southern California a perpetual condition for at least 30 years. On the other side of the nation in New York City, an examination of what happened after a nonprofit blew the whistle on abuse and mistreatment in adult homes illustrates the challenge of caring for people with mental illness in a system that only seems to respond to crises resolved by lawsuits.

NPQ has written before about the nonprofit sector advocating for more resources to house people with mental illness in New York City. In 2014, changes to a New York state-city collaborative program created concerns among advocates for supportive housing that “the state largely failed to coordinate community mental health services.”

The subject of the ProPublica story began with a class-action lawsuit filed by disability rights advocates, which brought on 10 years of litigation culminating in a court order to independently evaluate residents to transition those who can and wish to live independently to subsidized apartments with supportive services. After the court order, negotiations ensued, ultimately leading to the 2014 rules, which were supposed to improve conditions for mentally ill New Yorkers.

NPQ warned when the original court order was issued in 2010 that although the legal order decreed that “people currently in the adult homes be transitioned to supported housing as quickly as possible,” implementation might stall or go awry because of the vested economic interest of the operators.

ProPublica’s coverage chronicles the failure to close the homes that neither provided adequate care to mentally ill adults nor moved residents to supportive housing. In other words, it documents in detail how NPQ’s prediction came true. The financial interest in keeping people with mental illness, each representing a payment from the state of $1,200 per month, in these homes won out over the court decree.

The state legislature also created another revenue source for the adult home industry in the form of the assisted living program, a subsidy to house older adults healthy enough to live independently outside of nursing homes. The new business model for adult homes to house mildly disabled adults while keeping a substantial population of mentally ill adults has proven lucrative.

Independent assessors’ efforts to transition those capable of living in supportive housing was subverted by adult home staff. Use of scare tactics, such as raising the specter of becoming homeless, has been documented. At one home, an administrator circulated a form letter stating the residents did not want to move, which 74 residents signed.

Thus, despite the stated goal to move 2,500 residents within four years of the settlement, five years later, only 800 have been transitioned. The article describes the overall lack of commitment from legislators, home operators, and the state government to abide by the decree. Legislators also received contributions from adult home operators, which might have reduced pressure for action even further.

It would seem that the only parties invested in implementing the court order were a former state deputy secretary of health, who negotiated the settlement, and presiding US District Judge Nicholas Garaufis. In any case, the court decree has proved insufficient to protect the interests of people with mental illness over the financial interests of adult homes. The case’s value might be in posing a question: what, then, would it take to ensure that a settlement benefiting patients with mental illness is carried out?—Kori Kanayama