Opening Doors to Housing for the Mentally Ill
After years of waiting, people with mental health disabilities may start seeing some housing options for them, if a new legislative committee is successful.
By Rose Hoban
Four years ago, Nancy ended up in the hospital with pneumonia. While there, she received steroids to reduce the fluid accumulation in her lungs. The steroids made her psychotic, a common side effect.
Nancy’s case (she asked NCHN not to use her family name) was complicated by her history of bipolar disorder. She ended up staying in UNC Hospitals’ psychiatric unit for weeks, even though she was physically better.
And when it came time for Nancy to be discharged, she didn’t feel ready to go back to the house where she had lived independently for years. The only option Nancy was offered was to go to an adult care home near her Chapel Hill house.
She’s been there for four years.
Nancy’s predicament is of the nature that a new legislative group is pondering. Last week, the Housing Subcommittee of the Blue Ribbon Commission on Transitions to Community Living met for the first time to start the work of creating, over the coming decade, more than 3,000 housing units throughout the state for people with mental health problems. Those housing units will need to be accompanied by more community programs to help people with mental health problems stay out of the hospital.
“It’ll be a decade before we get to a level where we’re meeting community needs,” said state Sen. Ralph Hise (R-Spruce Pine), chair of the subcommittee.
Hise expressed his satisfaction after last week’s meeting, which brought together housing experts, bank representatives and mental health advocates.
The subcommittee fulfills part of an agreement North Carolina reached last month with the U.S. Department of Justice to resolve the state’s longstanding practice of housing people with mental health problems in adult care homes originally intended for frail seniors.
After an investigation, the DOJ determined that the practice violated the 1990 Americans with Disabilities Act. The state and the DOJ negotiated for a year before arriving at the August agreement, which also stipulates that North Carolina beef up community mental health services so that people like Nancy can eventually return to living independently.
“I managed my medications when I lived at home,” said Nancy, who said she would prefer to live at her house if she had some support.
“I don’t drive, so I have to have someone go grocery shopping for me,” she said, explaining that the arthritis in her knees limits her ability to get around and do activities such as deep cleaning. “I can keep track of my appointments, but I need help getting to them.”
No particular place to go
One of the first tasks for health officials is to create an inventory of housing options in the community for people who may be leaving a psychiatric hospital or who want to move from an adult care home or group home.
Under the agreement the state signed with the DOJ, housing options need to be integrated into the community surrounding them.
Martha Are, a housing expert from the state Department of Health and Human Services, showed the subcommittee a website maintained by the state with an inventory of currently available apartments and houses for low-income residents.
Are said there are about 4,500 units currently listed on the site. Landlords listing their properties can note whether they’d rent to low-income people with disabilities – physical or mental health – or to veterans, or victims of domestic violence.
“About 50 percent of landlords do select those categories,” Are told the subcommittee, “usually because they know someone in one of the categories and feel comfortable with the idea of leasing to them.”
Often, people with disabilities have poor credit histories or have police histories, Are explained. Landlords can check on a prospective tenant’s background and exclude them for those reasons without violating fair housing rules.
She said the Key program works with landlords to get them comfortable with renting to people who might not otherwise meet their criteria.
“We only have carrots with landlords, we have no stick.” Are told the committee. “We have to be aware of their concerns and we have to be aware of creating a program that they’ll participate in.”
The website has been funded for the past few years by federal stimulus money, which runs out soon. According to Beth Melcher, DHHS assistant secretary for mental health, developmental disabilities and substance abuse services, the department is looking for funds to keep it operating.
Are also outlined the state’s Key housing program, which pays landlords the difference between operating costs for a rental unit and the cost to rent one to a resident with a disability. Landlords building housing units get tax credits for setting aside a percentage of the units for use by people in the program.
“Key rental assistance is only given to individuals who are referred by a service provider who has committed to providing services to that individual,” Are said. “So when a developer receives the tax credits, they develop a targeting plan. They identify one service provider in their community to be the lead agency, usually the [mental health] local management agency. They promise to be the single point of contact.”
North Carolina has developed about 900 of the Key housing units over the past decade, but Are said most are occupied and turnover is rare. She admitted the state has many fewer subsidized housing units than what’s needed.
Another problem Are outlined to the committee is the fact that many of the federal programs providing funds for low-income housing require new units to be “disability neutral” – they cannot be set aside only for someone with a mental health problem.
Leveling the field for people in the community
One of the problems the DOJ had with North Carolina’s provision of services was that it was easier for people living in adult care homes to receive Medicaid reimbursement for help than it was for people living in their homes.
Under the old rules, residents needing assistance with one “activity of daily living” (bathing, eating, mobility, dressing or toileting) were eligible for Medicaid reimbursement for that help. But people who lived in their own homes – a cheaper option – needed to require help with two or more activities of daily living.
Under the Americans with Disabilities Act, services are supposed to be equally available to people living in their communities or in institutions.
“Unfortunately, we’re in a position where we’re not in compliance with [the law] set out,” Hise said. “We need to make sure we’re providing services in the least restrictive setting possible.”
Nancy said she’s aware of the settlement with the DOJ – she met with federal investigators when they were in the state in 2011, and brought them to her adult care home.
She said if she could get help with grocery shopping, transportation and cleaning, she’d be able to live more independently. She’s hoping the state creates some options for people like her soon. But for now, she’ll stay put.
“It’s not ideal; but for right now, it’s OK.” she said.