admin @ Sun, 2006-09-03 11:00
Specialized services for mentally ill people are expensive. The state in 1999 offered rest homes the option of setting up special wings for residents with Alzheimer's, dementia or mental illness.But lawmakers didn't supply more money to pay for the higher staffing levels needed; few centers, beyond those catering to private-pay clients, took advantage.
A state-backed research group last year recommended spending $2.4 million a year to hire 37 specialists to teach rest home staffers how to handle mentally ill residents. But state lawmakers haven't yet followed through.
A comprehensive solution "is clearly something I think that many people are committed to working toward," said Bonnie Morell, an official with the N.C. Division of Mental Health. "But it's very difficult to change the status quo."
The problem won't be fixed without money for adding and training staff, said Lou Wilson, executive director of the N.C. Association of Long Term Care Facilities. She pointed to another state-sponsored study that showed state, federal and county governments would need to spend as much as $198 million to upgrade staffing and care.
State lawmakers next month will begin offering higher reimbursements to homes for Alzheimer's patients. That's commendable, Wilson said, and homes will be able to hire more staff to keep a closer eye on those residents.
"The state knows of this problem. You would have to live under a rock in North Carolina to not know of it," she said. "It's time they got a handle on it."
The problem appears particularly acute at the Unique Living facility near Fallston, about 50 miles northwest of Charlotte. "What makes Unique Living so unique is that 76 of 77 who were there had some mental illness," Cleveland's DSS director Wasson said, referring to the last census of the home.
A worker was criminally charged with verbally and physically abusing a resident, but the state said the home failed to report it. The outcome of the criminal case couldn't be determined.
And a convicted sex offender was accused of raping a fellow resident on the mentally disabled woman's first day there. Criminal charges were later dropped against him, but the state said the woman failed to get appropriate care and supervision.
"We are at an impasse with this facility and believe that it is only a matter of time before other residents are abused, neglected, or exploited," Wasson wrote to the state in April 2000.
The residents they spoke to ranged from 22 to 84 years old. Most were dealing with schizophrenia, mental retardation or personality disorders. Many showed psychotic thinking, the report states. Mental health workers visited twice a week.
Some of the residents also wore tattered or dirty clothing, the report stated. Others wore inappropriate items, such as a winter coat on a hot and humid day.
Investigators found the residents were "not engaged in any kind of meaningful activity for long periods of the day." The residents said they were bored.
Investigators noted other problems. About a dozen mobile homes on the property were not regulated by the state, the county DSS or any government agency.
Yelton's and regulators considered the homes to be rental property that happened to be on the site of an adult-care center, according to documents from that time. But county officials said the homes functioned as an extension of the center, with residents moving there if they had been "good." They continued to get food and medicine from the main facility.
Those residents were cared for by Yelton's, but no agency had authority to make sure they were being treated properly. Meanwhile, the mentally ill residents in the main building weren't getting specialized activities or care for their mental health needs either because the home was an adult-care center.
The 2000 investigation gave state officials a chance to change the home -- and a chance to seek broader reforms. The team who visited Yelton's said the problems there weren't isolated to that center.The mental health team asked the state to come up with another way of licensing adult-care homes to provide shelter, services and treatment to large groups of mentally ill patients.
But the state said it didn't have a way to address a large facility such as Yelton's. It could allow small group homes of two to five residents, or large psychiatric hospitals for people in immediate and short-term crises.
In March 2005, Yelton's Health Care closed. The former owners' programming director, their son and his longtime girlfriend opened a new adult-care center in the same building on the same day. They kept the same residents and the same phone number.
Since then, the facility has had no serious violations or penalties. However, neighbors say little has changed. Residents continue to wander the neighborhood at all hours, knocking on doors. One resident routinely simulates sex acts on trees near the local church.
Investigations into his death are under way. Now county DSS officials and patient advocates are again trying to persuade the state to change the system.
The state and county Social Services departments regulate adult-care homes and public money funds many residents' bills. The state can fine the homes, suspend admissions or -- in the most serious cases -- revoke licenses. It has closed five homes since 2001.
North Carolina also has more than 300 nursing homes. Nursing homes provide care for those with greater medical needs and face state and federal oversight.
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