Adult home ruling (warning: long and boring)

in part, this success follows the series NYT did on the subject a few years ago.

NYAPRS Note: The following article is found in the Sept. 14th edition of Mental Health Weekly and covers last weeks exciting news that U.S. District Judge Nicholas G. Garaufis has ruled in favor of New York’s Adult Home residents by ruling that New York State discriminated against more than 4,000 people with psychiatric disabilities by placing them in adult homes and therefore not serving the residents in the “most integrated setting”.

This is great news and advocates are hoping that Governor Paterson, New York’s first Governor with a disability, will take advantage of this historic ruling by concretely planning for the movement of residents out of the homes.

To this end, disability advocates across the state are preparing to launch full scale advocacy efforts that include letter writing campaigns, sending thousands of postcards to the Governor, phone calls, releasing countless statements to the media, and meeting with government officials all in an effort to push the state to comply with the decision and at long last give New York’s adult home residents the opportunity to live in the community.

We will keep you posted on this developing story and keep you informed on how you can join thousands of New Yorkers in these important efforts.


Federal Court Rules N.Y. Discriminated Against Adult Home Residents With MI
Mental Health Weekly September 14th 2009

In a decision that could have national implications for the enforcement of integrated settings for consumers with mental illness, a U.S. District Court judge ruled last week that New York state had discriminated against more than 4,000 consumers with mental illness by placing them in adult homes.

On September 8, U.S. District Judge Nicholas G. Garaufis in a 210-page opinion ruled that New York had violated the Americans with Disabilities Act (ADA) and the U.S. Supreme Court’s Olmstead decision by unnecessarily segregating 4,300 adult home residents with mental illness. In his decision, Garaufis ruled that adult homes are “segregated institutional settings that impede integration in the community and foster learned helplessness.”

The Judge’s decision indicates that the plaintiffs have proven that all of the 4,300 adult home residents qualify for supported housing. According to court documents, the state has until Oct. 23 to develop a remedial plan to enable the residents to receive services in the state’s supported housing program.

The decision, which followed a five-week trial in May and June, culminates years and for some groups decades, of work by disability rights and mental health advocates on behalf of adult home residents with psychiatric disabilities.

The lawsuit, Disability Advocates, Inc. v. Paterson, alleged that the controversial adult homes, which house former psychiatric hospital patients, lack the staff, resources or mandate to provide integrated housing and services to promote community living.

Disability Advocates, Inc., an Albany, N.Y.–based nonprofit organization that provides legal representation and advocacy on behalf of individuals with disabilities in New York, filed the federal lawsuit July 1, 2003 (see MHW, July 14, 2003).

The suit was brought against then-Gov. George Pataki, the New York Department of Health (DOH), and the New York State Office of Mental Health (OMH). The Judge David L. Bazelon Center for Mental Health Law served as co-counsel in the lawsuit.

Adult homes are for-profit residential care facilities licensed by the state of New York that were initially created for the elderly. New York City’s adult homes became the subject of much scrutiny following a series of articles in The New York Times, which called attention to widespread abuse and neglect in the homes (see MHW, May 20, 2002, July 29, 2002, and Dec. 16, 2002).

The federal court held that Disability Advocates Inc. has proven that virtually all its constituents are qualified to receive services in supported housing, a far more integrated setting in which individuals with mental illness live in apartments throughout the community and receive flexible support services as needed.

Does the decision mean adult residents with mental illness are to be transitioned to supported housing? Observers say that a remedy has yet to be proposed by the state and by the court. The court held that New York does not have a comprehensive or effective plan to enable adult home residents with mental illness to move to supported housing. The plaintiffs, meanwhile, have set guidelines that would require the development of at least 1,500 supported housing beds per year until such time as there are sufficient supported housing beds for residents who desire such housing, according to court documents.

According to court documents, the evidence demonstrates that serving the constituents in supported housing rather than adult homes would not increase costs to the state.
Additionally, the court held that the defendants are required under New York law “to develop a comprehensive, integrated system of treatment and rehabilitative services for the mentally ill.” New York state had denied thousands of individuals with mental illness in New York City the opportunity to receive services in the most integrated setting appropriate to their needs, according to court documents.

Jill Daniels, spokesperson for the Office of Mental Health, told MHW that the court’s decision is still under review and the department has no immediate comment at this time.

Holding The State Accountable
“This case really is the first to address in detail how the state is responsible [under] ADA for administering a service system for people that would provide opportunities for them to live in an integrated setting,” Jennifer Mathis, deputy legal director for the Bazelon Center, told MHW.

“The decision is significant because it is a thorough, detailed, and well-reasoned decision that will have broad ripple effects across the country,” Mathis said. “It lays out in an understandable way what the Olmstead decision means and what it means in the context of facilities that are not a traditional public institution, like a state hospital, for example.”

She added, “This is one of the most comprehensive and detailed Olmstead decisions ever.” Adult homes essentially became “dumping grounds” for people with mental illness when the state started actively downsizing state hospitals but had not developed sufficient community services for individuals who were being discharged,
Mathis said.

The state had argued that it had a comprehensive and effective plan based on a series of steps that it had taken, including downsizing state hospitals, developing supported housing for people with mental illness, adding case managers to some of the adult homes, and making adult home residents a priority for certain supported housing beds beginning in 2005, she said.

“The court found that there was no evidence that these various efforts were effective in affording adult home resident the chance to move to supported housing,” she said. Meanwhile, the state has to come up with a working plan in October that will involve assisting adult home residents with mental illness into court-ordered supported housing, Cliff Zucker, executive director of Disability Advocates, Inc., told MHW. The plaintiffs will critique the plan in November, before the judge issues an injunction, he said.

Added Zucker: “This case will very likely be the impetus for similar litigation to [assist] people statewide who are removed from psychiatric institutions into nursing homes, or ‘board and care’ housing or other institutionalized settings that are not the most integrated, appropriate settings.”

While there are more than 12,000 people throughout New York state with psychiatric disabilities living in adult homes, the lawsuit focused on the 4,300 residents in New York City.

The decision will likely affect the other residents, he said. “This decision has will help residents of adult homes who have mental illness achieve a full and rich life in the community,” Zucker said.

Advocates Weigh In
“Our constituency is excited and thrilled over the judge’s ruling,” said Geoff Lieberman, executive director of the Coalition of Institutionalized Aged and Disabled (CIAD), told MHW. “It’s a vindication of many of the things we’ve been saying and fighting for, for many, many years.” Established in 1973, CIAD has spent much of the past 15 years working on adult home advocacy.

Lieberman added, this [decision] could be the beginning of the eventual demise of the need for our organization.”

In the wake of the Times investigative report on adult homes, then-Gov. Pataki had established an adult home work group, involving stakeholders that included adult home operations, state officials, advocates and consumers. They issued a report that estimated that about 50 percent of the 12,000 adult home residents could live in independent settings, Lieberman said.

Case management services subsequently became available to some of the adult home residents as a result of the work group’s recommendations. However, that and the 60-bed housing unit the state legislature supported for adult home residents, “doesn’t amount to the far reaching reform that the judge’s decision provides,” he said.

“Harvey Rosenthal, executive director of the New York Association for Psychiatric Rehabilitation Services (NYAPRS), told MHW in an interview last week following the court’s ruling. “This has been a long time coming. It caps a decade of advocacy in New York by many advocates.” “The decision is going to have “reverberating national consequences,” he said. It is the first major legal decision to hold a state legally accountable for enforcing Olmstead and moving people forward.”

Rosenthal noted that some observers might point to the eroding economy and wonder where funding might come from to support this decision. A number of potential funding streams might include a combination of monies from the health department, Medicaid, grants and state aid, he said.

Karen Schimke, president and chief executive of the Schuyler Center for Analysis and Advocacy (SCAA) in New York, said while the organization was very pleased with the court’s decision, there is always the prospect of an appeal.

Schimke was part of the adult reform workgroup established by Pataki and said she had been involved with adult home reform since the 1970s. She recalls a time when it was common in these homes for medications literally to be kept in a fish bowl on a dining room table for residents to take whenever they felt the inkling to do so.

New York state officials “failed to provide leadership and failed to act” on the issue, she said. “That’s why we would be so disappointed if they appeal this decision. The state of New York has a real opportunity to right a wrong that has gone on for 30 years. It’s their moral obligation to do so.”