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Under threat of lawsuit, state crafts plan to house mentally ill

RALEIGH (AP) — North Carolina’s state health agency is moving ahead with the first step of a multi-year plan to help move potentially thousands of mentally ill residents from adult care homes to affordable housing and less restrictive living conditions.

The state Department of Health and Human Services publicized Thursday the action plan, which responds to allegations made a year ago by the U.S. Department of Justice that the state was failing to comply with the Americans with Disabilities Act. The government threatened to sue unless improvements were made.

The plan is a calculated risk for state officials because federal attorneys haven’t told them whether it’s enough to avoid litigation. That could require a judge-approved agreement with the federal government that may be more rigorous and expensive to carry out.

Government lawyers said in July 2011 that thousands of people with mental illness were segregated from society in adult care homes that had essentially become mental health treatment centers without giving them access to community treatment.

The plan, which will cost $10.3 million this fiscal year, will begin moving at least 100 residents with severe mental illness outside the homes to other community housing. Based on their income and ability to function, the displaced residents also will get help with paying rent, job training and potential employment.

The eight-year plan, which could cost a total of $67 million, would work to create 3,000 “slots” for people seeking a full slate of community services, acting HHS Secretary Al Delia said. The number of people that move could be much more because not everyone will need all of the offered services, Delia said.

Those who want to stay in adult care homes can remain there, he told The Associated Press.

“People will have choice,” Delia said in an interview. “They will not be required to live in any one place, whether it’s in a facility or in the community.”

The DOJ investigation followed a July 2010 complaint by an advocacy group that found hundreds of adult care homes statewide had improper conditions and lacked trained staff, creating a dangerous environment.

The General Assembly set aside money in this year’s budget to begin the transition, which has been the subject of months of talks with the Department of Justice. Delia described HHS and the federal government agreeing largely on the improvements being made.

HHS is “moving forward on implementation because we believe that it’s the right policy,” Delia said.

Vicki Smith with Disability Rights North Carolina, the group that leveled the 2010 complaint, said the plan sounds good on the surface but lacks a method to require the state to carry out the plan completely. Smith pointed out there’s less than six months before Gov. Beverly Perdue leaves office and another administration arrives.

“Many of the people who are issuing these promises will not be around even at the end of the first year to ensure implementation,” said Smith, adding that the state has fallen short of expectations in the past when it comes to mental health treatment.

“I just don’t think people with mental illness can recover from another failed promise,” Smith said.

The department said it still doesn’t have an accurate count of the number of mentally ill residents in homes. DOJ wrote in July 2011 that 5,800 people with mental illness live at 288 adult care homes with at least 20 beds where people with mental illness comprise at least 10 percent of the population.

The action plan is one solution to deal with intertwined legal and government challenges involving North Carolina’s adult care homes, whose residents include people with chronic health problems, Alzheimer’s disease or mental illness. The homes don’t have medically intensive services that are found in nursing homes.

The state budget also set aside another $40 million in part to provide assistance to adult care homes that aren’t expected to receive some Medicaid reimbursements when a streamlined policy for personal care services goes into effect soon.

The plan’s unveiling came on the 22nd anniversary of the signing of the Americans with Disabilities Act. The 2010 complaint by Disability Rights North Carolina also was filed on Thursday’s date.


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