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Blue ribbon commission takes on mental health housing

Posted September 5, 2012

A legislative committee today began sorting through how the state will move as many mentally ill people out of adult care homes as possible following a settlement with the U.S. Justice Department earlier this summer.

The Blue Commission on Transitions to Community Living doesn't have the power to make changes on its own, but is aimed at bringing together various government and industry interests, said Rep. Nelson Dollar, R-Wake, one of the committee's co-chairman.

"We believe it's important to pull together all the players in a way they haven't been before," Dollar said during a break in Tuesday's meeting. The commission includes representatives of adult care homes, housing advocates and mental health advocates as well as legislators as part of an effort to break down barriers between those various groups, he said. 

The mental health housing issue and ensuing settlement is complicated. But at its heart is a preference under federal law for mentally ill and mentally disabled people to live in the least-restrictive settings as possible. Earlier this year, the federal government found North Carolina had a bias toward housing people in group facilities rather than trying to find places for them in the community. 

Under the settlement, the state must aim to have 3,000 slots for the mentally ill to move out of adult care homes and back into their community by 2021, said N.C. Department of Health and Human Service General Counsel Emery Milliken.

The agreement is lengthy and the state has agreed to provide some specific services in order to meet its goals. For example, the state has agreed "in reach" to educate patients who are in institutional settings but may qualify to move back into the community, she said. 

And some things the state is already doing will fit with the plan. For example, "ACT" teams put together to respond to patients have a specific crisis will be useful as patients move back into the community.

"A lot of what's in this agreement are things that North Carolina currently does," she said. 

An outside monitor, hired by the state but approved by the federal government, will monitor efforts to to comply with the settlement. 

Meeting the terms of the settlement could cost as much as $287 million over eight years. That's money lawmakers didn't plan on spending when they put together their budget this year. And federal rules restrict how the state can pay for certain services or count what is an adult care home versus what is not.

"I guess we need to get elected to Congress to change some of this stuff," said Rep. Marilyn Avila, R-Wake, audible frustrated with limitations imposed by federal rules.

The Commission will do much of its work over the next two months as two separate committees. One will work on how the state can create housing opportunities for those who might be leaving adult care homes.

The other subcommittee will look at problems this transition could cause for the adult care industry, Dollar said.

"We have tens of thousands of individuals that are either impacted directly ... or who just live in those homes," Dollar said. 

Prior changes in state and federal rules have taken business away from businesses that provide personal care or case management services. Many of those have gone out of business or had to radically change how they work without help from the state government. Asked why adult care homes were of special concern, Dollar said it was because the homes provide for some of the most basic needs. 

"You're talking about basic housing, food," he said.

Still, there are other kinds of houses that serve those with mental disabilities.

"There's nothing in that (law that created the commission) that protects the group home industry in the state," said Julia Leggett, a lobbyist for the ARC of North Carolina. "Only one industry got a life preserver."

According to a schedule handed out at Tuesday's meeting, the commission is due to meet over the next four months and finish its work in January before the new legislative session begins in 2013. Dollar said it was possible the group could recommend new legislation, but he didn't know what that might entail. 

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