New York City: Surf Manor Adult Home

New York, March 1, 2010 Update:

A federal judge issued a decision ordering New York State to create 4,500 units of supportive housing for people currently living in adult homes. The ruling issued today by Judge Nicholas G. Garaufis of the Federal District Court in Brooklyn ordered the state to develop at least 1,500 units of supported housing a year for three years. This ruling follows a September 2009 decision in which a judge ruled that adult homes were by their nature segregation and thus a violation of the Americans with Disabilities Act. You can read more about the decision and its impact here.

And you can read the article written by Jennifer Gonnerman about the adult home problem in the March 2010 issue of Mother Jones and here online.

The New York Times update is here.

*****************************

New York, September 8, 2009 Update:

Federal Judge Orders New York State to Move Adult Home Residents into Supported Community Housing

Decision Ends Decades of Warehousing People with Psychiatric Disabilities

*****************************

I've been visiting an adult home in Coney Island called Surf Manor; its residents live in small bedrooms, two to a room. It's one of many 200 bed-plus institutions peppered throughout New York City that are home to persons, many who have been diagnosed with mental illness, who have no where else to go.

These cramped rooms are nearly identical, but the people who live in them are highly individual.

In 2002, after a year-long investigation of adult homes in New York City, Clifford Levy of the New York Times wrote a Pulitzer Prize-winning series about the conditions of these privately run, for-profit facilities that house this forgotten population. Levy studied the adult homes that are referred to by the New York State Department of Health and the New York State Office of Mental Health as "impacted homes."

An impacted adult home is defined as one in which 25% or more of it's resident population has been diagnosed with mental illness. Today, nearly half of the people in the 52 licensed adult homes in New York City are living with mental illness. The adult home resident population remains cast out and disconnected from society, and their sense of disenfranchisement and isolation is palpable.

Adult homes were originally established to serve the elderly needing supervised living arrangements without nursing home care. According to Levy, when New York State began closing it's Psychiatric Hospitals in the 1960's, it was done with little planning of how it would house and treat the mentally ill. He believes that the state's motivation in closing the institutions was largely financial. Once de-institutionalized, the care of the mentally ill would still be regulated by the state, but it would be federally funded. Levy says that mental health programs that consumed about a third of the state's budget in the 1950's, now consume just two or three percent of the budget. Though ill-prepared to meet their needs, for-profit adult homes began to house a younger population of people with mental illness.

Levy's findings exposed assembly-line surgeries on consenting but uninformed residents, squalor, neglect, and far too many unexplained deaths. Though in a few cases the worst homes have been closed or management has changed, many of the unacceptable conditions persist. Currently, for example, about 90% of adult home bedrooms are without air-conditioning. It is not uncommon for residents who receive only $130 monthly of Supplemental Security Income to be required to pay the home's operator up to $125 monthly, or $250 for a 2 person bedroom, to receive in-room air conditioning.

For the many residents who suffer from cardiopulmonary conditions or take psychotropic medications, heat exposure can be fatal. As their bodies are less able to regulate and withstand high temperatures, these residents are highly susceptible to heat related illnesses. To escape the dangerous conditions, residents often compete for space to sleep in common areas, such as lobbies and recreational rooms.

After great effort on the part of the Coalition for the Institutionalized Aged and Disabled, the state has just made provisions for 2 of the estimated 7 million dollars that are needed to supplement the cost of air-conditioning in adult homes. Though a valuable start, this is still an inadequate effort by the state for the residents who will endure another summer without relief.

Adult home residents receive federally funded Supplemental Security Income which is paid to the home operator. If the home is impacted, by contract, the operator is required to serve the needs specific to this population. But, as reported by Vuka Stricevic from the advocacy group Community Access in 2004, in New York "12,586 people with psychiatric disabilities resided in adult homes; mostly under funded, overly large, for-profit facilities ill-equipped to offer rehabilitative services..and, too often, violate the most basic standards of adequate and dignified care." And adult homes are not health care facilities; regulations prohibit the operators from directly providing health care services or employing staff to provide health care services.

In conversation with CNN, Levy says

They were discharged from psychiatric wards, and they were pushed into this new system of care. It was the first time we had ever looked really closely at it, and in fact, the system has really escaped the scrutiny of a lot of its institutions, whether it's journalists or government or even advocacy groups.

What we found is that the state has basically put all these people in homes that are not mental health facilities that are not run by people with mental health training or staffed by people with mental health training.

As a result, the state has essentially created a whole network of de facto psychiatric hospitals but, in fact, they're not hospitals at all. They're just residential facilities.

Some of these places have 200 or 300 beds. They're larger than many of the remaining psychiatric hospitals in the United States, and as a result you have people who have enormous needs, who are being looked after by people with no skills to take care of the mentally ill.

In many of the impacted homes, institutional-like policies and regimens slowly erode personal autonomy and rob residents of their independence, individuality and decision-making power according to the Coalition for the Institutionalized Aged and Disabled. They point to residents' dependence upon a system that "neither meets their needs nor consults them on how their needs could best be met."