The five members – Republican Reps. Patrick T. McHenry, Sue Myrick, and Walter B. Jones and Democrats Mel Watt and Larry Kissell – signed a joint letter March 30 to Attorney General Eric Holder.

 
The letter notes that the U.S. Centers for Medicare and Medicaid Services have threatened to cut off Personal Care Services money to North Carolina on April 30.  The cutoff is the result of a long-running dispute over the state’s non-compliance with federal PCS rules.

 
The members say the federal action would result in 50,000 North Carolinians – including 30,000 adult-care home residents – being cut off “from their essential health care services.”

 
They concluded, “Therefore, we would urge an extension that would allow the PCS program to come into compliance while not sacrificing seniors’ access to much needed care.”

Click Here to view the letter

Sign our online petition to Governor Perdue!

North Carolina is facing an adult-care crisis.  The cost in human life and the economic impact will be larger than any storm that has hit our coast. 

 
This storm is the result of government inaction, blindness and bungling – in Raleigh and in Washington.
But the bureaucrats won’t have to pay the price.  It will be the people who live and work in North Carolina’s 1,200 adult-care homes.

 
The people living in adult-care homes are elderly or disabled.  They need around-the-clock help.

 
If something isn’t done, more than 30,000 residents of adult care (or assisted living) homes will lose their homes.   Another 30,000 Adult Care Home staff will lose their jobs.

Here is what has happened:

• For seven years, the federal government has warned the State of North Carolina that it must fix problems in the Personal Care Services program. (PCS is a Medicaid programs that pays adult-care homes to help residents with activities like eating, bathing, dressing, personal hygiene and other activities of daily living.)  
• But the state has done nothing.
• So now, the federal government says it will cut off all PCS money on April 30.
  

That would shut down most adult care homes in North Carolina!

Frankly, it’s hard to believe that the federal government – and President Obama’s administration – would punish 30,000 North Carolinians for the state’s inaction.

 
But that will happen – unless Washington gives the state more time to solve the problem.

What can you do?

1. Contact your member of Congress.  Tell them to urge the U.S. Department of Health and Human Services to extend the deadline for PCS services.
   • Click here to contact:
   • Office of the Governor
   • US Congress
   • To find your Representative in Congress, click here, and follow the directions below
   • There is a box at the top right hand corner. Enter your zip code to find your Representative.
   • Click here to view a contact list of US North Carolina Congressmen and US Congresswomen and Senators.
2. Contact Governor Perdue and urge her to request an extension of the deadline and develop a comprehensive plan to assure that adult care homes remain a viable industry.  
   • Click here to contact:
     Office of the Governor

The people in government work for you – and for your friends and relatives.  They need to hear from you!

The dire situation facing adult-care homes over mentally ill residents threatens to get even worse.

 
The N.C. Department of Health and Human Services now says 52 homes, up from the state’s previous estimate of 38, could face a disastrous loss of Medicaid funds. That would leave as many as 2,700 residents, including the mentally ill, with no place to go.

 
We are still analyzing this development.  It is not clear why the state dropped 10 homes from the original list, but came up with a new list of 52 homes that might be classified as Institutions for Mental Disease (IMDs).

 
If a home is determined to be an IMD, it will no longer be able to bill for personal care services for ANY residents – beginning that day. That includes all residents of all ages, no matter their diagnosis, age or condition.

 
The home wouldn’t have funds to pay staff to care for residents who are elderly, medically fragile, confused, has mental illness or are developmentally disabled.

 
We have also been told that:

• The federal government is unhappy with the “tone” that North Carolina is using to describe the pressure the feds are exerting on the state to make these changes. 
• The state has been notified that the final decision regarding IMD status is solely the responsibility of the North Carolina Medicaid agency.   

It is important to remember that no adult care home in North Carolina has been determined to be an IMD. In fact, ACHs licensed pursuant to Article I, Chapter 131D of the North Carolina General Statutes are expressly forbidden from admitting residents “for treatment of mental illness, or alcohol or drug abuse.”  No adult care home in North Carolina provides “care and treatment” for residents with mental disease. No adult care home is allowed to bill Medicaid for any Medicaid mental health service.

 
Therefore, we and our attorneys believe that if the state correctly applies the federal definition of IMD, no adult care home in North Carolina will be determined to be an IMD.

 
Again, we stand ready to work with DHHS, the Office of the North Carolina Attorney General as well as the General Assembly to on these critical issues. If you have questions, call me at 919-606-2533.

Once again, self-styled “patients’ advocates” are putting their political agenda ahead of the real needs of real people.
 

The latest example is a shrill and ill-informed attack on the “rest home industry” by Rob Schofield of NC Policy Watch.

 
http://www.ncpolicywatch.com/2011/08/24/a-%e2%80%9cperfect-storm%e2%80%9d-or-are-the-stars-aligning/print/

• Schofield calls adult-care homes “little more than warehouses in which people are ‘dealt with’ – i.e. kept out of sight and mind as virtual inmates.”
• He refers to our industry as “a powerful and politically-connected network of businesses that has figured out a way to make a lot of money off of these people.”
• He attacks our public-education efforts as “a political spin campaign.”

Finally, he attacks DHHS Secretary Lanier Cansler and the Perdue Administration for trying to address the problem.
 

Clearly, Schofield didn’t do his homework. He didn’t get the facts:

• That our homes take care of more than 6,000 mentally ill residents who otherwise might end up in jail, on the streets or in emergency rooms – or dead.
• That penalizing our homes for taking care of these people will jeopardize the other 34,000 aged and disabled residents we care for.

We have one question for Rob: If our industry is so “powerful and politically connected,” why have we for years been unable to persuade the legislature to increase the pitifully low rate of $58 a day that we get for caring for Medicaid residents 24/7/365?

Schofield’s essay reflects the bias of Disability Rights North Carolina, which presents itself as a patient-advocacy group. But the group’s agenda is to promote – during a budget crisis – a costly effort to provide in-home and community settings for all mentally ill persons.

 
That is a laudable goal. But North Carolina has never provided the funds it would cost, and it’s unlikely the money will be found now.

 
Disability Rights has pushed for federal intervention.  That could not only jeopardize the mentally ill population, but all of our residents.

North Carolina instead needs a thoughtful, open and unbiased debate about this issue. And our industry is ready, willing and eager to be part of a solution.

 
To read an objective and comprehensive exploration of this issue, we again commend you to the Page One article by Mandy Locke that ran in The News & Observer.

 
http://www.newsobserver.com/2011/08/14/1411893/mentally-ill-could-face-loss-of.html#ixzz1V7pbczcV

A hurricane watch was issued for North Carolina’s Outer Banks Thursday, and meteorologists expect the storm to shift west and possibly make landfall near Morehead City Saturday morning.

Evacuations have been ordered for all residents and visitors in Hyde and Dare counties, as well as for visitors in Currituck and Carteret counties. Residents of Bogue Banks in Carteret County must leave by 8 p.m. Friday. The two bridges to Bogue Banks will close then, officials said. Other counties may also call for evacuations; listen to your local news.

All AL and ACH staff needs to be on high alert even if you are not in the path of the storm. The storm is one of the largest storms to have threatened NC in decades. It is predicted that wind and flooding may stretch inward from the coast for well over 200 miles.

Be prepared: Be sure to have food and medications in the facility to last for at least three days. Keep the doors alarmed and asked residents to remain inside and stay safe. If you are in one of the eastern counties you may want to notify the Emergency Management Coordinator in your county and let them know where you are located and how many residents you have living at that location. If you need assistance to evacuate call the Local Emergency Management Office and ask for assistance.  I have attached a list of county emergency coordinators. County emergency coordinators should be able to give you information and numbers for Functional Support Services Coordinators who are stationed in the Red Cross Shelters if you need them. Also there is a link to emergency information and utilities emergency contact information.

 Stay safe and let NCALTCF know if we can help you and your residents in any emergency situation!

County-by-county emergency information

Utilities, emergency contact information

List of County Emergency Coordinators

A front-page article by Mandy Locke in The News & Observer and The Charlotte Observer Sunday http://www.newsobserver.com/2011/08/14/1411893/mentally-ill-could-face-loss-of.html#ixzz1V7pbczcV  spotlighted a dispute between North Carolina and the federal government that could have catastrophic consequences:

“The seemingly sudden standoff is a result of years of failed state mental health policy. And within months, it could force as many as 1,200 mentally ill people out of adult care homes. Those people live in 38 such homes that federal regulators say may be acting as mental institutions because more than half of their residents are there because of mental illnesses.

“People with mental illnesses could be scattered to the streets, to homeless shelters and into emergency rooms as social workers and relatives scramble to find scarce beds in mental hospitals or in group homes.”

For months, the North Carolina Association, Long Term Care Facilities has warned policymakers about this looming crisis.  We have asked the state to pressure the federal government for more time, and we have urged the state to bring together all interested parties to work out a long-term solution.

We hope the N&O story will help.

And we hope that adult-care homes will be recognized for stepping up and providing a viable housing option.  Our homes do all they can to provide a safe living environment for all residents, including those with mental illness, 24 hours a day, seven days a week.  We do that even though we receive a Medicaid reimbursement of just over $18 a day per resident.  

The Irresponsibility of Disability Rights

We also hope the article will expose the irresponsibility of Disability Rights North Carolina, which has pushed the federal government to pressure state officials.  Locke quoted Vicki Smith, executive director of DRNC, as saying: “It’s all coming together right now, and it couldn’t be a worse time.”

In fact, it’s all happening now because of DRNC.  They initiated a U.S. Department of Justice investigation by filing a complaint that was largely inaccurate.  Then they sent a letter to the Center for Medicaid and Medicare (CMS) asking them to investigate adult care home in North Carolina, accusing us of being IMD’s.  They have no plan.  They expect the state to fund individual housing and services for every mentally ill person living in an adult care home – even though the state is in an unprecedented budget crisis.

Disability Rights sits back, makes outrageous and unsupported claims and touches off a crisis.   Yet, they are not held accountable for placing their agenda above the needs of the very constituents they are supposed to represent. 

How many residents are they willing to allow to become homeless, jailed or institutionalized, just so Disability Rights can advance its goal of individual, scattered housing?

Putting Residents and Families First

The N&O article put this issue in context by talking to Jim Glenn of Charlotte, whose 47-year-old son is in an adult care home in Mooresville:

“For more than two decades, Glenn,73, had watched his son, James; struggle to find his place in the world.

“’These places fill a gap,’ Glenn said. ‘My son is a step above being in a mental hospital and a step below being able to be in normal society’.”

“When Glenn got his son back home, he found a place for him in an adult care home, where aides are available around the clock. That was 15 years ago.

“James Glenn had his first break with reality in his mid-20s. Doctors diagnosed him with schizophrenia.

“Ever since, the Glenns have been on a roller coaster. James spent time in psych wards. He lived on the streets and in jail cells.

“Years ago, Jim Glenn found a place for his son in a group home near Charlotte, a smaller facility for people who need help but don’t require 24-hour supervision. But James vanished.

“It took a year before a retired FBI agent hired by Glenn located James in Utah. Police had found him sleeping in an empty classroom on a college campus and locked him up. James Glenn couldn’t tell officers who he was and how he came to be there.

He concluded with words that the state and federal governments and Disability Rights North Carolina should heed:

“They are playing poker with people’s lives.  They have no business.”

HELPLESS AND HOMELESS . . . PEOPLE WITH MENTAL ILLNESS FACE MASS DISCHARGES FROM NC ADULT CARE HOMES
- D. Lee, Elder Rights Coordinator, The Outlook, July-September, 2011

Like villagers on isolated islands, NC young adults (under 50) living in adult care homes are, for the most part, unaware of the disaster waiting to strike in the next few months.  Director of NC Department of Health and Human Services (DHHS), Dr. Lanier Cansler, calls the situation a “perfect storm”, but there is nothing perfect about the likelihood that more than 1,500 PEOPLE will be displaced from their HOMES due only to their age, diagnosis, and the lack of appropriate services for people with mental illness in North Carolina.  These are PEOPLE with feelings and fears.  These are PEOPLE with little voice in what has happened to them along the path of their life.  There are men and women who are often wards of the state due to lack of family or other social support.  Now, these are PEOPLE who are helpless to fight back against the wave of change that is coming their way and PEOPLE who will be homeless since there is insufficient housing in which these PEOPLE can relocate.

Advocates have been working for several years to bring attention to the challenges faced by facilities that are “mixed populations”.  Both young and old, mentally ill and those experiencing the ravages of illness such as Alzheimer’s, Parkinson’s, and arthritis.  When the light was shown on this problem, never was there an idea that the solution would be to discard one group as if they were a disposable paper cup.  The lack of sufficient preparation and meaningful planning falls directly on the doorstep of DHHS.  Now, as the crisis approaches, the warning signals are blaring and the “villagers” have no life vests, no safety shelter, not emergency plan, no knight in shining armor to come to their rescue.  Shame on us for seeing the storm and not preparing for success.

In spite of the state’s lack of support, ACH owners all across North Carolina have been good partners with the state and have struggled to continue to provide quality services to people with mental illness due to the limited residential options available. ACHs have done this at the same time they have been vilified and maligned by the press, criticized by legislators and belittled by the advocates.

Now, 2011 brings a perfect storm that puts in jeopardy the financial stability of a number of adult care homes to continue the service. More importantly, it puts at risk thousands of residents being displaced in communities all across North Carolina.

As many as 1,200 North Carolina adults who are mentally ill could soon be put out of adult care homes when federal Medicaid regulators start enforcing an antiquated law called “Institution for Mental Disease.” The law does not allow facilities with 16 or more beds to have more than 50% of the residents with a mental illness. Federal Medicaid officials have given North Carolina two months to determine how many homes and residents will be affected.

Lou Wilson, Government Relations Director of, North Carolina Association of Long Term Care Facilities said, “This is just the beginning. The 1,200 identified individuals are the first to be at risk, but we predict that there will be a few thousand more when all is all said and done.”

Many residents of these facilities will lose their Medicaid benefits and will have no way to pay for much needed medications and doctors’ visits. Homes will no longer be able to receive Medicaid funds to provide care that is critical to the well-being of residents.

It took decades of neglect by policy makers and those in leadership in North Carolina to reach this crisis situation. It cannot be resolved in two short months. North Carolina must have time to develop a comprehensive plan to stop this likely catastrophe that jeopardizes the health and safety of thousand of mentally ill citizens in our state.

The North Carolina Association, Long Term Care Facilities and Friends of Adult Care Homes call on Governor Perdue to address this looming crisis by seeking assistance to delay this action, all the way to the White House if necessary, to keep our residents safe and out of harm’s way.

Help get our message out to the Governor by contacting her office at:

Office of the Governor
Constituent Services Office
116 West Jones Street
Raleigh, North Carolina 27603
Phone: (800) 662-7952 or (919) 733-2391
Email: governor.office@nc.gov

Please read today’s article from the Raleigh News & Observer regarding this looming crisis:

Mentally ill could lose housing in adult care centers
BY THOMAS GOLDSMITH AND MICHAEL BIESECKER - Staff Writers
PUBLISHED IN: HEALTH/SCIENCE, JUNE 10, 2011

RALEIGH - As many as 1,200 North Carolina adults who are mentally ill could soon be put out of rest homes and assisted living centers, as federal Medicaid regulators start enforcing a long-standing law that prohibits housing too many such residents alongside elderly people.

When more than half of the residents of an adult care home have a primary diagnosis of mental illness, it becomes what federal regulators term an “institution of mental disease.” By law, patients in such facilities don’t qualify for the Medicaid benefits now paying for much of their care.

Lanier Cansler, secretary of the state Department of Health and Human Services, said Thursday that dozens of adult care homes in the state could be forced to close and their residents sent away with few options for a new place to stay.

“There’s a lot of fear out there among people in these facilities that … they are going be dumped out of the street,” Cansler said.

Losing the Medicaid contribution to residents’ housing would cost about $9 million a year. The state predicts beds won’t be available for at least half of those to be discharged.

Though Cansler has described the looming crisis as a “perfect storm,” advocates for the mentally ill and operators of adult care homes say they have long warned the state about the issue.

Vicki Smith, director of the advocacy group Disability Rights North Carolina, said the problem is a direct result of the failed 2001 effort to reform the state’s mental health system by closing hundreds of beds in government-run psychiatric hospitals in favor of private outpatient services that in many cases have yet to materialize.

“They’ve been warned, but they deferred taking the hard steps needed to appropriately invest in the state’s community-based infrastructure,” Smith said. “And now it is going to come home in a really devastating way.”

Federal Medicaid officials have given North Carolina two months to gauge the depth of the problem. Cansler said state mental health officials are working to lessen the consequences of the change by finding appropriate housing for some residents and lowering the number of residents at other facilities below the federal threshold.

40 facilities affected

The law, which applies to centers that house more than 16 people, will affect about 40 facilities in North Carolina that house about 1,200 residents.

“You are going to have a lot of facilities that have more residents than are allowed,” said Mary Bethel, a state AARP lobbyist. “They are going to have to find other placement options for these individuals. And they aren’t the kind of individual that facilities are clamoring to take.”

For years, adult care home operators and advocates for the mentally ill have warned the state about the dangers of mixing older people with medical problems in the same facilities as younger people with such serious illnesses as bipolar disorder and schizophrenia.

But with a shortage of private psychiatric hospitals that will take Medicaid patients and long waiting lists for the remaining state mental hospitals, there are few remaining options for thousands of people with severe mental illnesses.

Last year, after four residents of adult care homes with mental illness were murdered in separate violent incidents, Disability Rights filed a complaint about substandard conditions in some of the facilities with the U.S. Justice Department. The resulting investigation is under way.

Options are limited

Lou Wilson, a lobbyist for the adult care industry, sent a letter to legislators this week saying the operators of the homes have been put in a tough spot.

“In spite of the state’s lack of support, owners all across North Carolina have been good partners with the state and struggled to continue to provide quality services to people with mental illness because there are limited residential options available,” Wilson wrote.

Under current state policy, when a resident leaves an adult care home, a team that includes facility staff, family members and social workers is supposed to collaborate to find the person a new home.

But legislation now moving through the General Assembly would relieve private facilities from finding a safe, secure new setting for residents being discharged. Supported by the industry, the measure passed the state House overwhelmingly Tuesday and will likely head to a vote in the Senate within the next week.

Smith said there is little doubt where many of the hundreds of people being discharged from the adult care homes will end up.

“The state isn’t prepared for this, and there are few options,” Smith said. “People will be sent home, if they have a home to go to. We’ll see people ending up in emergency rooms. The state hospitals won’t be able to handle the volume, and ultimately the jails will swell. It is a terrible crisis.”

thomas.goldsmith@newsobserver.com or 919-829-8929

The budget would cut Medicaid payments for Alzheimer’s beds by $210 a month and all other beds by about $20 a month.  The current Medicaid rates are already so low, many in the industry are forced to borrow money to provide the services residents need and deserve.

Lou Wilson, the legislative liaison for The North Carolina Association of Long Term Care Facilities, said:

“Twenty dollars a month for every resident might not seem much to the Senate, but for many adult care homes, it could be the difference between staying in business and closing their doors.

“These are small businesses that must pay cash on delivery for food, pay the electricity bill to keep the heat and air conditioning on, buy gas to take residents to their doctors and pay the interest on their bank loans. These facilities get less than $60 a day to provide housing and care 24 hours a day, seven days a week.

“What’s worse, these cuts would come on top of the burden that our residents and homes are being put at risk by the state’s ill-conceived plans to move thousands of mentally-ill residents from the facilities with no real homes to go to.

“The people who live in adult care homes have been short-changed by the legislature for years, even when the state had money to spend.  We had hoped that the new legislative leadership would bring a new attitude.  But the Senate budget does not.

“The House budget avoided cuts in adult care.  We deeply appreciate that.  But the Senate will continue the legislature’s long-standing neglect of adult care residents.  And its proposed cuts would jeopardize these residents’ health and safety.

“This is shameful neglect.  We have warned legislative leaders of the consequences.  We will make sure that our residents and their families and friends know the consequences of the Senate’s action.

“The people of North Carolina do not want to see disabled people and older people suffer neglect, lose the only homes they have and face unsafe and uncertain futures.  We urge the House to stand firm, and we encourage the full Senate to reverse these disastrous cuts.”

T.L. was in an adult care home in Buncombe County.  A patient-advocacy group persuaded him to move into an apartment.  He was promised help managing his medications and getting a job, psychiatric care and food stamps.  But none of that happened.  Within three days, he fell into a cycle of not eating and abusing drugs and alcohol.  He returned to the adult care home for help when he began to feel suicidal, and then left again.  He had to be involuntarily committed to a psychiatric hospital.  He was discharged to a substance-abuse facility despite warnings from the adult care home staff that he was not stable.  He fled to South Carolina where he beat his father and was arrested.  He was sent to a state mental hospital there and then released.  At last report, he is back and forth between the street, mental hospitals and various treatment facilities.

Mr. G, who was in his early sixties but looked much older, had been back and forth between the streets and state hospitals more than 40 times.  He arrived at an adult care home in Asheville in 2005, and he quickly settled into the routine there.  Two years later he had to be sent to a nursing home because he needed more care.  He later returned to the adult care home.  In 2009, Mr. G was arrested on an old warrant for trespassing.  The adult care facility’s operations manager gave the arresting officer his business card so the facility could be contacted when Mr. G was released.  But the facility was not called when Mr. G was released from jail to the streets with only his medication.  He was beaten and robbed.  Then came a period of several months in which he bounced between jail, emergency rooms and the street.  During one stay in jail Mr. G suffered a seizure and was taken to the hospital where he was discovered to need surgery because he had trouble swallowing.  But the surgery was repeatedly delayed because Mr. G’s cognitive problems made him appear to be drunk.  The adult care facility sought to help him even though he no longer lived in the facility.  Finally, the facility was able to arrange the surgery and have him moved to a skilled care facility.  He receives regular visits from the only family he has: the staff and management of the adult care home.

E.M., who had a history of arrests and substance abuse, had settled into a healthy routine at an adult care facility for several years.  Then his girlfriend persuaded him to move to Charlotte.  The facility staff warned that the move would not be wise, but the state’s ombudsman strongly encouraged the move.   Early this month, the facility staff got a call from his girlfriend’s sister.  E.M. was off his medications, out of control and using drugs.  E.M. himself called to say he couldn’t “hold it together” and heard voices telling him to do bad things.  The facility staffer urged him to get to a hospital for help.  He went to the emergency room, but left and may now be living on the streets.

These stories dramatize the complex problems that face mentally ill people in North Carolina who need care and treatment but often end up in jail, in hospitals, on the streets or living under bridges.  Often they end up in one of the state’s approximately 1,200 assisted living homes.

Patient-advocacy groups such as Disability Rights North Carolina are well-intentioned, but their determination to put mentally ill people in two- or three-bed settings is unrealistic.  Many of the mentally ill people who live in adult care homes need health monitoring, supervision, constant assistance with medication management and extensive support for basic survival. The cost to the state to wrap 24-hour services around many of these needy people will be in the hundreds of millions of dollars and will be felt by state taxpayers for years to come. The simple fact is that the State of North Carolina has never spent sufficient funds to provide services for the mentally ill.

Now, a combination of ill-informed actions by advocacy groups and a lack of planning by the State threaten to put out into the streets or jail or emergency rooms thousands more residents of adult care homes across North Carolina.

Here is what is happening:

• The State is preparing to assess the needs of an estimated 1,200 residents of 38 selected assisted living facilities.  If more than 50 percent of an individual facility’s residents are found to have mental illness, the facility will be designated an “Institution for Mental Disease” and thus no longer eligible for Medicaid for those residents.
• Those individuals will be discharged due to a lack of funds to pay for their services.  
• There are no good options for where they will go.

In addition, the state now is planning to require all 1,200 adult care homes to sign letters stating that fewer than 50 percent of their residents have mental illnesses.  If more than 50 percent of a facility’s residents do have a mental illness, the facility will lose its Medicaid funding until the residents with mental illness are discharged.

This raises the threat of thousands of mentally ill patients being discharged from 1,200 adult care homes in the weeks and months to come.  This is a serious, urgent crisis facing our state!

In addition, the loss of Medicaid funds will jeopardize the finances of the assisted living homes.  Some may close.  What will happen then to their other residents?

What should be done?

The North Carolina Association, Long Term Care Facilities and Friends of Adult Care Homes call on Governor Perdue, the General Assembly, the N.C. Department of Health and Human Services and Disability Rights North Carolina to sit down together and develop a comprehensive solution.  Today’s combination of good intentions and unintended consequences jeopardizes the health and safety of thousands of mentally ill citizens in our state – as well as the jobs and economic security of thousands of assisted living employees who want to take care of those citizens.

The assisted living industry stands ready to work with the state and with all interested parties to find a solution to this urgent, looming crisis – and to protect the health and safety of North Carolinians suffering from mental illness.