Another recent case of patient w/ mental health problems waiting 5 days for bed:Community Hospital beds are not in place

excellent article from the Greensboro News & Record about another case of a person w/ mental health concerns being handcuffed to his bed for 5+ days re: no available beds.

Let's see: sheriff's fees (let's be modest: $10/ hour x 5 day$10 which is 24 x 5 x $10 = $1200. Don't forget the ER fee where money bleeds: let's assume a modest $500/ day which is $2500 for taking up a room in the local ER. That makes (very modestly assumed cost of): $3700.

It would be great if the news services could come up w/ the bill based on the cost of the ER room and the sheriff's fees.

If you do this again and again, its easy to see that its short-sited to have sheriff's sitting around in ER's w/ chained up patients----like something out of the Dark Ages-----

**********************
http://www.news-record.com/content/2009/05/30/article/mentally_ill_may_face_longer_stays_in_the_er

"...A committee of state legislators Thursday recommended a minimum 25 percent slash in the human services budget. The proposals, if enacted, include cuts that mental health officials say would deepen the crisis.

“We will have more (mentally ill) people in the emergency departments,” warned Michael Lancaster, chief of clinical policy for the N.C. Department of Health and Human Services.....

“This is just going to exacerbate the situation. We’re not going to be able to fund Mobile Crisis Teams, the ACT Teams,” Lancaster said of the community support programs potentially jeopardized by the health subcommittee’s cuts....

Though Pyrtle declined to give specifics about the 96-hour ER guard duty, he was no doubt referring to a commitment order served in early April on a young Eden man awaiting transfer at Morehead General Hospital.

Schizophrenic and off his medication, he needed treatment at a state hospital, but there were no beds available. As with the Cone patient, he was handcuffed to his bed under police guard.....

During the time the young man in Eden was waiting for hospital admission, the same pattern was being repeated elsewhere in the state.

According to an April patient delay list obtained by the News & Record for Cherry Hospital, a 274-bed facility in Goldsboro, admission wait times ran from four to 92 hours.....

Meanwhile, at Central Regional, which serves the Piedmont, 299 people could not be admitted during April, according to the HHS Web site, because the hospital was at capacity and operating on delay status.

Why the crunch?

The ostensible goal of mental health reform was to close the big state hospitals except for the most ill people and replace them with services in people’s home counties.

Toward the first goal, the state has eliminated 100 beds since 2007 and, in the governor’s proposed budget, would eliminate another 50 beds between Cherry and Broughton state hospitals.

The problem is that the community beds are not in place to meet the need — putting the cart before the horse and now overloading the cart.

“We’re now bringing people from all over the state to one hospital that was overcrowded by the time it was built,” Mike Weaver, Guilford chapter president of the National Alliance of the Mentally Ill, said of Central Regional, which opened last summer.

“The services in the community are not adequate, and there are not enough hospital beds. They blew it.”

Department of Health Service Regulation will not enforce the Family Care Homes law & Residents w/ Mental Health challenges go wanting

Marsha V. Hammond, PhDmy cell phone number: best times to reach me: afternoons: 404 964 5338
my e mail address: hammondmv@netzero.com

May 31, 2009

RE: why isn't Family Care Homes law enforced?

Dear Lou Morton of DHSR (within NC DHHS), regulatory agency over Family Care Homes in NC:

This is what I want to speak to Doug Barrick, the legislative liason (as I understand it) for DHSR about. Thank you for giving me his name. As per the e mails below this one, he is not responding to my requests for information about why the NC Family Care Homes law is not enforced or what needs to happen to make it enforceable.

Basically, here is the matter: I do not understand why the Family Care Homes law is so minimally enforced. The 'enforcer', essentially, is the local DSS. Also, local, is a DHSR office. It is not clear to me what the purpose of that office is given the difficulties of these residents to obtain any information and as related to my one plus inch file now of letters back from DSS Buncombe and DHSR in Raleigh stating that 'there's no evidence for your complaint.'

Buncombe DSS is dead busy, I realize. And Cheryl Simcox and her boss and other people associated with going out to the Family Care Home in question (WNC Homes, Asheville, NC) try to do their jobs, I realize. If I saw clients at other locations, I believe there would be some of the same problems but maybe not.

Nothing has improved or changed as associated w/ the meeting I had w/ DSS Buncombe, WNC administration, myself, the two local DHSR women, two months ago.

Are we going to have to ask the already overburdened Pisgal Legal Aide Services to sue WNC Homes for these back monies or can't DHSR and DSS Buncombe do what they have been determined to do? Or will Disability Rights NC pick up the case perhaps?

All the legal aide services including Disability Rights NC seem to understand that there are 'problems' w/ the Family Care Homes which house thousands of NC citizens who have mental & physical health problems and no where to go.

Ms. Morton: you indicatethat you believe there is a 'problem with the law.' I don't see this problem w/ the law; what I see is DSS Buncombe and DHSR NOT ENFORCING the law.

However, specific to the complaints, these are the specific problems and NOTHING has been solved which is apparently what Barbara Ryan believes as per an e mail she sent to me several weeks ago after the meeting at DSS Buncombe between myself, WNC administration, Simcox, and the local DHSR representatives :

1. Residents' mail is not given to them: residents' mail is taken and/ or never given to them (along these lines I have sent a registered letter on May 28, 2009 to ---, House # 12, 231 Country Time Lane, Leicester, NC----one of the houses for WNC Homes----it can only be delivered to him personally with he presenting his ID; if he does not receive this mail or it is returned to me because they say 'he's not home' when he IS at home, I will follow that matter up ). I paid $10 to have this letter sent to BRC just to see if he could receive mail. Obviously, I cannot do this for all mailings to residents. The letter I sent to him is a carbon copy of a letter we wrote and sent to Congressman Heath Shuler regarding the taking of federal monies e.g., the SSDI monies.

The mail of resident --- was taken by Jeff Clifton, administrator of WNC Homes, and passed around the DSS Buncombe county meeting room as per the meeting a couple of months ago and it had to do w/ my carbon copy to Pisgah legal aide Services as associated with his desire to regain his competency. Mr. Clifton passed it around with comments like: 'can you believe that this psychologist is trying to get this done?' and at that point I LEFT THE ROOM.

Here is the law from the Family Care Homes law:subchapter 13G – licensing of family care homes: http://ncrules.state.nc.us/ncac/title%2010a%20-%20health%20and%20human%20services/chapter%2013%20-%20nc%20medical%20care%20commission/subchapter%20g/subchapter%20g%20rules.html

10A NCAC 13G .0906 OTHER resident SERVICES

(b) Mail.

(1) Residents shall receive their mail promptly and it must be unopened unless there is a written, witnessed request authorizing management staff to open and read mail to the resident. This request must be recorded on Form DSS-1865, the Resident Register or the equivalent....

If WNC Homes has had its residents to sign this Form DSS 1865 or its equivalent, the residents with whom I have spoken and who are mentioned here, are not aware of it. At the very least, it seems that DSS Buncombe could verify to the resident(s) that they have signed this form and allow them an opportunity to 'unsign' it.

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

2. Distribution of money problems: residents cannot get a response on questions associated with their Personal Needs Allowance (PNA). specifically) When they write letters, they hear nothing back from Jeff Clifton or anyone else in the administration of WNC Homes. Why can't DHSR or Buncombe DSS f/u on this? When DSS Buncombe goes out to WNC Homes it appears they have as an agenda to speak to the SIC or Supervisor in Charge and the resident. I do not know what questions they are asking but they are not researching the matter such that any 'charges' can be made.

It is not my intention to bury WNC Homes; it is my intention to have the law enforced so that the civil rights of the residents are protected and their mental health can improve rather than constantly winding back around to violations of their civil rights.

I am told, in writing, by one of the Community Support Services workers for Direct Care LLC, that the residents---who have stated this to the CSS worker----- are AFRAID to say something to the DSS investigator because they are afraid of retaliation.

Problem A:

As re: that matter, --- Hse # 12, and I have written ANOTHER request for information on his back PNA monies. To make the matter even more complicated, Evergreen, who ran his home prior to that, did not give him his PNA. As DHSR and Buncombe DSS knows (they should) Evergreen left in a whirlwind of problems including the non payment of PNA's. Where is this resident's back PNA? And why can't DSS Buncombe follow this thru?

Problem B:

Another disability check matter: client CJW, unknown numbered house on Thurland Avenue (DHSR went out to see about this a couple of months ago; the resident has moved into a homeless shelter rather than have his money kept from him). This resident gave a two week notice in writing to WNC Homes/ Jeff Clifton. I wrote a letter w/ this man this past week to Simcox, indicating that Social Security had stated that his SSDI check had been scooped up by WNC Homes---his April, 2009 check, and it had not been returned to his SSA account. Why can't DHSR or Buncombe DSS follow this through?

Here is the Family Care Homes law:

http://ncrules.state.nc.us/ncac/title%2010a%20-%20health%20and%20human%20services/chapter%2013%20-%20nc%20medical%20care%20commission/subchapter%20g/subchapter%20g%20rules.html re: two week notice he gave to WNC Homes:

h) If a discharge is initiated by the resident or responsible person, the administrator may require up to a 14-day written notice from the resident or responsible person which means the resident or responsible person may be charged for the days of the required notice if notice is not given or if notice is given and the resident leaves before the end of the required notice period..

more details from the Family Care Homes law: 10A NCAC 13G .1103

ACCOUNTING FOR resident's PERSONAL FUNDS

(e) All or any portion of a resident's personal funds shall be available to the resident or his legal representative or payee upon request during regular office hours, except as provided in Rule .1105 of this Subchapter.

(f) The resident's personal needs allowance shall be credited to the resident's account within 24 hours of the check being deposited following endorsement.
*************************************
Here is recent responses between a helpful woman, Lou Morton, DHSR Raleigh, who some time speaking to me about a month ago. However, I have not been able to get in touch w/ this gentleman, Doug Barrick whom is described by Lou Morton as the legislative liason.

Ms. Morton indicates that she believes there is a 'problem with the law.' I don't see this problem w/ the law; what I see is DSS Buncombe and DHSR NOT ENFORCING the law.

----Original Message----From: hammondmv@netzero.comDate: May 30, 2009 3:12 To: "Lou Morton"Cc: Subj: what is Doug Barrick's ph number again?Hi Lou: I still have not heard from him. what's his number again?marsha hammond, phd
At 01:30 PM 5/31/2009 -0400, you wrote:
Doug,Dr. Hammond would like for you to get in touch with her. Please let me know when you speak with her.

Citizen w/ Mental Health Issues waits for EIGHT DAYS in the local ER before a bed in NC opens up

Man: it looks like a contest: which part of NC will go beyond EIGHT DAYS of a citizen waiting in the ER in order to get a mental health bed SOMEWHERE in NC?

Better yet, this is like re-working Dickens story about Tiny Tim : welcome to the Tale of the Future of mental health care as it drops yet another level ----yet to take place.

But I digress: back to the present: the poor schmuck, our very own Tiny Tim, I'm betting a state funded MH citizen: no insurance of any kind: Let's see: cost to the taxpayers, assuming that sheriff deputies get paid---let's be modest----$80/ shift x 3---that's $240/ day x 8 days = $1920.

KACHING.

Cost to the sanity of the citizen aka Tiny Tim? : PRICELESS. (yes, oh yes, I see how easy it is, Mr. Eudy of Capstrat---former NC Dem Party chairman---& maker of BCBSNC infomercials about why we don't need government sponsored health insurance like Medicare with its single digit administrative costs, to create those sound-byte commercials that just reach out and grab ya?)

Oh, you say, but right around the corner is universal health care? Naw: not if the insurance companies who just finished another round of padding the pockets of Congress-people have anything to say about that. There will NOT be any choice of Medicare vs the other crapola.

Hmm: looking at those 158 items that the NC House just put forward as necessary in order to cut items re: public mental health care in NC---are there any cuts in there pertaining to sheriff's?

I know the Gov'na lobbed off the Waynesville Detention Center in WNC----to bad----a nice new building too----where two of my clients indicate they keep the deep freeze on even in the winter so as you won't get too comfortable---and give you a thin blanket.

Sheriff's cuts, sheriff's cuts, let's see: what might be the profile of a poor schmuck who sat in the ER for 8 days awaiting a mental health public bed: I can speculate on a profile:

1. basically homeless or w/o a family to take care of him or capable of taking care of him/ her

2. didn't or couldn't get access to medication re: no Medicaid (bet the person was a state funded client or I'll eat my hat)

3. couldn't get access to therapy or f/u as there is a limit of 8 sessions / year/ person for state funded clients (if you even get that; as per Smoky Mountain Center LME, there is no individual therapy for state funded clients since Tom McDevitt, former CEO for SMC LME, so conveniently drove all the business to his bud, second in command at SMC LME, to Meridian Behavioral Health Services who scooped up the lion's share of ALL the state client funding in most of WNC)

*****************************
So, how about those funding cuts as re: this poor Tiny Tim of the future, in the world associated w/ these proposed cuts for 2009-2011?:

Oh, there's Item 17: close 50 beds at Broughton & Cherry Hospital----where assumably the ER person could have gone....but not if they did not have Medicaid......

And there's Item 74: reduction of rental subsidy (that's rent for people who have mental health issues---we're talking Section 8 housing & having access to Medicaid & Medicare via disability checks)...s/he could have been someone who had to choose between a place to live and medications....

Or Item 92: reducing aid to the county DSS's that can be points of contact for things like Food Stamps and heating oil (very small amount of money available for that and its first come/ first serve every fall).....s/he might be, in the future, someone who has to wait forever to get to services via the local county DSS....longer yet because of reductions in funding...

Or Item 111: reduction of case management support which might be instrumental for Tiny Tim in attempting to understand how to get any services at all, as a state funded client...

Read here, Mr. Bob Cratchitt, and peer into the future:

http://pulse.ncpolicywatch.org/wp-content/uploads/2009/05/hse-bdgt11.pdf

Community Support Services for people w/ Severe Persistent Mental Health to be eliminated?

My response to a Raleigh News & Observer article:

http://www.newsobserver.com/1565/story/1546434.html

Scrutinized NC health program would be eliminated
By GARY D. ROBERTSON - Associated Press Writer
Published: Thu, May. 28, 2009 06:23PM
RALEIGH, N.C. -- House budget writers rolled out deep health care cuts for the next two years Thursday, including one that would phase out a heavily scrutinized program that pays for non-medical care for mental health patients living at home.

The draft proposal by the House health and human services budget subcommittee would essentially eliminate the "community support" services program paid for through Medicaid. Lawmakers would direct state regulators to rebuild the program...."

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

"People appear not to understand the usefulness of Community Support Services (CSS). This is how CSS augments therapy. The psychologist or therapist is not able to take care of all the needs of the client. There may be needs associated w/ being able to get to medical appointments (not all cities have public transportation). Clients may not be able to get to work. Clients may have no capacity to get to the store. Clients may not be able to take part of a lot of matters such as NAMI meetings or NC Traumatic Brain Injury Association meetings or AA or NA. This is what CSS makes possible as pertaining to the improvement of lives. Self sufficiency is its agenda.

Take this away, and what you have is a lot of useless therapy addressing issues that need to be attended to and CANNOT be attended to.

Marsha V. Hammond, PhD: Licensed Psychologist, Asheville/ Waynesville, NCNC mental health reform blogspot: http://madame-defarge.blogspot/

158 Items:Mental Health Care Cuts put forward by House Health & Human Services Proposed Budget:2009-2011

Trimming the fat?---or cutting off your nose to spite your face somewhere down the road?

These are short-sited cuts. A better strategy would have been to go after more taxes from the corporations. HEY! YOU COULD START W/ BCBSNC! Naw, won't happen because Capstrat, headed by Eudy, former NC Dem Party Chairman, now creating adds for BCBSNC in order to block choice of government sponsored health insurance like Medicare, is right in the center of NC Dem Party and gee, we can't be rude to him, can we?

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

There are 158 items associated w/ suggested cuts put forward by the House Appropriations Subcommittee for Health & Human Services, 2009-2011.

These are some of the more notable ones pertaining to issues I have been keeping up with.

Here is the document: http://pulse.ncpolicywatch.org/wp-content/uploads/2009/05/hse-bdgt11.pdf

***********************************
1. Lots of loss of money and positions within NC DHHS. (This will only make my job harder)

2. LME's are to have funding cuts and loss of positions (This will only make my job harder and make me steer away even more pointedly from the state funded clients).

3. Non-core LME functions lose money (This means I won't have to speak to Meridian Behavioral Health Services aka Smoky Mountain Center LME-----they were supposed to privatize, remember?-----regarding trying to steer my Medicaid client into their Recovery Education Center----group therapy not led by particularly skillful people----which would have meant I could not bill Medicaid for therapy)

4. Lots of miscellaneous cuts to children and infant services. (This means that kids w/ problems will grow up to be adults with problems and then go to jail where we will pay for them there).

5. No more new local health departments (It appears that what is in place, stays in place; local health departments are used by indigent clients).

6. School health nurses will lose funding (This is another stop-gap measure which keeps people from getting sicker, particularly those w/o health insurance).

7. Item 72: No more Special Olympics, a source of pride in the Waynesville community, in particular.

8. Item 74: The Key Program, which works on housing subsidy has reductions (Does this mean that Tom McDevitt, formerly CEO of SMC LME, will get a salary reduction----since he's still running that SMC LME program----even though he was fired).

9. Item 77: reduces Weatherization Assistance Program (Its not clear to me if this means that indigent clients will get a break re: some of their heating fuel or not. If disabled clients are living in Section 8 housing, they can't have a wood stove and they can't have a functioning fire place. Therefore, they are stock w/ expensive heating fuel).

10. Item 92: Big $5 million cut to the DSS Public Assistance programs. (more problems w/ Food Stamps which are already way to little. Bring on more soup kitchens, I reckon.)

11. Eliminates 5 positions within Vocational Rehabilitation Services (as far as I can tell---and after years of working w/ Vocational Rehabilitation Services, they should just get rid of all VR Services. Other than paying me for assessments, I have seen very little benefit from VR Services over the past 10 years in either GA or NC).

12. Eliminates funding for Senior Center Outreach Program (I guess my elderly client won't get her Meals on Wheels anymore; I don't know what the link of Meals on Wheels is re: this, however).

13. Item 132: Establishes a $50 co pay for non-emergency visits to the emergency room. (Now how are they going to bill Medicaid for this? It won't happen and they will not be able to squeeze blood from the turnip of indigent clients who would not be going to the ER unless they really needed to).

14. Item 135: Medicaid cards will be printed quarterly and not monthly.

15. Item 136: Big $53 million saved here: Case management services will be consolidated throughout the Medicaid program.

16. Item 138: 4% reduction in Medicaid fees across providers (that means you will have less available mental health services).

17. Item 142: all providers must file Medicaid claims electronically (its the easiest billing I've ever done, for sure, via EDS that interfaces w/ NC Medicaid)

18. Item 143: reduces dental services within Medicaid (There are very few dentists that will take Medicaid as it is; therefore, people will just continue to lose their teeth and the dentists that create dentures will make more money).

19. Item 144: reduces funding for Hospice services (I know that Hospice is already cutting out things like physicians, using instead nurse practitioners; I assume that Hospice is fairly dependent on donations and as we know, there are fewer of those these days. ).

20. Item 154: Positions eliminated within Department of Health Service Regulations (this is the agency within NC DHHS that is SUPPOSED to regulate Family Care Homes; I have a one inch plus file of letters from them indicating that they never could find a basis for any of my 10+ paper complaints associated w/ WNC Homes and so hey! we can save paper too; I turned the case over to Congressman Shuler's office; I bet HE won't get downsized).

21. Increase of licensing fees (I guess that certainly means I will not be able to rejoin American Psychological Association for its whopping $500+/ year).

One piece of good news: Federal judge ruled that Broughton Hospital should not have had its accreditation revoked in 2007 which means that $8 million goes back into the pot from the Feds re: monies that were kept when Medicaid/ Medicare clients were in Broughton.

Family Care Home refuses to answer requests regarding Personal Needs Allowance assoc w/ Social Security check: CALLING CONGRESSMAN SHULER

FROM: Marsha V. Hammond, PhD: Clinical / Health Psychologist
NC License # 2748 e mail: hammondmv@netzero.com
Cell phone: 404 964 5338 FAX: 828

TO: Congressman Heath Shuler
356 Biltmore Ave., Suite 400. Asheville, NC 28801

RE: Social Security check monies not made available to recipient, B--: address: House # ---- WNC Homes -------Leicester, NC 28748-6213

May 24, 2009

Dear Congressman Shuler:

I am a clinical psychologist in Asheville, NC. I am writing to you regarding a client of mine, B--, who has given me permission to speak to you regarding the loss of his Medicaid regulated Personal Needs Allowance (PNA) as per his agreement w/ Western North Carolina Homes (the Family Care Home that provides him w/ food & shelter) in Leicester, NC.

I am sorry to trouble you with this but my client and I have been trying for six months to get some information on why he has not received PNA, for the most part, and we have gotten nowhere re: what has happened to his PNA as per the NC Regulatory Agency, Department of Regulatory Services, which oversees Family Care Homes in NC, as well as their local representative, DSS Buncombe County (Adult Protective Services, Family Care Homes, supervisor Cheryl Simcox).

Specific to that matter, I wrote a letter to WNC Homes (telephone number: administrator, Jeff Clifton, FAX: 254 4844; general telephone number: 828 808 3597) in December, 2008 and received no information. The client is followed by myself as well as receiving Community Support Services (CSS) via ---------------, an Endorsed Provider company as per Western Highlands Network LME. ------------ CSS worker, RH, called WNC Homes mid April, 2009, and received no answer.

Additionally, I have a one inch plus file now related to problems vis a vis clients/ residents associated w/ WNC Homes and over 10 letters back from DHRS and DSS Buncombe indicating that ‘nothing in error was found.’

So, in exasperation, and at the insistence of the client, I am asking you to investigate the thievery of federal monies pertaining to B--'s PNA which is what he receives BACK from his Social Security Disability check. WNC Homes is the current payee; this entitles them to manage his check but per Medicaid guidelines, they must give back to him $66/ month minus any co-pays for medications as is warranted by the pharmacy documentation.

Mr. C indicates to me that he has received his PNA less than a handful of times over the past two years, the length of time he has been living at WNC Homes (WNC Homes took over the same physical address formerly known as Evergreen Homes in August, 2008 and so prior to that time, the owners were different but according to Mr. C, they did not give him his Medicaid regulated $66 / month PNA either).

According to Family Care Homes law in NC, requests for clarification must be given when there is a request. And as I stated above, the client has requested verbally and I have requested in writing and RH via ----------------- the Endorsed Provider company, has asked via telephone calls to WNC Homes.

Can you please help this citizen to find out what has become of his PNA which are monies that are part of his Social Security Disability check? These are federal monies we are talking about here and so I believe that is within your purview.

Thanks for your assistance and if I can provide you w/ more information, I am glad to do so and have the permission of the client to do so.

NC Family Care Homes: mental health issues go unaddressed & providers are banned from premises: defacto mini-prisons

Marsha V. Hammond, PhD: Clinical / Health Licensed Psychologist, NC e mail: hammondmv@netzero.com cell: 404 964 5338 fax: 828 --------

May 13, 2009

Dear Doug Barrick, of Department of Health Service Regulations (regulating agency) within NC DHHS:

Thank you for reading this e mail letter. I appreciate your time.

I understand, as per Ms. Lou Morton, in the complaint department at the Department of Health Service Regulation (DHSR),the state agency which oversees Long Term Care (LTC) and more specific to what I am talking about, Family Care Homes, that you are the administrative liason between the NC state legislature & DHSR. If I am mistaken, please forward this e mail to the appropriate person or parties. Indeed, forward it to anyone you like.

I have seen clients at the WNC Family Care Homes for about a year and a half. Over that period of time, management has changed. When these homes morphed from Evergreen to WNC Homes in August, 2008, is when problems began re: working w/; that administration and specifically, Jeff Clifton, of that administration.

Specifically, all hell broke lose as clients complained to me about they not receiving their Personal Needs Allowance (PDA), a record which is demanded to be kept 'in the home' as per this law, within the Family Care Homes law:

"10A NCAC 13G .1103 ACCOUNTING FOR resident's PERSONAL FUNDS(a) To document a resident's receipt of the State-County Special Assistance personal needs allowance after payment of the cost of care, a statement shall be signed by the resident or marked by the resident with two witnesses' signatures. The statement shall be maintained in the home."

Since I like to solve problems rather than endlessly talk about them in therapy, the client and I, with the permission of the Supervisor in Charge, looked at the signed PNA sheet of paper in their charts which also included the documentation from the local pharmacy re: co-pays. Oh, Jeff Clifton did not like that at all because then the clients with concerns wrote letters asking about the absence of the PNA----letters which he never answered. And so we asked and asked.
And so he called the Buncombe sheriff's department at 7 pm one Sunday evening in February, 2009, and threatened me w/ arrest as I sat with a client rendering therapy.

The purpose of this letter is to ask you how to more exactingly apply the law or even change the law such that the mental health provider may interface efficiently with her clients in keeping w/ NC Mental Health Reform which has as an agenda the movement of mental health services out into the community.

This being said, prior to WNC Homes, there were times when the trash spilled out onto the lawn, the Supervisors in Charge were not paid (their statements), the residents did not receive their PNA, Personal Needs Allowance (what is left over after their co-pays for meds are paid and which is Medicaid 'law'....usually a sum of approx $44/ month), and days when there was no food in the house.

Since WNC Homes took over, there are still problems with residents not dependably receiving their PNA's and more than this, there is a concerted push to not cooperate with Community Support Services which, as you perhaps know, is a Service Definition associated w/ NC Mental Health Reform which was to have taken mental health services into the community. Thus, Brad Owen and Donald Reuss of Western Highlands Network LME (WHN: the old community mental health service people who are now administrators under NC Mental Health Reform) are cc'd in order to keep them updated on these continuing problems and the impact it makes on literally hundreds of clients who receive Medicare/ Medicaid services----which is part of what WHN LME oversees.

I have a one plus inch file now of complaints I have filed on WNC Homes, in February, March, April, 2009, which is regulated by DHSR and the management of that regulation is overseen by DSS Buncombe, specifically, Cheryl Simcox (she is cc'd here). None of these complaints have gone anywhere. The complaints range from: mail stolen; refusal to allow me to speak to my clients on the phone; non-cooperation in providing a ride to the client to appointments, etc.

Of note, the Family Care Home law: "Residents shall receive their mail promptly and it must be unopened unless there is a written, witnessed request authorizing management staff to open and read mail to the resident. This request must be recorded on Form DSS‑1865, the Resident Register or the equivalent;"

There are also HIPAA concerns re: opening of residents' mail. I am not idly stating that this has taken place. Indeed, Cheryl Simcox, her supervisor, Sara Tarpey who works directly w/ the matter of overseeing Family Care Homes in Buncombe county, and Buncombe DHSR employees WITNESSED this fact during a meeting at DSS Buncombe a couple of months ago when Jeff Clifton pulled out a letter I had sent ----in the mail----to a resident of the WNC Homes in Asheville, NC----in order to try and prove to the group in that room----as he had stolen and then copied my letter that had been sent in the US Mail to the resident----- that the schizophrenic resident had no right to ask for a rehearing of his mental competency and his ability to manage his own SSDI check. Since that time, I have continued to advance his desires vis a vis Pisgah Legal Services in Asheville, NC.

So, the proof is already there and was witnessed by about a dozen people during that meeting. Apparently, the resident has to plough ahead with the matter----no matter that he is now homeless and living in the local Mission shelter-----as he had had quite enough of having his mail stolen, etc.

My point: the investigative powers of DSS Buncombe are PITIFUL. Cannot something be done here? I know that DSS is busy and I am sorry to load up their plate w/ yet more work but the lack of ability to adequately investigate matters as per some protecol which allows the Family Care Homes to allow DSS to see what they want them to see is really unacceptable. I have 10+ letters indicating that 'nothing was found' as re: my complaints.

A director at DHSR, Barbara Ryan, wrote me a letter a couple of weeks ago which seemed to indicate that she thinks things are settled. They are decidedly not.

About a week ago, I received a helpful phone call from DHSR's complaint division, Lou Morton that 'our hands are tied' as re: the matter of me being banned from seeing my clients in their homes as 'it is private property.' She inferred that a 'change in the law' is necessary. Thus, I am writing my letter to you (and placing it on my blog) in order to outling whom in the NC State Legislature oversees this law or might be interested in advancing it? What is your role and that of DHSR as pertaining to such an interest?

This is not a request associated w/ just WNC Family Care Homes. There are tens of thousands of people w/ Severe Persistent Mental Health issues residing in these homes, many very rural, across NC. Thus, since we are talking about the law, I am also cc'ing the head attorney of Disability Rights NC.

Given the difficulty w/ working w/ WNC Homes, the Endorsed Provider company working w/ the residents receiving CSS has been advancing clients into Section 8 housing as it becomes available and given that they have mental health diagnoses, ,this housing can be found. This allows them to be more independent and CSS provides them w/ support to move into this role.
And they have more spending money in their pockets----more than $44/ month.

I am fairly familiar w/ the Family Care Home law (Subchapter 13G Licensing of Family Care Homes). I won't go into all the details, but basically here is the problem: I cannot go to this Family Care Home as I am banned from seeing my clients there.

Yes, WNC homes does have a van to take people to appointments. If I schedule clients/ residents to ride in the WNC van, given that the Leicester WNC homes is very rural, they literally sit in the van for hours while other people are carried around. I find it hard to believe that my time with them is that valuable. Clients/ residents who receive Community Support Services (CSS) are helpfully transported to my office in Asheville by the company offering those services. However, not every client receives CSS and thus they are denied mental health treatment (unless I want them to be subjected to hours of travelling around in a van; many of these people have chronic pain problems). In overviewing the Family Care Home law, as you know, these are the sections of that law:

1. overview of physical structure and licensing process
2. staff issues inclusive of qualifications/ training/ training
3. management/ co-administrator qualifications/ duties
4. resident assessment/ care plan; resident services
5. medication management/ self administration of meds, etc.
6. residents' personal funds & management of that
7. policies and procedures
8. use of physical restraints and alternatives
9. rating of the homes (assumably DHSR's role).

In terms of civil rights or residents' rights, here is the broad brush statment that seems to be completely overlooked as re: all these problems outlined above:

"10A NCAC 13G .0908 COOPERATION WITH CASE MANAGERSThe administrator shall cooperate with and assure the cooperation of facility staff with case managers in their provision of case management services to the appropriate residents. 10A NCAC 13G .0909

RESIDENT RIGHTS: A family care home shall assure that the rights of all residents guaranteed under G.S. 131D-21, Declaration of Residents' Rights, are maintained and may be exercised without hindrance."

I ASKED Buncombe DSS, in a letter to Cheryl Simcox, if, as a clinical psychologist, was I not to be accorded the minimal status of 'case manager' and I never received an answer.

I am asking DHSR to lend assistance to allowing mental health providers to see their clients at the Family Care Homes at the reasonable request of the resident/ client.

Otherwise, Mr. Barrick, what you have is a de facto mini-prison wherein the wardens declare what shall be the rules/ who shall make them/ who shall enforce them/ what they shall eat/ and whom can visit.

Sincerely,

Marsha V. Hammond, PhD

********************Here are the e mail addresses of the public officials & attorneys at the legal aid firms in NC who were forwarded this e mail:

lead attorney, Disability rights, NC: john.rittelmeyer@disabilityrightsnc.org,lou.morton@ncmail.net

Family Care Homes DSS Buncombe"Cheryl Simcox, APS, Buncombe DSS " cheryl.simcox@buncombecounty.org

"Barbara Ryan, chief investi Family HOmes " <Barbara.Ryan@ncmail.net>,

"Brad Owen WHN LME " <owen0752@westernhighlands.org>,

Piedmont Legal Services, lead attny: "Douglas Sea" dougs@lssp.org

Pisgah legal Aide services, Buncombe county, NC: anne@pisgahlegal.org

NC State Legislature, House: "Susan Fisher" Susanf@ncleg.net

NC State Legislature, Senate: "Martin Nesbitt" <martinn@ncleg.net>,"Martin Nesbitt" Nesbittla@ncleg.net

NC State Legislature, House: co-chair along w/ Nesbitt for Joint Legislative Oversight Committee for Mental Health Reform"Verla Insko" verlai@mindspring.com

"Nicole Dozier" Nicole@ncjustice.org

DSS Buncombe, Family Care Homes worker: "Sarah Tarpey, Adult Pro Serv, Buncom DSS " <sarah.tarpey@buncombecounty.org>

NC Department of Health Service Regulation, within NC DHHS: reportedly liason person w/ NC State Legislature: doug.barrick@ncmail.net