Tuesday, October 25, 2011

The Little Understood 'WHY' the Family Care Homes are Problematic for Those With Mental Health Challenges

Though I have not infrequently written about my experience, as a professional, with the family care homes in Western NC, I had not realized just what the issue was as to why NC DHHS (Medicaid) was being called on the carpet by the Department of Justice as pertaining to citizens w/ mental health challenges living in these homes. Apparently it has to do with the PERCENTAGE of people in the home who have PRIMARY mental health diagnoses.

The matter of 'primary' is very important as the profile of clients I have seen in family care homes have what you might expect from a life-time of living by their wits, best they could, and frequently have histories of childhood abuse and/ or neglect. These clients have BOTH physical and mental health issues. They commonly have chronic pain, diabetes, hypertension and then they have co-morbid depression, or other mood disorders or personality disorders that go along with living such a life.

So, HOW will these 'assessors' mentioned below in the NAMI article from the Fall, 2011 newsletter (see below), assess the clients as having a PRIMARY mental health issue, which is to say, this is the main and number one reason why they are in the family care home.

I am betting that this is the outcome of the matter: the 'assessor', depending on whether it is a mental health person or a allopathic medicine professional e.g., MD, Nurse Practitioner, Physician's Assistant, etc., will note----according to their expertise-----the primary illness. If I were NC DHHS, I would be hiring non-mental health professionals to assess these family care home residents.

I am betting that little will change in terms of where these people live because the method of assessment will have a hidden issue in it which is what are the professional qualifications of the person who does the assessment. Also bear in mind, as per the NAMI article, that the assessment is completely voluntary.

And I might imagine that most people having 'primary' mental health diagnoses will not want to be assessed because they are understandably suspicious of that and they do not want to be forced to leave unless they want to. And so, will those people who decline to be assessed simply be chalked up as having a 'primary' mental health or physical health diagnosis?

When I was a more brazen practitioner, I assisted clients in looking at their family care home charts to see 'what's happened to my money' (a frequent complaint) in that the residents are left with only $66 (yes, exactly that)/ month out of their disability check. There used to be more frequent complaints that they didn't get their money or they didn't know when they were going to get their money for that month, etc. That was my impetus for assisting the clients regarding the matter of 'where's money' and I have to say the quality of the family care homes has improved significantly over the past couple of years . They are generally more responsible people that run them and they act more professionally.

Complaints like mine surely made a difference as I carried them all the way to the regulatory agency of the family care homes.

See, for instance, one of these posts here: http://madame-defarge.blogspot.com/2009/04/wnc-family-care-homes-dss-buncombe.html

So, this is how the family care homes are paid:

1. the resident's disability check is taken by the family care home or rarely the client manages their own money and pays the family care home out of their check. Commonly, disability checks are anywhere from $650-850/ month----depending on whether the resident has 'vested' in the Social Security System or not. Bear in mind, that if the resident was mentally ill prior to turning 21 or perhaps 18, they could be utilizing the Social Security Number (and associated benefits) of a deceased parent's Social Security.

2. In that it costs approximately $1300/ month for living at the family care home----which is not a particularly bad deal given that they have a comfortable room, usually shared with someone else, a bigger family room where there is a TV, and food put on the table, as well as transportation to appointments----the remainder of the tab is picked up by the local county DSS. I assume that this is the problematic Medicaid money of which the article speaks.

3. out of the $66/ month that is by law given to the resident, they have to pay for medical co-pays and medication co-pays which for Medicaid are generally $3/ prescription. That leaves very little spending money as you can see.

The devil's in the details.

Here is the NAMI article:

"Adult care homes, originally designed as homes for the elderly and that now offer housing to people with mental illness, are being scrutinized byNorth Carolina because of a conflict with the federal regulations governing how the state pays for their care. Medicaid will not pay for care for the mentally ill in facilities that have more than half of the residents with a primary diagnosis of mental illness. Those residents woud have to be moved to other housing. There are now 52 facilities in North Caroina at that level. There is one in Western Carolina.

These homes and their residents will be assessed startig in the next few months. Cient assessment is done only w/ the client's permission.

Lanier Cansler, sec retary of DHS said. "We're working on this constantly. The problem is there's no easy solution."

Mental health organizations and advocates are concerned that some of the affected residents will end up in emergency rooms, jails, homeless shelters or on the street. this problem is yet another result of the state's mental health reform ten years ago. .....

Please contact the office of DHHS to voice your concern: contactmh@dhhs.nc.gov Subject Lines: Adult Care Homes/ Mental Health........"


And so, accordingly, I wrote this e mail to that e mail address today:


I note that there is an assessment taking place over the next several months----on a voluntary basis----of residents of family care homes that are deemed to have more than half the residents with a primary mental health diagnosis.

I have a couple of questions, when you get a moment:

1. What will be the status of the resident who does not want to engage in the assessment process, in that this is a voluntary process? More specifically, will their primary diagnosis be deemed to be what was already in their chart or will it be reassigned and on the basis of what criteria?

2. Who will be the assessors? Will they be mental health practitioners; will they be physicians, nurse practitioners? Will it be a team? Where are the rules/ regs regarding that assessment process.

Thanks for your hard work, NC DHHS.
Marsha V. Hammond, PhD


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