MHW: Housing Agreement Ends 10-Year Battle for NYC Adult-Home Residents with SMI

Housing Agreement Ends 10-Year Battle for NYC Adult-Home Residents with SMI
Mental Health Weekly - July 29, 2013

New York mental health advocates who fought for a decade against the state for segregating people with serious mental illness in adult homes and not in the most integrated settings are heartened that a July 22 settlement agreement of a 10-year lawsuit challenging this action will mean supported housing for those residents, along with community-based services and supports to promote their full participation in the community.

The U.S. Department of Justice (DOJ) and the U.S. Attorney’s Office for the Eastern District of New York announced the comprehensive settlement agreement with the state of New York under the Americans with Disabilities Act (ADA). According to court documents, more than 4,000 consumers with serious mental illness currently reside in adult homes in New York City.

“Under the agreement, the state will develop at least 2,000 units of scattered site supported housing for adult-home residents with serious mental illness, and as many more units as are necessary to ensure that all residents with serious mental illness who are qualified for supported housing have the opportunity to receive it,” Jennifer Mathis, director of programs at the Bazelon Center for Mental Health Law, which supported the plaintiffs, told MHW.

Mathis added, “At least 2,500 individuals must have transitioned out of adult homes within four years. By the end of five years, all of the requirements of the agreement must be met.” While the agreement is a compromise, the plaintiffs believe that if it is implemented properly, it will enable virtually all adult-home residents with serious mental illnesses to obtain and succeed in supported housing if they would like to do so, said Mathis.

The state will also ensure that these individuals will receive the services that they need to succeed in supported housing, said Mathis. The settlement ensures that the residents will have the opportunity to live in their own homes. Under the agreement, service community services and supports include, but are not limited to, care coordination, psychiatric rehabilitation services, home healthcare, employment and Assertive Community Treatment (ACT).

The agreement may have national implications, said Mathis. “The New York from page 1 agreement resolves an issue that has been litigated for more than 10 years,” she said. “The Disability Advocates case was the foundation upon which much of the subsequent Olmstead litigation has been based, and its successful resolution is important in the larger scheme of Olmstead enforcement.”

Meanwhile, the U.S. Senate Health, Education, Labor and Pensions (HELP) Committee on July 18 released an in-depth report about the way state service systems continue to support the needless segregation of people with disabilities. In 2003, Disability Advocates, Inc. had filed a lawsuit, Disability Advocates v. Pataki (former New York Gov. George Pataki), alleging that New York City adult homes, which housed former psychiatric hospital patients, lack the staff, resources or mandate to provide integrated housings and services to promote community living (see timeline of events below).

U.S. District Judge Nicholas G. Garaufis ruled in 2009 that the state discriminated against more than 4,000 people with psychiatric disabilities in adult homes by not serving them in the most integrated setting (see MHW, Sept. 14, 2009).

Three years later a Court of Appeals ruled on April 6, 2012, that Disability Advocates, Inc. did not have the “standing” to bring a lawsuit against New York state for segregating people with mental illness in adult homes despite that historic ruling three years prior (see MHW, April 16, 2012).

“We have taken over a year to resolve this complex matter,” Cliff Zucker, executive director of Disability Rights New York (formerly Disability Advocates Inc.), said about last year’s ruling. “[Gov. Andrew] Cuomo’s administration really recognized the plight of adult-home residents with mental illness and wanted to do something about it. We think it’s a fair settlement. We’re pleased with it.” The entire process has been a “long haul,” added Zucker, who filed the initial lawsuit in 2003.

“Adult home residents every year have held a lobby day to try to get their voices heard in Albany. Their voices have finally been heard, and 4,000 of them will have a chance to live in the community. The state is committed to create as much supportive housing as needed.” The settlement agreement has been filed with the U.S. District Court for the Eastern District of New York for the court’s approval. “The next steps are that the district court will hold a fairness hearing,” Zucker said. “The judge [Garaufis] will hopefully approve the settlement.”

Advocates pleased

“This is historic,” Glenn Liebman, CEO of the Mental Health Association in New York State, Inc. (MHANYS), told MHW. “For many years, adults in New York City have lived in conditions that are second class and deplorable.” Some of the city’s adult homes are okay, but for thousands of adult-home residents, they’re more like institutional settings versus independent housing, he said.

“We are going to see a dramatic shift in the direction of independent [community living],” said Liebman. “This really is groundbreaking; this is not a piecemeal approach. This is real systemic change.” The agreement calls for a comprehensive assessment of each NYC adult-home resident by Health Homes and Managed Long Term Care Plans (MCLTCPs) to determine housing and service needs and preferences.

Liebman said MHANYS will continue its outreach efforts to ensure that the assessments are conducted in a way that shows individuals can have an opportunity to live in the community, he said. “We want to make sure that they know about all the housing options that are available to them,” said Liebman. “The more housing options are available, the more someone recovers.”

“Although the lawsuit was confined to New York City adult-home residents, we expect the case to set a precedent across New York state, including Long Island and upstate, and to have ramifications across the country,” Harvey Rosenthal, executive director of the New York Association of Psychiatric Rehabilitation Services, Inc. (NYAPRS), told MHW.

Rosenthal is a member of the New York State Coalition for Adult Home Reform, established during the Pataki administration. “We had been stymied for years by an administration not committed to life in the community for adult-home residents,” he said, also citing the administrations of former Govs. Eliot Spitzer and David Paterson.

He added, “We’re grateful Gov. Cuomo, in three years, has undertaken long-awaited major initiatives: overhauling the Medicaid system; downsizing and reconfiguring state hospitals [see MHW, July 22] and the adult-home settlement.”

Advocates also credit the systemic efforts by the DOJ to encourage states, such as Georgia and Oregon, to move people with disabilities into the most integrated settings, he said. The governor has just appointed Rosenthal, Liebman and Kate Breslin, president and CEO of the Schuyler Center for Analysis and Advocacy (SCAA), to the Workgroup for Transitional Adult Home Regulation, a retooling of sorts of a previous workgroup formed a number of years ago to advocate on behalf of residents to improve quality in the adult homes and exit plans for those residents who were ready to leave.

“We expect through this workgroup to play an advisory role and follow up on the next steps in the settlement,” said Rosenthal.

Timeline: A brief recap of events involving adult homes in NYC

  • 2002: New York Times publishes “Broken Homes,” by Clifford Levy, a scathing series of articles that brings the public’s attention to suspicious deaths and inhumane conditions in adult homes.
  • 2002: Gov. George Pataki appoints an adult care facility workgroup to evaluate the strengths and weaknesses of adult homes in New York City. The workgroup submits a report to Department of Health Commissioner Antonio C. Novello, M.D., in October 2002.
  • 2003: Disability Advocates, Inc. files a lawsuit, Disability Advocates, Inc. v. Pataki, under the Americans with Disabilities Act (ADA) and the Rehabilitation Act, on behalf of disabled residents of large New York adult homes. Plaintiffs were joined by the Bazelon Center for Mental Health Law.
  • 2009: U.S. District Judge Nicholas G. Garaufis rules on Sept. 8, 2009, that the state discriminated against more than 4,000 people with psychiatric disabilities by placing them in adult homes and not serving them in the most integrated settings.
  • 2010: The Eastern District Court of New York orders the state to afford all qualified residents an opportunity to move into supported housing.
  • 2012: The U.S. Court of Appeals vacates the ruling that New York’s practice of segregating more than 4,000 people with mental illness in large adult homes constitutes discrimination and violates the ADA.