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Nazareth, Pa., United States

Monday, August 09, 2010

With Closure of ASH, Group Homes Need More Scrutiny

When Allentown State Hospital shuts its doors for the last time at the end of this year, it will be the third state mental health hospital to close since 2006. As developers pick away at its 217-acre carcass, the sickest patients will be transferred to Wernersville. The rest are coming back to the community. Lehigh and Northampton Counties are scrambling to find new homes for approximately eighty local residents. Group homes. But how can eighty people, who were institutionalized for their illness, suddenly be well enough to be re-introduced into the community?

Northampton County Mental Health Administrator Kathleen Kelly is already increasing the number of group homes housing the mentally ill, from from four to seven. (The County maintains another 39 group homes for people with different disabilities). Hanover Township Supervisors, told by their Solicitor that the Fair Housing Act gives them little choice, have already approved a home for six mentally ill residents along Airport Road. Bethlehem's Zoning Hearing Board is considering a similar proposal to house another eight people at 943 Monocacy Street, located just one block from Moravian College and William Penn Elementary School. That home will also include four "day visitors" who live in nearby apartments.

According to the state DPW, the mentally ill "are best served in community settings through an array of services and supports." Community home providers are quick to jump on that bandwagon. But so are mental health professionals. "[P]eople with even the most serious mental illnesses, including those with the least relief from their symptoms, can be served much more effectively in the community than within the walls of a state institution," says Sue Walther, Executive Director of Pennsylvania's Mental Health Association.

This "deinstitutionalization" movement - moving people from mental hospitals into neighborhoods - began back in the 1960s, a reaction to the horrific conditions prevalent in many state institutions, including nearby Chester County's Pennhurst State School and Hospital, where mentally and physically disabled children were routinely abused. Mental patient census has declined in Pennsylvania from 4,934 to 1,627 as of 6/30/09. But as state hospitals fade away, will the same abuses and neglect begin to appear in group homes for the mentally ill?

That's exactly what happened in New York, where state institutions began closing over twenty years ago. A 2002 New York Times report, the result of a year-long investigation, revealed that many community homes had themselves devolved into places of "misery and neglect," just like the psychiatric institutions they replaced. That should be so surprise. After all, who will believe the complaints of someone suffering from mental illness?

One thing is certain, "deinstitutionalization" has led to an explosion of group home providers like Bethlehem-based LifePath, Inc. and Resources for Human Development (RHD), which started in Philadelphia. On its web page, RHD claims to run more than 160 programs in 14 states. It outright owns seven properties in Northampton County, and rents others.

Although a nonprofit, RHD's Form 990 (for 2008) is proof that there's money - big money - in insanity, at least if you are an executive. RHD raked in $161 million in '08, and paid 256 managers over $50,000. Executive Director Robert Fishman's compensation package that year was $233,331. Chief Operating Officer Margaret Mowatt raked in just under $190,000. Five Directors, like Philadelphia dentist Frank Torrisi, and six associate directors, were paid over $100,000. Independent contractors like Bethlehem psychiatrists Neville Kotwal ($311,615) and Deborah Rodgers ($137,423) were also very well-compensated.

In addition to their high salaries, group home directors and associate directors often invest, as silent partners, in individual group homes, where the monthly rent is a sure thing.

But the high salaries end with managers. According to what a middle manager from that industry tells me, on condition of anonymity, the workers who actually staff these group homes could probably do better at Burger King. They are largely uneducated and untrained, although they do get certified in basic first aid, CPR, and to administer medications. Supervisors only make somewhere around $10 per hour.

Because of the high turnover at these group homes, employees are often forced to work double shifts while managers skirt wage and hour laws. Staffers fired from a facility for patient abuse can quickly find a job at another group home. Some workers will accept all kinds of hours, and dole them out to friends. In these 24-hour facilities, it is common to find the overnight staffer asleep, primarily because he is already working well in excess of a forty-hour week. As long ago as 1993, a largely ignored Congressional report warned about under-trained, poorly paid, and incompletely screened employees at group homes.

Many group home providers, well aware that they are controversial, will fly under the radar, trying to hide their true purpose. For example, vague names like "LifePath" and "Resources for Human Development" are actually misleading, especially on a zoning application. It certainly fooled Bethlehem residents at Monacacy and Fairview Streets, who had no idea that a group home for the mentally ill was being planned in their own neighborhood.

My anonymous middle manager claims that when a company uses misleading names and pressures low-paid staff to work long hours, it ultimately hurts the resident. "The level of care depends on how happy the workers are," he tells me. "The model is successful. Group homes generally are a good way to integrate people with disabilities, into the community. You won't even notice a good one." But he cautions, "Dissatisfaction trickles down, and it shows in the quality of care."

That apparently is what has happened at a Philly group home. Late last week, state officials revoked the license at a community home, following the death of an autistic client. He had been locked for five hours in a hot van and was dead by the time staffers realized he was missing. The supervisor has been charged with involuntary manslaughter.

Don't get me wrong. I do support the concept of group homes. But I question whether group homes are up to a dramatic surge in mental health patients, who have suddenly been declared fit for the community. It's also hard to accept the notion that someone being paid $8 per hour has any special qualifications or training that sets him apart from a McDonald's employee.

Will Philly's tragedy be repeated here? Northampton County Director of Human Services Ross Marcus has promised to answer that and other questions in the next few days. I will try to bring you the perspective of both County officials and group home operators.


Lighthouse said...

Please keep in mind that we are talking federal laws (such as Fair Housing, IDEA, and ADA, etc) that create these situations....something that a local community or school district facing a good lawyer is almost guaranteed to lose, unless our Congressmen (such as Rep. Dent) fight to make these laws more balanced (rights of individuals with disabilities & rights of the community at large).

Below is a repeat of my June 23 comment:

For about two and a half years I worked in a community-based program for adults with severe disabilities. Several of these individuals had lived a good part of their lives at Pennhurst before it was closed. So I do understand the issues of human dignity, and societal responsibilities--though it becomes societal because of families who are unable or unwilling. Some of these individuals with disabilities do require much care and supervision. Some can learn tasks for low-skill employment. Again, they are people and I understand the dignity/humanity issues. Animals are treated better than some of these individuals have been.

That said, I remember some individuals that I did not really believe were appropriate in the community for health/safety/welfare of the larger community. I'll refrain from breaking probable confidentially and telling stories. Also, as the Commonwealth has closed facilities (A.S.H. being the latest) the past twenty-plus years these individuals are placed into group homes....but not necessarily with the resources following them to live up to the noble thought. Also, with the closing of facilities, there are some individuals that ARE at times a risk to themselves, their staff, and their neighbors, and the police become by extension on-call "orderlies" (even for the "for profit" homes) at the local tax payer's expense.

The spirit of the original Fair Housing Act, (much as IDEA does with schools) has over-compensated, and a lawyer and a lawsuit await those who challenge someone's "right" to services (not that the resulting cost-benefit necessarily improves the long-term lives of individuals). The rights (and wallets) of the majority of citizens at that point becomes secondary to the protected class of citizens.

Lighthouse said...
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Chris Casey said...

My biggest concern with closing ASH is what will they do with all of us malcontent bloggers? We are going to need a place eventually! Our families won't take us!

Bernie O'Hare said...

I appreciate the intent of the Fair Housing Act, but also believe that municipal officials can insist that the homes be staffed by people who are properly trained, educated and compensated. In Bethlehem, I think the request for variance falls on its face bcit needs 12 parking spots. I have to say it is a bit disconcerting to hear a former employee from that setting admit that some "consumers", as they are called for some reason, just will never fit in.

Bernie O'Hare said...

Chris, I expect to be shot long before I'm institutionalized.

Anonymous said...

This is what happens in private Nursing Homes. That is why Gracedale is so needed and beloved by generations of the hardworking citizens of Northampton County.

michael molovinsky said...

ross marcus already answered when he advocated and defended the closing last year. i can tell you from ross's days in allentown, he's first a bureaucrat and team player.

Bernie O'Hare said...

MM, Thanks for your uninvited character assessment. Ross just went up a few nothces in my estimation.

michael molovinsky said...

bernie, ross was quoted by the morning call's article on the closing of allentown state, that in fact the counties have both enough group homes and the ability to monitor them. what different answer do you now expect from him? sorry, i didn't know my comments were "uninvited"; as usual you continue to insult commentators whose opinion you disagree with.

Bernie O'Hare said...

MM, Your comments concerning group homes or the closure of ASH are most welcome, but your disparagement of Ross Marcus was uninvited. Bcause he is a public official, I allowed the attack to stand, but responded appropriately. If you regard that an insult, then perhaps you should think twice before launching insults of your own.

michael molovinsky said...

bernie, i suspect you're more defensive of a stoffa appointee than a pawlowski appointee, but all that aside; the question is why would marcus's answers now differ from his opinion quoted by the morning call last winter? why aren't you wondering about the anecdotal differences from the group home employee you interviewed, and what marcus said last year? btw, maybe while you're at it, you should interview some private nursing home employee's.

Bernie O'Hare said...

MM, Your journalistic insight, as always, is something that astonishes us all.

michael molovinsky said...

bernie, your reply again insults the questioner, but avoids the question. i don't purport to be a journalist, ironically, you do. you could be a credible reporter, but first you would have put down the water buckets.

Bernie O'Hare said...

Once again, I must thank you for your evaluation. You can be certain I will give it the weight to which it is entitled.

Anonymous said...

Micahel is right on this Bernie. If the topic is Charlie Dent, Ron Angle or John Stoffa, you are protective of them and their minions. If it is about Pawlowski, now Callahan or McClure all is fair and true. The personal insults are considered fair shots.

You are a partisan operative and your blog accurately reflects that. I am a liberal Democrat the opposite of Molonvinsky but know he is right on the money about Mr. Marcus. He is a team player and an Community and Economic Development guy with a tenuous association with Human Services. Stoffa needed a clueless yes man and he got it.

Anonymous said...
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Anonymous said...

Bernie... please understand that this is a federal issue. Ask Bethlehem Township as it settles its Federal Lawsuit with a group home. Locals can not and must not regulate or attempt to regulate these places or they will pay. Where is your boy Charlie Dent??? Why is he immune to questioning or having to do anything about this???

Bernie O'Hare said...

The Fair Housing Act is federal law and I support it. Jim Broughal gave good advice. But the group homes, licensed by the state, need tighter scrutiny.