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.