NEW YORK
Housing for the mentally ill became a major long-term care issue in New York in 2002 as a result of newspaper stories about poor housing and services in adult homes for this population. The governor and state agency officials took action on a number of fronts to improve community-based services for people with mental illness. The state also began moving in 2002 to considerably increase the number of people with mental retardation and developmental disabilities who would be eligible for home and community-based services.
Mental Health
Governor George Pataki in January 2003 proposed spending at least $80 million on housing and services for residents of adult homes for the mentally ill to replace privately run adult homes, which currently house about 15,000 mentally ill people in the state. In his FY 2004 budget, the governor proposed creating 2,000 units of housing in the immediate future with several thousand additional units in future years. He also proposed continuing to reduce the size of the state psychiatric system and to use the money from closing several facilities to improve local mental health services.
The plan calls for 1) special evaluations of adult home residents to determine whether they can be moved to smaller facilities, and 2) hiring nurses and social workers to improve medication practices and supervision of the residents. A special administration task force, established in May 2002 to review the existing system after a series of newspaper reports detailed widespread problems, had recommended the creation of 6,000 housing units.
The work group's primary focus had been on resident assessments, resident rights, case management, medication management, personal care, coordination of services, and alternative housing options. The state health commissioner and other state agencies announced a series of actions in November 2002, including clinical, psychiatric and functional assessments by health and mental health care providers, improved case management and coordination, enhanced medication management, improved social and recreational services, and increased advocacy and legal support.
Home and Community-Based Services
In August 2002, the state received federal approval for an amendment to its Medicaid home and community-based services (HCBS) waiver program for individuals with mental retardation and developmental disabilities. The action authorized $135 million over three years to support the NYS-CARES program, which is the largest waiver program for this population in the country. Enrollment will be increased by 12 percent to 15 percent to a total of more than 51,000 people within three years.
2002 Legislation
The Legislature passed bills in 2002 providing a tax credit for consumers who purchase long-term care insurance, allowing hospice programs to offer palliative care, and appropriating $25 million to plan and implement a program of expanded in-home, case management and ancillary community services for the elderly.
Lawmakers also created the Nursing Home Quality Improvement Demonstration Program to improve the quality of care for nursing home residents through an increase of direct care staff. The state also sought to expand and improve the direct care work force through quality improvement projects funded by the state. The state issued requests for proposals for projects that would increase direct care staff, increase training and education, and decrease staff turnover or other efforts at recruitment and retention.
Lawmakers established a task force, the Most Integrated Setting Council, in 2002 to develop and oversee the implementation within one year of a comprehensive, statewide plan for providing services to people of all ages with disabilities in the most integrated setting possible. The legislation requires the state to review existing funding sources for community-based care to increase availability of these services and to analyze ways to organize varied funding streams into a coherent system.
The measure also mandates development of a single assessment process, implemented by one community-based agency using a uniform assessment tool. The council also must contract with an independent organization to conduct an evaluation of the council's plan, to be completed within three years.
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