- Commissioners may investigate problems at adult-care homes
- Buncombe County Board of Commissioners Feb. 16, 2010 meeting
- Conservation easements preserving Buncombe's heritage
- Commissioners to take turns leading opening prayers
An influx of mental patients and elderly people from South Carolina is straining the county's budget and causing problems for other adult-care-home residents, an advisory committee told the Buncombe County commissioners during their Feb. 16 meeting.
"One of the most pressing [problems] is the co-location of frail elders with those who are mentally ill in these facilities," noted Bob Tomasulo, vice chair of the Adult Care Home Community Advisory Committee, who was delivering the group's annual report. "These facilities were not designed to handle severely mentally ill individuals; the staff is not trained properly to do that."
The presence of mentally ill people in the homes — a result of North Carolina's statewide mental-health reform, launched in 2001 — puts elderly residents in jeopardy and results in more calls for emergency services, added Assistant County Manager Mandy Stone.
In addition, noted Tomasulo, the recruitment of elderly residents brought in from South Carolina places further demands on Buncombe County's already strained Medicaid funding.
"There's nothing to prevent [care-home owners] from going to South Carolina and bringing back residents to live in their facilities here," said Tomasulo. "They become Buncombe County residents, and they become our responsibility."
That news didn't sit well with Commissioner Holly Jones, who observed, "I don't like that very much."
According to the report, Buncombe County's 90 adult-care homes — the most such facilities of any North Carolina county — collectively serve 1,290 residents. The state-mandated advisory committee is made up of volunteer appointees who visit the homes regularly, interact with patients and caregivers, and report to county leaders and to the state Division of Aging and Adult Services' regional ombudsman.
Changing the rules governing accepting out-of-state patients, stressed Stone, would require state legislation. But the commissioners, she continued, could have an impact by communicating with the local legislative delegation in Raleigh. "We have been the most vocal in the state, because we have been so profoundly affected by this," noted Stone.
State Sen. Martin Nesbitt, she said, has introduced a bill that would extend the amount of time residents must be in a home before Medicaid reimbursement kicks in from 90 to 180 days, but so far, it hasn't found support in the General Assembly. The state has appointed a task force (which Tomasulo also serves on) to look into the situation.
Board Chair David Gantt wondered how the South Carolina residents get here. "They don't know anyone here, do they?" he asked. "Are these people just being taken away from where they are living and brought up here?"
Barbara Hinshaw, lead regional ombudsman with the Land-of-Sky Regional Council, said these patients are typically discharged from health-care facilities and then recruited by the owners of Buncombe County homes.
"They are being discharged from the mental hospital as well as the hospital," Hinshaw explained. And once they're here, their prospects for returning to South Carolina are slim. "We get complaints from people saying, 'Why am I here? How did I get here?' And they want to go home."
Commissioner K. Ray Bailey suggested that Gantt appoint two commissioners to work with the county's advisory committee and make contact with Nesbitt's office, "so that he understands the concerns that we have."
Those appointments, noted Gantt, will most likely appear in the form of a resolution at the commissioners' March 2 meeting.
Partners in conservation
In what Gantt called "the best partnership in the history of Buncombe County," nearly 70,000 acres of local farmland and forest have been secured by conservation easements since the program began in 2003. In 2009 alone, 1,781 acres in easements were finalized, said Albert Sneed, who chairs the county's Land Conservation Advisory Board.
Conservation easements are a way to preserve farmland and open space without purchasing the property outright. Instead, the owners simply give up the right to develop it, in exchange for a tax break and a negotiated financial settlement. The money — which typically comes from a mix of sources, with groups such as the Southern Appalachian Highlands Conservancy often playing a key role in lining up private and nonprofit donors — is intended to make up, at least in part, for the loss of property value.
"When you put an easement on your property, you're never going to make up the difference," said Sneed. "It will never be worth what it was the day before you got the easement."
In addition, property owners often agree to accept less cash than the easement's assessed value.
Ten such agreements were inked last year, he reported, including Claxton and Bee Tree farms, though the work on those projects stretched back further. "Some of these have been lurking around for a few years," said Sneed.
Gantt called for a standing ovation to recognize the work of Sneed and the advisory board. "You've taken this thing and you've made it work by spending a lot of time developing the type of relationships it takes," he said.
The Buncombe County Board of Commissioners will continue to open its meetings with prayer, but the commissioners will now take turns delivering such invocations themselves.
The announcement by County Manager Wanda Greene came on the heels of a January ruling by a federal judge that Forsyth County's use of sectarian prayer before its Board of Commissioners meetings was unconstitutional. The case centered around the specific reference to Jesus in the prayers.
Until recently, the Buncombe commissioners' long-standing practice had been to invite a different local religious leader to offer up a prayer before the start of each meeting.
In December, however, with the Forsyth County case pending, County Attorney Michael Frue issued a memo implying that Buncombe's Board of Commissioners would discontinue the use of such prayers in favor of a moment of silence. But Frue's announcement proved premature, and in a series of one-on-one phone calls before the commissioners were slated to dicuss the matter publicly in January, they decided to continue their former practice until the Forsyth case was resolved. (see "On a Meeting and a Prayer," Jan. 13 Xpress) And though the commissioners never did discuss the issue publicly, their January meeting was punctuated by heated public comment on the matter.
Having the commissioners deliver invocations themselves mirrors the Asheville City Council's approach, and Clerk to the Board Kathy Hughes said the move is intended to temper the controversy and protect the county from a similar lawsuit.
"They came to the conclusion that this is the best way to do it," she told Xpress. "The commissioners don't want to stop the invocation, but they didn't want to get sued."
Meanwhile, City Council postponed a discussion of its own practice last month because City Attorney Bob Oast was absent.
Brian Postelle can be reached at 251-1333 ext. 153 or firstname.lastname@example.org