Nowhere to go

Commissioner Bill Stanley listens as county officials give a presentation about the fiscal and human ramifications of adult-care homes in Buncombe County. (photo by Caitlin Byrd)

A familiar yet distressing tale unwound at the April 17 Buncombe County commissioners meeting — one involving too many mentally ill people living in adult-care homes that cannot meet the needs of their residents.

“It’s not the clinically correct placement for these individuals,” asserted county Social Services Director Mandy Stone. “We see these individuals cycle in and out of court systems, and in and out of jail, and they’re not receiving the care they need.”

Adult-care homes, also known as assisted living facilities, house older adults and disabled residents who may require 24-hour supervision and help with personal-care needs. Last year, however, a U.S. Department of Justice investigation found that North Carolina, which licenses adult-care homes, mishandled the placement of mental-health patients in these homes, and violated the Americans with Disabilities Act.

The human impact

Even though state law forbids adult-care homes from admitting residents for the treatment of mental illness, a 2010 report from the N.C. Institute of Medicine notes that 24.7 percent of total adult-care-home residents in the Tar Heel state had a mental illness. However, county Adult Services Program Manager Jennifer Chilton told commissioners that the typical adult-care-home resident she encounters has a primary diagnosis of a mental illness and a high level of need.

“There’s really no alternative housing or supportive community options that are available, or are readily available to them,” she said, saying these people then end up in adult-care homes, often taking on average 15 medications a day. Unfortunately, she continued, this can spell disaster for residents in situations that happen frequently.

“When residents end up in jail, on the streets, or shuffled from adult-care home to adult-care home, which they often do, this results in a loss of stability for their medication and behavior management, many times leading to an inpatient psychiatric hospitalization,” Chilton explained.

Curtis Venable, a local attorney working with DSS on the adult-care-homes issue, maintained that this is what happens to residents in these situations because they have nowhere else to go. “This is sort of the end of the line for a lot of these folks, and it’s either one of these facilities or you’re under a bridge, literally,” he said.

Though she says local agencies do their best to help these residents, it remains a challenge, and Chilton compared the process to “trying to fit an unmatched puzzle piece into place.”

In its letter last July to state officials, the Department of Justice squarely placed the blame on the state for failing to develop enough community-based mental-health-service settings. Instead, the state has chosen to fund a “substantial portion of the cost of providing care in adult-care homes.”

“The State plans, oversees, funds, and regulates programs and services for individuals with mental illness in a manner that leaves thousands of individuals with mental illness isolated in large, segregated adult-care homes,” the letter notes. “The State’s failure to redirect resources and its failure to prioritize community-based settings over institutional care has confined thousands of people with mental illness unnecessarily and indefinitely in adult-care homes and puts many others at risk of unnecessary institutionalization.”

The fiscal impact

For Buncombe County, dealing with the situation has not been cheap.

During the 2010-11 fiscal year, officials found that it cost the county $941,915 — or almost $78,000 per month — to provide services to three homes that were the highest users of county services. Those services include costs involved with sending law enforcement, emergency-medical technicians or firefighters to respond to calls at the home, housing residents in jail, admissions to Mission Hospital’s emergency room and required DSS services.

In total, Buncombe County has 87 adult-care homes — more than any other county in North Carolina. However, the county’s adult services program administrator, Angie Pittman, noted that about 50 percent of residents have no ties to Buncombe County before their admission.

Yet they often form infamous relationships with the Buncombe County Sheriff’s Department.

The law enforcement impact

During fiscal year 2010-11, sheriff’s deputies made 237 calls to one adult-care home, costing $10,665 in services. In fiscal year 2009-10, the same home made 144 calls, costing $6,480 in services. But Sheriff Van Duncan said this was nothing new for the department.

“We have been dealing with the adult-care-home problem for quite some time. When you go back and look at the data and calls for service, it’s been going on since before this administration took office,” he told the commissioners, adding, “I think it’s extremely important that everybody understands the crisis that we’re in.”

For example, Duncan reported that crimes committed by residents of at least one home in Candler have “wreaked havoc” in the surrounding community. “We’ve had some serious breaking and enterings in that community where we’ve had homeowners say that it was only by the grace of God and a little self-control that they didn’t shoot somebody,” Duncan said.

Sometimes, he explained, these crimes are not always what they appear.

Duncan told commissioners about a recent example in which a woman broke into a home, but when she got inside, she didn’t realize what was going on and called 911.

Along with mental illness, Chilton said she’s also seen another characteristic of typical adult-care-home residents in Buncombe County: a violent criminal history. Maj. Glen Matayabas, who heads the county’s Detention Bureau, reported that the No. 1 charge filed by law enforcement against residents of adult-care homes is simple assault.

The next step

When the presentation ended, Chairman David Gantt called the issue “a huge problem,” Commissioner Carol Peterson called it “tragic” and Commissioner Bill Stanley said, “We need help.” With a nod from Commissioner K. Ray Bailey and verbal agreement from Commissioner Holly Jones (who participated in the meeting via telephone), the commissioners said they will follow up with state legislators on this issue since only the state can regulate these adult-care homes.

In other business:
• Commissioners heard highlights from the Buncombe County Sheriff’s Department’s comprehensive annual report. The 26-page document is available online at http://mx/ew.
• Commissioners also heard highlights about Buncombe County’s health rankings. The rankings are available online at

Commissioners also did the following:
• authorized the county manager to acquire about 30 acres of land on Desert Drive in Arden for use as a park.
• approved a budget amendment of $34,000 to allocate additional LINKS funds for children in foster care.
• approved opening and maintaining Court Plaza as a public road.
• approved a process related to hiring pyrotechnical experts for fireworks displays.
• authorized the county manager to accept a grant of $280,500 from the N.C. Parks and Recreation Trust Fund.
• declared May as Stroke Awareness Month, Motorcycle Awareness Month and Foster Care Awareness Month. The board also declared May 3 as Special Olympics Day.


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