Bernard Sexton, 53, says his daily cocktail of psychotropic drugs includes Seroquel and lithium. August Terzol, 52, claims to suffer from schizophrenia. Linda Smith, 55, says she is being treated for bi-polar disorder.
They are among the residents of Riverdale Manor Adult Home, at 6355 Broadway near the Henry Hudson Parkway, who believe they could function in a more independent environment and, in October, New York State agreed that “seriously mentally ill” people should be housed in less institutional settings.
The Office of Mental Health and its Department of Health have put out new regulations that will cut the proportion of “seriously mentally ill” residents to a quarter of any adult home’s population.
Those being removed from the homes would be dispersed into supportive housing and other units where, according to the state, they would receive necessary services.
While it appears that New York is trying to ensure compliance with the Supreme Court’s 1999 Olmstead decision, which held that unjustified institutionalization of people with disabilities violates the Americans with Disabilities Act, those representing the interests of adult homes say residents will not get the services they need in other types of facilities and that the change in regulations will force facilities like Riverdale Manor out of business.
Jeff Sherrin, a lawyer for New York State Center for Assisted Living, New York Coalition Quality Assisted Living and individual adult homes including Riverdale Manor, said the history of debate over whether adult homes comply with the Olmstead decision dates back to 2003, when Disability Advocates Inc. filed a lawsuit against the state on behalf of adult home residents.
It claimed the state violated the Americans with Disabilities Act because residents were not being given required services in the least restrictive setting available.
Disability Advocates won. The decision was reversed on appeal because Disability Advocates did not have standing to sue on the residents’ behalf, but the ruling left open the possibility of other lawsuits.
Around the same time, the United States Department of Justice began suing states for non-compliance with the Olmstead decision. Mr. Sherrin said he believes the state’s action was spurred by the Department of Justice threatening to sue New York State.
“Nobody wants to defend themselves in a fight against the federal government,” he said.
But Matt Wing from Gov. Andrew Cuomo’s office said the state is not acting out of fear, but rather upholding its duty to make sure New York is in compliance with the law of the land.
“The cabinet is charged with developing recommendations to comply with the U.S. Supreme Court’s decision requiring that people get the services they need so that they can live as independently as possible,” he said. “Clearly, putting people on the street without that treatment would not accomplish this goal.”
He said that as adult homes put together compliance plans for how they will adhere to the new regulations, the state is looking at alternatives that include supportive housing and developing assisted living programs, as well as ensuring that the seriously mentally receive managed care.
However, it remains unclear where residents will go and whether there is enough housing and services to support them.
Eva Morgan, administrator of the 256-person capacity Riverdale Manor said residents there are referred from hospitals and community residences.
Many have already tried and failed in other settings when they get there, she added.
Among the services they receive at Riverdale Manor are an onsite clinic, supportive case management, and help taking their medications.
“I’m not saying there aren’t going to be a few that can go, but 75 percent that’s a different story,” she said.
The for-profit institution claims $39 in disability funding per resident, per day, which comes from the federal government through the patients’ Social Security Insurance (SSI), and covers room, board and other services provided by the adult homes.
At that rate, Ms. Morgan claims the home needs 80 to 85 percent occupancy to stay afloat.
“The home will not be able to sustain itself” if the regulations go into effect unchanged, she said.
Jeff Edelman, who owns facilities in Queens and in the Bronx, agreed.
According to Mr. Edelman, not only would the “seriously mentally ill” population be looking for new homes, but bringing the populations of adult homes down to less than 25 percent would force the simultaneous closure of multiple facilities, leaving all their residents scrambling to find suitable places to live.
“We’re not Medicaid billers … as it is we’ve always been under-funded, but instead of shoring that up they’re kind of throwing out the baby with the bathwater here,” Mr. Edelman said.
It’s basically telling me to shut down,” he said. “There’s no way I can do that.”
The result, he said, is that many will end up in the city’s homeless shelters or in nursing homes or emergency rooms, getting higher levels of care than what they require.
For Linda Smith, the bi-polar resident of Riverdale Manor who said she started her institutional life in a facility in Far Rockaway after living on the streets, the new regulations could mean a new start.
“You can’t cook and clean for yourself,” she complained of her current situation. “You can’t function; you can’t be your own person.”
But for others, including those who could be displaced if facilities begin shuttering en masse, the future remains fraught with doubt.
Even Cynthia Stuart, of Supportive Housing Network of New York, has been caught off guard by the inquiries she’s receiving on the new regulations.
“This caught us somewhat by surprise as well,” she said.