NJ Public Advocate unveils measure to reduce overcrowding in Ancora and other state psychiatric hospitals

Calls for shift of state funds from expensive state hospitals to community care homes knows as Residential Health Care Facilities

TRENTON– The overcrowding crisis in New Jersey’s state psychiatric hospitals could be reduced without an increase in state funding by shifting state funds from public hospitals to community homes that offer modest supports such as medication management and meals, according to a report issued today by the New Jersey Department of Public Advocate.

Read full report:
HEADING TOWARD HOMELESSNESS: ISSUES IN RESIDENTIAL HEALTH CARE FACILITIES

An existing but steadily dwindling network of Residential Health Care Facilities (RHCF) located throughout the state currently accommodates about 2,400 low-income people who are mentally ill or elderly. Space exists in these facilities for an additional 300 residents.

A modest increase in the state funding for these homes combined with expanded support and “wrap-around” services for residents and technical assistance to providers, would dramatically increase the quality of these care homes and provide a viable transition out of public hospitals for many people.

“Better supporting our network of RHCFs makes good economic sense,” said New Jersey Public Advocate Ronald K. Chen. “The cost of maintaining an individual in a RHCF is a fraction of the $218,000 annual cost of providing treatment in a state psychiatric hospital -- $128,000 of which is borne entirely by the state .”

The New Jersey Public Advocate’s divisions of Mental Health Advocacy and Elder Advocacy compiled the report, “Heading Toward Homelessness: Issues in Residential Health Care Facilities”, after visiting all 82 state-licensed, free-standing RHCFs and interviewing residents as well as owners and operators.

While many of the RHCFs have deteriorating physical plants and vary in quality of care,  they provide consistent nursing care and medication monitoring and are an affordable alternative for people who require assistance to live independently and who might otherwise face unnecessary institutionalization or homelessness, the report found.

“These RHCFs are an essential housing resource for low-income elderly and mental health consumers that we must strengthen,” said Chen.

Currently, there are about 1,000 patients in state and county psychiatric hospitals who have been deemed well enough for discharge but are being involuntarily held awaiting an appropriate community placement. Improving the quality of RHCFs and providing additional mental health and daily living support services to people living in them would allow hundreds of these individuals to be discharged from hospitals and to live independently. 

The importance of RHCFs as a housing resource for people with mental illness was recognized by the Governor’s Task Force on Mental Health, convened in 2005 by former Governor Richard Codey.

“This report builds upon the important work that was started by that task force,” said Chen, noting that RHCFs received about $2 million in additional funding upon the release of that report.

Noting that the number of RHCFs in New Jersey has dropped from 144 in 2005 to 82 today, the report states that “many of the individuals in RHCFs have neither the ability nor the desire to live elsewhere. With affordable housing so lacking, it is unlikely that these individuals would be able to continue living in their communities of choice should their RHCF close down.”

While many people who are elderly or mentally ill live in group homes, transitional houses, supportive apartments, assisted living facilities or nursing homes, many do not have access to these services or cannot afford them. RHCFs are an affordable alternative for those who do not require or qualify for facilities that provide a greater level of support.

Residential health care facilities have been part of a loosely regulated system of housing in New Jersey for about 40 years.  Originally designed as homes for aging citizens, RHCFs began to house large numbers of mental health consumers following the deinstitutionalization movement that began in the late 1960s and peaked in the early 1980s.

RHCFs remain a housing option largely because they are often the only affordable one for people with low incomes.

Most RHCF residents receive federal Supplemental Security or Disability payments totaling $623 per month. The state of New Jersey supplements this payment by $210 per month for those people living in RHCFs, for a total monthly state/federal payment of $833. Of this amount, $731 goes to the operator and $102 to the resident for personal needs. Most people living in RHCFs receive their health care through either Medicare or Medicaid and many RHCFs receive modest reimbursements from those agencies for medication monitoring or other medical services.  In the end, with all sources of funding considered, most RHCF providers receive about $24 a day per resident.

In order to give operators more resources to improve services in th e RHCFs, th e Public Advocate recommends increasing th e state SSI/SSD supplement by $16 a day, or $5,900 a year, wh ich would make total state/federal daily reimbursement $40 a day, or $14,600 a year per consumer. The increased costs to the state would be more than offset by dramatic savings in state psychiatric hospitals, which could be downsized.

In addition, the Advocate recommends that the mental health community join with the RHCF operators to improve quality at the facilities. Specifically, the Advocate recommends informal networks be established to encourage operators to share information about their own experiences and best practices.

Finally, the Advocate recommends that the state Division of Mental Health Services expand services for people with mental illness living in RHCFs. Specifically, the Advocate recommends that successful community-based programs that provide “wrap around” services – like case management, medication monitoring, life skills and vocational training – be expanded to support people being discharged from state hospitals into RHCFs.

While the state has provided such support to specific RHCFs in the past, the report notes that those services have been curtailed in recent years.

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