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State Delays Changes for Group Homes

Posted on: Saturday, 2 July 2005, 00:00 CDT

Jul. 1--This was to be the day new state rules raised staffing standards in North Carolina's group homes for mentally ill children.

They were supposed to fix a 4-year-old mistake and improve care in a system that's failing many mentally ill kids.

Instead, the proposed rules have stalled and could be delayed months -- or even a year.

Meanwhile, group homes can still use one worker to supervise as many as four mentally ill kids -- staffing widely seen as inadequate. And the state is still paying group homes for more workers than it requires.

An Observer investigation in January found that North Carolina has wasted tens of millions of dollars since 2001, when it raised reimbursement to group homes to pay for increased staffing, but failed to enact rules requiring more workers.

Tougher rules requiring two workers to supervise up to four children were awaiting final approval in June when some group home operators used two provisions in state law to delay them.

N.C. Mental Health Division Director Mike Moseley says he doesn't know what the state could have done differently to avoid the delay.

But critics say mental health officials erred by refusing to address group home providers' concerns, almost guaranteeing that some disgruntled owners would opt to stall.

"It's not like they didn't have plenty of warning flags," said Asheville lawyer Curtis Venable, who helped write rules in 2000 that were never enacted.

Mental health officials should have enlisted group home providers to help craft the new rules, as they have in the past, he said. They should have acknowledged that their rules were more extensive and costly than those written for the 2001 rate increase. And they should have pushed for a reimbursement rate increase to accompany the new rules.

"Their mistake was their failure to involve industry," Venable said. "Presumably, because they were scrambling for butt cover, they just tossed something out."

N.C. mental health officials counter that they responded to group home providers and made changes. "I can assure you that the providers were heard," said N.C. Mental Health Commission Chairman Pender McElroy, a Charlotte lawyer.

N.C. mental health officials began working in January to enact new staffing rules and pledged to put them in place quickly. Their actions followed Observer stories that detailed the state's failure to enact staffing rules in 2001.

Many good group homes have staffed at higher levels, even without the rules. But when the state raised reimbursements by 49 percent in 2001, many entrepreneurs saw a cash cow and rushed into business. Since 2001, the number of group homes in North Carolina has tripled, to more than 1,000.

That growth overwhelmed state inspectors, who began limiting oversight and only responded to complaints. Some group homes took advantage of the lax oversight and ignored even the state's minimal rules.

Concerns about the homes intensified in September, following the death of Shirley Arciszewski. The 12-year-old died of asphyxiation in a Charlotte group home when a worker who lacked required training tried to restrain her by lying on top of her.

The state's leading group home providers have said they support tougher staffing rules. But proposed changes are so costly, they say, that they'd put some good providers out of business unless the state raises reimbursements.

Mental health officials at first said that current rates were generous enough to cover any added costs. In May, however, they agreed to review payment rates.

But as July 1, the effective date for the new rules, grew closer with no rate increase in sight, some group homeowners took action.

In June, two providers asked the Office of State Budget and Management to review the economic impact of the rules. The state allows such a request, which could take several months. If the budget office finds the rule changes have an impact of at least $3 million, the rules would have to go through the approval process again.

The new rules also may be delayed by a state provision requiring the legislature to review proposed rules if the state gets at least 10 letters requesting review. The state received 37 letters.

Under that law, the rules can't become effective until the 31st legislative day of the legislature's next session. That would push their approval to at least mid-2006.

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Source: The Charlotte Observer (Charlotte, N.C.)

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