by Vicki Smith
December 17, 2012
Irrespective of our political views, I and most everyone I know were relieved to see campaign season end. This campaign season was divisive. Differences between candidates and parties were not just highlighted, they were polarizing.
With the election over, winning candidates must move from campaigning to governing. To govern successfully, our newly elected officials need to quickly get up to speed - but not at the expense of accurate information. Complex and longstanding problems (such as North Carolina’s failed mental health reform) which were used as campaign sound bites now become opportunities to demonstrate solutions that work. The time for pointing fingers and laying blame has passed. It is now time for deliberate and well-informed action, not rhetoric.
In the case of twelve years of failed mental health reform, people with intellectual, developmental, and/or mental health disabilities have suffered from our state’s past decisions long enough. There have been many causes for our current problems: lack of resources; lack of compliance with federal and state laws; lack of accountability; decisions in response to powerful private interests; and underestimating the complexity of the problem. The list goes on and on.
Governor-elect McCrory has an opportunity. But to avoid prior mistakes, he must first understand the complexity of the problem. Unfortunately, some of his initial statements to the media on the subject demonstrate that he has been poorly advised and has a way to go in order to get up to speed.
McCrory’s first mistake was to conflate two very distinct issues.
At present, the immediate crisis confronting the state is the potential closing of group homes because of a change in the eligibility definition for a single Medicaid service called “personal care supports.” Personal care supports (PCS) is a name for help with activities of daily living like eating, toileting, dressing and bathing.
During a recent post-election interview, McCrory referenced the PCS crisis and conflated it with the State’s recent settlement with the US Department of Justice over the warehousing of persons in adult care homes. The PCS crisis was not caused by the settlement. The 28-page adult care home settlement was signed to bring North Carolina into compliance with the Americans with Disabilities Act.
It will be implemented over an eight-year period and will gradually create services and housing for adults with mental illness stuck in adult care homes because there were and are few alternatives. The settlement requires a gradual change over several years and does not threaten to leave anyone homeless. It is a long-overdue change in our state’s service system for people with mental health disabilities and should be applauded. You can read more about it at http://www.ada.gov/olmstead/documents/nc-settlement-olmstead.pdf.
The PCS crisis, in contrast, was caused by a state budget amendment passed by the General Assembly in July of this year. The General Assembly’s intent was to correct a 2010 change to North Carolina’s Medicaid program that had actually made it easier to get PCS services in an institution than in a person’s own home.
This forced people who needed the services to move into expensive facility-based care when they were capable of living in their homes with PCS. Unfortunately, while the General Assembly provided funds ($39 million) to protect the adult care home industry (which is represented by a powerful lobbying group) during the transition to the new definition, it provided no such transitional funding for people living in smaller group homes.
The PCS crisis has a January 1, 2013 deadline and would result in a loss of funding for critical services for over 1,400 people that may make it impossible for their group homes to stay open. Make no mistake, this is a crisis. That should not be minimized. There are few alternatives and little time for creative problem-solving. The likelihood of homelessness is real. But this problem was created during the recent short session of the General Assembly by failing to include group homes in transition funds. Governor Perdue and the General Assembly need to fix it instead of playing a blame game. Whatever it takes, our leaders just need to do it.
And Governor-elect McCrory will need to get up to speed fast if he going to hit the ground running on this and other issues related to mental health care. He must carefully select his advisors and appointees. What people with disabilities need is a well-informed executive branch. What we don’t need is four more years of a failed service system and decision makers who are so confused by the symptoms they fail to address the root cause of the problem.
Vicki Smith is the Executive Director of the advocacy organization Disability Rights North Carolina.