Funding Shortages Cause Problems for Florida’s Community-Based Mental Health Treatment System

Many of Florida's assisted living facilities, which act as private boarding homes for the mentally ill, "cut corners" in care provision to earn a profit because they are "force[d]" to operate without adequate reimbursement, according to a special investigation by the Miami Herald. Problems in caring for the mentally ill in assisted living facilities came to light with some recent "tragic incidents" in Florida; most recently one man with mental illness killed another at an assisted living facility. In its investigation, the Herald reviewed "thousands of pages of regulatory files" and interviewed state officials, assisted living facility operators, residents and advocates, determining that many facilities are "run-down, crowded facilities that offer little supervision or treatment" for individuals with mental illness.

Deinstitutionalization
Fifteen years ago, state officials began phasing out large state institutions for the mentally ill and began funneling patients into assisted living facilities, which also care for "frail elders who are not quite sick enough to require a nursing home." In Florida, 2,381 licensed assisted living facilities contain 79,455 beds, about 10,000 of which are occupied by residents with chronic, severe mental illnesses who are receiving Social Security disability benefits. However, the Herald reports that the facilities "often imitate" the institutions they were supposed to replace, which were closed in an effort to improve care for the mentally ill. Howard Finkelstein, a mental health advocate and chief assistant public defender in Broward County, said, "This is what I call the big lie of deinstitutionalization. (These facilities) are supposed to be not only shelter, but a part of mental health treatment. The truth is (that) there is no mental health treatment." He added that housing the mentally ill in assisted living facilities is "a bad idea made even worse by government officials who have signaled very loud and clear they have no interest in marginalized people."

Enforcement Problems
When state investigators find problems at a facility, the situation is usually resolved within a few months, the Herald reports. However, facilities "seldom" are fined more than a few thousand dollars for violations, and state mental health officials are "extremely reluctant" to take action against "substandard facilities" because there is almost nowhere else to house the mentally ill, the Herald adds. Bob Tomasulo, Broward County's outreach director for the Social Security Administration, said, "We know that the situation is very bad, but we don't want to make it worse. Often, attempts to correct things do just that." Advocates add that when improvements are made at the facilities, they are often "short-lived." Audrey Bennett, a volunteer inspector for the state Long Term Care Ombudsman Council, said, "When you go back (after an inspection), most stuff has been taken care of, or (is) in the process of being taken care of. Then you go back six months later, and the place is just horrible again." The council only can inspect facilities and investigate complaints; it does not have the authority to enforce standards.

More Funds
Without an increase in funding, advocates and facility owners say it will be "almost impossible to dramatically improve care." Funding for such centers has "failed to keep pace" with increasing medical costs and a "growing number" of patients. In addition, liability insurance costs for homes increased 500% last year. The facilities receive $700 a month per patient for the patient's room, board, "some" personal assistance and activities. James Kidwell, the owner and administrator of Henry's Retirement Center in Ft. Lauderdale, said, "We're expected to provide everything a person needs on $23.83 per day. That $23.83 doesn't go very far." Facility owners have lobbied for an increase in funding to $818 per month, but the Social Security Administration has yet to approve the raise. The Herald reports, however, that a "major infusion of new dollars" is unlikely in Florida, as social welfare programs "have historically been neglected." Assisted living facilities "are nothing more than a box to put people in with hope that they will die soon, so we don't have to spend any money on them," Finkelstein said (Miller, Miami Herald, 2/11).