New York State must immediately begin moving thousands of people with mental illness into their own apartments or small homes and out of large, institutional adult homes that keep them segregated from society, a federal judge ordered on Monday.
The decision by Judge Nicholas G. Garaufis of Federal District Court in Brooklyn followed his ruling in September that the conditions at more than two-dozen privately run adult homes in New York City violated the Americans With Disabilities Act by leaving the approximately 4,300 mentally-ill residents isolated from the outside world in warehouse-like conditions.
The remedial plan offered by Judge Garaufis, which drew from a proposal presented by advocates for the mentally ill that was backed by the Justice Department, calls on New York to develop at least 1,500 units of so-called supported housing a year for the next three years in New York City. That would give virtually all residents the opportunity to move out of adult homes.
Gloria Thomas, who lives in a shared room at the Queens Adult Care Center, reacted to the ruling with joy. “Thank you Jesus, this is what I’ve been waiting for for the longest time,” said Ms. Thomas, 54. “I need to get out of here.”
In supported housing, a resident lives alone or in small groups and receives specialized services from counselors who visit as needed. Advocates for the mentally ill, who were delighted by the ruling, touted supported housing as more humane housing option that allowed residents to become self sufficient community members.
“This will give adult home residents the opportunity to live the way the rest of us do,” said Jennifer Mathis, deputy legal director of the Bazelon Center for Mental Health Law, which provided legal support for the lawsuit. “In the future people should not be steered to adult homes if they don’t want it and they don’t need it.”
The state is considering an appeal, according to the one sentence statement released by the office of Gov. David A. Paterson. During a five week trial last summer the state argued that advocates had overestimated the demand for supported housing and underestimated the cost, making a quick transition for the bulk of the adult home population unfeasible. It was unclear whether any changes resulting from the lawsuit, which was limited to New York City, would be applied to adult homes elsewhere in the state.
Jeffrey J. Edelman, president of the New York Coalition for Quality Assisted Living, which represents 14 of the 28 group homes in the case, called the order irresponsible and deeply disturbing and he urged the state to appeal. “The judge’s decision, entirely following the advocates’ agenda, could force thousands of the mentally ill from their stable lives in adult homes into independent living situations for which the majority are neither psychiatrically suited nor prepared,” he said in a statement.
If it stands the order would begin a process aimed at transforming a system that first took shape in the 1960s, when the government embraced adult homes as a way to care for people with mental illness following the rapid closure of large state-run hospitals. But as with the predecessor institutions the adult homes struggled with continued lax state regulation and poor private management.
The lawsuit was filed in 2003 by Disability Advocates, a nonprofit legal services group, following a series of articles in The New York Times that described a system in which residents were poorly monitored and barely cared for, with residents left to swelter in the summer and sometimes subjected to needless medical treatment and surgeries for Medicaid reimbursement.
The state argued that conditions had improved markedly at adult homes in recent years, but the judge ruled last year that their very setup discriminated against residents by keeping them separated from society and providing little encouragement to find work, make friends or learn skills like cooking, shopping or budgeting.
“This decision is really important for those of us who want to live in the community,” said Erica von Nardroff, 49, who has lived at Elm York Adult Home for the past three and a half years. “I need to move on with life and being isolated here is not the way to do it.”
The order by Judge Garaufis rejected the remedy proposed by the state, which continued to dispute many of the findings of his previous rulings and which sought to cap the number of new supportive housing units at 1,000, to be made available on a more restrictive basis over five years. “The court is disappointed and, frankly, incredulous that defendants sincerely believed this proposal would suffice,” the judge wrote Monday.
The state had argued that, particularly in current economic conditions, such a mandate would be too expensive. But the judge wrote last year that evidence showed that supported housing would cost less per resident than group homes do.
In Monday’s order the judge said that only people with the most severe mental illness, including those deemed a danger to themselves or others, should be housed in adult homes. He also said that residents who were eligible for supportive housing may choose to stay in adult homes as long as they have been apprised of their options.
The judge ordered the appointment of a federal monitor to ensure the state followed his plan and said that both sides must suggest candidates by the end of the week.
“Defendants’ demonstrated resistance to the remedy, as evidenced by their refusal to abide by the court’s findings in crafting their patently inadequate proposal, further highlights the need for a Monitor in this case,” he wrote.