Taking Care of People for $35/Day
When I was in college, I had a recurring dream about tornadoes on the horizon. For a while, they were far away, and though a bit unnerving, it did not seem as though they were imminently dangerous. Over time, they moved closer and closer and it became clear that there was something in my life that produced some stress or left me feeling vulnerable.
It is no different with public policy in our system of government. The warnings of a future crisis loom on the horizon, like tornadoes in the distance, but until there is a danger that they are going to blow the roof off something, it’s hard to get the attention of government.
To understand the root cause of the tornadoes, one needs a prophet -- a truth-teller -- to sound the alarm. In our personal life, it could be a counselor or a good friend who speaks truth. “Danger is on the horizon,” says the prophet. “You have to face this.”
Right now, finally, it appears that there is growing awareness that the state of the board and care system (also referred to as Adult Residential Facilities) is the tornado in our path that threatens to make our housing crisis worse, particularly for those with mental illness in our state. Just this week, CalMatters published a tornado watch called: “Overlooked Mental Health Catastrophe: Vanishing Board and Care Homeless Leave Residents with Few Options.”
Barbara Wilson is a prophet in my book
Two and a half years ago, while I was in the midst of my Stanton Fellowship, I noticed this tornado on the horizon. As we were tracking the most severely mentally ill people on our Hollywood Top 14 list, I noticed that six of the most vulnerable, as they moved from the street to a psychiatric hold to a conservatorship (which led them to live in a locked facility—IMD-- under the care of the public guardian until they were stabilized), ended up in a board and care facility. These were people who had been homeless, in some cases for decades, and because they were no longer considered chronically homeless, by virtue of living in an institution, the federal government definition declared that they were ineligible for the supportive housing that existed in the community!
As I started to research this situation, I met a prophet who was tirelessly yelling into the wind: “a crisis is looming!” That person was Barbara Wilson, an LCSW who had lost her own son who battled his mental illness, and was devoting her life to counseling families on how to navigate the system. Barbara was generous with her time, sharing stories about how board and care operators were barely holding on, because of the shocking low reimbursement rate. She arranged for me to tour some facilities and organized a summit on this topic in the spring of 2017.
In late 2017, under the leadership of the then-chair of the Los Angeles County Mental Health Commission, Caroline Kelly, we formed a small working group to draft a report to sound the alarm to leaders in LA County. We were joined by Brittney Weissman, the LA County executive director of the National Alliance for Mental Illness (NAMI) LA County Council.
Over the course of the five months that we worked on our report, we were shocked by how little data was available. It would be important to know how many beds existed in LA County (the baseline) in order to track the rate at which they were disappearing. It certainly did not seem that anyone, in this economic climate, would consider opening a board and care facility. If anything, given rising property values, in some cases, it would make the most sense for an owner to sell the property to a developer who might want to build a boutique hotel or a high density apartment project.
Our report, “A Call to Action: The Precarious State of the Board and Care System Serving Residents Living with Mental Illness in Los Angeles County” was issued in January 2018, and we began to share this with groups in LA County who could be in a position to sound the alarm: the Los Angeles Homeless Services Authority(LAHSA), the HHH Citizen’s Oversight Committee, the United Way Home for Good Business Leaders Task Force.
What has been stunning is that no agency – state or local –has felt the responsibility in the past to inventory these precious beds and track the trends. This source of housingseems to be off the radar of city housing departments, because they are state licensed facilities. The challenge, however, is that the funding model is outdated and impossible, and owners of these facilitieshave little wiggle-room in the face of rising costs (minimum wage, insurance, cost of living) while reimbursement rates remain stagnant.
As the CalMatters article points out, the board and care operators receive a set amount of $1,058 a month, which amounts to about $34/day for the operator to provide 24/7 services: three meals a day, laundry, bedding, maintenance and the like. The residents, many of whom are mentally ill, receive their income from the Social Security Disability Income (SSDI)program, hence the static rate. Their share, after paying their “rent” is about $120-ish a month to pay for their basic needs – clothing, hygiene, entertainment, cigarettes, snacks, transportation, non-prescription meds, etc. It’s impossible. By contract, the Bridge Home system, which is currently in the works for the city of Los Angeles, provides $60/day to provide less services than a board and care.
As reported in the article, policymakers are beginning to occur to take this seriously. The Steinberg Institute held a convening just this month to look at options available to either provide more funding to operators to bring the daily rate up, to also researching whether the recent funds authorized by the voters in November 2018 (Prop2 - No Place Like Home) could be deployed to supplement these living expenses.
Steinberg Institute convened experts in April 2018 to discuss the importance of preserving precious board and care beds for our state's residents who experience mental illness. Dr. Jonathan Sher in of LA County DMH participated in the summit.
Further, Assembly member Richard Bloom, who represents a big portion of Hollywood, has introduced legislation to address the very issue that frustrated our ad-hoc committee when we tried to find data. His AB1766 would mandate that the state’s Community Care Licensing Division collect data on the number of people with severe mental illness who are living in licensed ARF’s or board and care homes.
It is heartening to see the media catching on to this looming crisis. NBC covered this story in the fall of 2018. Just this past week, Dr. Jonathan Sherin, the director of Los Angeles County Department of Mental Health was interviewed on KPCC AirTalk, and raised his concern about the need to shore up the board and care system. We are grateful to Dr. Sherin, who has only been leading the LA County Department of Mental Health for a little over two years, because he has taken this issue seriously is vocal about the importance of protecting this housing resource.
Property just a few footsteps south of Bel Air board and care off of Sunset Blvd in Hollywood. The pressures on board and care operators to sell their properties to private developers are enormous in the face of receiving just $35/day to care for - in this case - over 60 residents.
I visit a member of the Hollywood Top 14 who lives in a board and care off of Sunset Blvd in Hollywood. I took this picture last year to show the luxury apartments that were being built on the same street. I know the owner of this board and care truly cares for her residents, but at some points he may need to throw in the towel. I am grateful for prophets like Barbara Wilson and Caroline Kelly who have been sounding the alarm for years. I am grateful for Dr. Sherin who is using his bully pulpit to bring attention to this issue. Let’s hope relief is on the horizon before it is too late.