An important development has transpired among Guilford County’s poorest residents over the past nine months: People who once slept in tents in the woods, curled up on church porches at night or took advantage of spare couches until friends withdrew the welcome mat are now living in their own apartments.
Three agencies — Family Service of the Piedmont and Greensboro Housing Coalition in Greensboro, and Open Door Ministries in High Point — have been responsible for placing formerly homeless people in apartments, and their housing support team coordinators have won rave reviews from the clients.
The program is based on a harm reduction model: Stabilize the client by getting a roof over their head, and then address the challenges that put them on the street in the first place: alcoholism, addiction, mental illness, disability, lack of employability and the like. An array of secondary agencies — private providers endorsed by Guilford Center for Behavioral Health and Disability Services, and compensated by federal Medicaid and state mental health funds — are tasked with providing those additional services to help the formerly homeless clients get their lives on track.
Clients report that the support services have been administered in an uneven fashion. In some cases, transportation assistance critical to filling drug prescriptions and getting to food banks and job sites has not transpired. Clients have found no one at the other end of emergency crisis lines in some instances. In other cases, clients say providers have been unable to tell them what treatment they might need. Some of the agencies have been placed in corrective action for failing to provide appropriate treatment, while others have nearly lost their endorsements for failing to meet new state requirements for a certain percentage of services to be provided by qualified professionals.
“They are supposed to be helping us do things,” said Reid James, an RHA Health Services client and recovering addict who lives in the Dixie Building across the street from NewBridge Bank Park in downtown Greensboro. “If we need a ride to go get our medicine, they should give us a bus pass or take us there, but they don’t. At the same time they expect us to make sure the prescriptions are filled, but they don’t give us the transportation to do that.” Mike Rhoades, the chief operating officer for subsidiary RHA Behavioral Health said service providers are not allowed to bill transportation expenses to Medicaid.
“Our job is to help the consumer become self supportive, help them use the public transportation system, and help them build networks with friends and family to get rides to where they need to go,” he said. “We’re a training provider, not a taxi provider, and that is a common misperception.”
Rhoades said he was sympathetic to clients who are unable to reach job sites far from public transportation routes or find themselves short on cash for bus fares.
“That is a huge need in many communities in North Carolina — lack of transportation access,” he said. “This is a short-term service.
We’ll be gone in three to five months. I would hate for them to get a job based on our ability to drive them to a job, and then we leave and they don’t have a way to get there.”
Marc Graham, a 46-year-old formerly homeless ex-marine and RHA Health Services client, concurred that the agency has failed to provide transportation for doctor’s visits and food pantry runs. Moreover, he said that after an initial meeting with his caseworker at RHA
Health Services he remains unclear about exactly what services the agency offers at all. “It’s going on three weeks and I still haven’t heard back from him,” Graham said. “I’m sure they’re billing my Medicaid card. I called them and they tell me they don’t provide transportation. No hard feelings. I’m just going to stop my Medicaid card and tell them to cut it off.” Lee Kallam, a formerly homeless recovering alcoholic, also 46, has already dropped RHA Health Services.
“I had no idea what they were supposed to do,” he said. “I could never figure out what they were supposed to do…. The guy at RHA just didn’t do nothing.”
Rhoades said he was not aware of any complaints against RHA, but would
be open to investigating any concerns brought to the company’s
attention.
Andrew Kristel, a housing support team coordinator with Greensboro Housing Coalition, echoed some of the clients’ concerns.
“It’s
been a bit of a bumpy road so far with the service providers,” he said,
adding that he and other housing support team coordinators have met
with service providers to prod them to meet their commitments to the
clients.
Transportation to doctor’s offices, food banks and
jobsites is a regular if unremarkable need; a reassuring voice at the
other end of a phone line during a moment of personal distress can be
more critical.
“At one point, one of the providers’ emergency
numbers did not have anybody at the other end of the line for weeks on
end,” said Kristel, who did not single out any agency in particular.
“If they have a mental disability and they don’t have anybody to talk
to, they could be having a mental breakdown, a meltdown. If there’s not
anybody at that number, it could keep them from receiving the aid that
they need to keep themselves together.”
One housing support
client with a history of crack cocaine use who asked not to be
identified because his overall experience with service provider All
Stars Group of Greensboro has been positive said that on one or two
occasions he tried to call a crisis line over the weekend and got an
outgoing message instructing him to call back during business hours
from Monday through Friday rather than a live human voice. Mitch McGee,
a housing support coordinator with Family Service of the Piedmont,
confirmed that crisis lines should be staffed 24 hours a day and seven
days a week. Calls to All Stars Group requesting comment for this story
were not returned.
Kristel also corroborated another deficit
highlighted by clients. “There have at times been issues with the
providers getting people their medicines on time, which is similar to
the emergency-number situation,” he said. “It could send somebody into
a tailspin.”
The uneven provision of services in the housing support program, a state pilot program in Guilford County, is emblematic of a larger crisis in North Carolina’s
mental health system, which was privatized in early 2007 as a result of
legislative reforms initiated some five years earlier.
“You have shredded the safety net,” said Republican state Auditor Les Merritt.
“I’m sort of a private-enterprise guy, but there’s certain things
you’ve got to have government do. You’ve got to provide some basic
services to the most vulnerable citizens. You don’t get much more
vulnerable than mental health patients. What happens when you don’t have those basic services is you end up in jail
or in the emergency room. “That’s a long way of saying that you’re
never going to have private enterprises look after the needs of the
most vulnerable citizens,” he continued.
“They cherry picked.
They were giving some patients far more services than they really
needed. That’s the ones they could make money on. They had certain ones
that required far more services than the [Medicaid and state mental
health funding] rates reimbursed for, and those were the ones that
didn’t get the care they needed.”
In May 2007, the NC
Department of Health and Human Services and so-called local management
entities — former county mental health departments that now function as
a sort of mid-level regulatory and technical advisory agency — began
conducting post-payment reviews for community support clients who were
receiving in excess of an average of 12 hours of service per week. The
state ordered the Guilford Center to review 236 consumer files to
determine whether agencies provided appropriate clinical intervention
and treatment.
A review by YES! Weekly found that 34
agencies were ordered to submit corrective action plans and 26 were
subjected to further audits by the Guilford Center, while 24 agencies
were referred to the NC Division of Medical Assistance for
investigation. One review of the Voca Corporation, a company set up in
Jamestown by officers with listed addresses in Kentucky and Georgia,
uncovered a 92.3 percent failure rate. In other words, the local
management entity’s review of one of the agency’s invoices found that
in 12 out of 13 criteria the agency did not provide appropriate
clinical intervention and treatment to a client. Wes Root with the
Guilford Center said Voca Corp. no longer provides community support
services in the county.
In April 2008, the NC Department of
Health and Human Services announced it had received notice that the
federal Center for Medicare and Medicaid Services would defer payment
for community support mental health services — an amount calculated by
the Division of Medical Assistance at $137 million — “until the federal
agency is satisfied that abuses are no longer occurring in the
program.”
“There were lots of paybacks from the provider
community,” said Susan Campbell, manager of access and care management
at the Guilford Center.
At least two agencies used by clients of the housing support program in Guilford County were flagged during
the
Guilford Centers’ post-payment reviews in the summer of 2007. One was
Asheville based RHA Health Services, an agency used by James and Graham
that serves clients across North Carolina and Tennessee.
Another
was Star Care, the agency chosen by Kallam after he dropped RHA Health
Services. “Those infractions had to do with the way we were documenting
our services not related to the way we were providing the services
themselves,” said Rhoades of RHA Behavioral Health.
A team
from the Guilford Center visited the company’s High Point office and
determined that it had satisfactorily corrected its deficiencies, Root
said. Of the 34 agencies flagged by the local management entity, Star
Care is the only one still serving clients in Guilford County that has
not completed its corrective action plan. Root said the Guilford Center
has an agency site visit scheduled for this week. Administrator Martina
Ukattah said Star Care is prepared for the local management entity’s
visit.
“The service definitions were not defined for the
providers,” she said. “For us to be in line with the service
definitions, we have to know what they are. [Root] said they had a plan
coming out. They keep changing on the service providers.”
While
some agencies have struggled to get out of corrective action, others
have found their endorsements in jeopardy because of difficulty meeting
new state requirements mandating that at least 25 percent of billable
hours be provided by someone considered to be a “qualified
professional.”
Phoenix-based Recovery Innovations of North Carolina,
an agency that operates its local office out of the same county-owned
building that houses the Guilford Center, was notified on Aug. 13 that
its endorsement for adult community support services was being
withdrawn. Jamestown-based Family Service of the Piedmont received
notice the same day. Both agencies successfully appealed, and had their
endorsements were restored on Sept. 8. Recovery Innovations was the
first of a succession of service providers used by James.
“The
psychologist, she’s having some personal problems; she was way out of
line,” said James, who is in the process of applying for disability
benefits from the Social Security Administration for a degenerative
condition that she contends preceded her alcohol and substance abuse.
“She said, ‘I think you’re being lazy, and you don’t really want to
find a job.’ She also had been under a lot of stress because her
husband has untreatable cancer, so I can understand.”
Chronic
lung problems, asthma, degenerative cervical vertebrae that makes her
right arm go numb, degenerative arthritis affecting her left shoulder
and a host of other health problems have so far proven to be
insurmountable hurdles in James’ search for gainful employment.
“The
case manager, she didn’t know about half the resources I do,” James
continued. “She didn’t put her heart into it. I said, ‘Screw this: This
is going absolutely freaking nowhere.’”
Phone messages to
Recovery Innovations were not returned. James’ housing support team
coordinator is Mitch McGee, with Family Service.
Following her disappointing experience with Recovery Innovations, she also signed up with Family Service for enhanced services.
“Family
Service did hook me up with a talk therapist, but for some reason they
didn’t continue that,” James said. “They hooked me up with a
substance-abuse therapist, but they’re not sure that’s where I’m
supposed to be. Today, I’m literally sitting in limbo right now.”
Family Service of the Piedmont interim President/CEO Tom Campbell said
the agency’s policy is to transfer client data at the service
provider’s request on condition that the client signs all appropriate
releases.
Notwithstanding Family Service’s handling of James’
substance abuse problems and alleged failure to provide continuity as
she transitioned to RHA, the client lavishes praise on McGee, who
continues to serve as her housing support team coordinator.
“Mitch
has been the best resource of any that I have had,” James said. “He
will take care of you. He will make sure you’ve got your phone bill
paid. He gave us rides to the Hive over the summer on Fridays to get
fruit and vegetables.
“They paid for dental work,” she
continued. “That was Mitch McGee. He just said, ‘Get a receipt and I’ll
cover it.’ Right now, I’m sitting here with an empty socket where my
tooth was, but it’s a lot better than having an exposed nerve.”
Other clients have also credited their housing support team coordinators with helping them get their lives back on track.
Still
others have said they are not bothered by the uneven performance of
support providers because they have enough self reliance to seek out
resources such as Alcoholics Anonymous meetings on their own. “It makes
it really hard for these private providers to survive because they’re
going to have their qualified professionals working crazy hours,” said
Kristel of Greensboro Housing Coalition, “or they won’t be able to meet
their QP requirements and thus they’ll get dissolved.”
