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Small homes for the mentally ill under zoning consideration

The Hawk Eye - 6/4/2017

June 04--On Oct. 23, 2016, Burlington firefighters rushed to the aid of four residents of a home for people with mental illness on North Ninth Street.

Everyone inside got out safely, and the fire was put out without much difficulty. There were no working smoke alarms in the home, but one resident knew of the fire the moment it started. He had been upstairs in his room and, according to the fire department's report, playing with fire when he lit some clothing.

That was a scare. A fire last year was an even bigger one. On June 19, 2016, a similar house in Washington, Iowa, was engulfed in a structure fire, according to Washington Fire Department records. The fire killed one of its residents.

The technical name for these homes is not "group home." Rather, they are Medicaid waiver homes. Their particulars are the result of national trends in caring for people with mental illness, Iowa'sMedicaid privatization and a heavy need for these sorts of services.

There are a handful of companies running these homes in Burlington. Hope Haven, a nonprofit, has several. Many, like Self Reliance, whose home burned Oct. 23, are run for profit. Other companies running them include Optimae Life Services, First Resources and Insight Partnership Group. Optimae is a familiar name to people in Keokuk, where a town hall meeting recently was held for residents to voice their concerns over the large business opening a waiver home in their neighborhood.

Bob Bartles, Hope Haven's director, thinks the number of Medicaid waiver homes in town could be getting close to 100, and there are at least several dozen.

The homes themselves typically are rental houses. They're not marked in any way or listed on any sort of city document. The businesses rent the homes and hire and train workers to lend hands to their tenants. They keep things running according to Medicaid's specifications, with a structured lifestyle that immerses them in their community.

At best, it's a wholesome, heartfelt way to maintain a community and teach those in need how to take care of themselves. But some are worried that, at worst, it's a fire hazard.

"I just think it's an unsafe situation," Crooks said.

Because the homes generally only are considered rental properties, they are inspected every five years by the marshal. Crooks thinks they need to see inside more often.

Larry Caston, a Burlington code inspector, recently has been examining zoning laws on the homes. During the past few weeks, he has looked into it, but nothing official has come of it to report. Caston is being careful with the subject because he understands the potential to cause hardships.

If waiver homes were to be reclassified as something other than one- or two-family homes, which Caston has not said is what's being considered, they may be forced to abide by stricter fire safety regulations. Think things like more frequent inspections or installing sprinkler systems.

Crooks thinks they need a change in the name of safety.

"We're taking single family homes that were designed for one family and we're putting three or four people in these homes," Crooks said. "Their use has changed."

Something like a zoning change likely would be ill-received by many people running these homes. To some, especially at Hope Haven, it goes against the idea of the homes in the first place.

There is a national trend moving away from large care facilities and toward these integrated sites. The old institutions are closing, and the reasons generally are humanitarian in nature. Big institutions treat the needy, like prisoners, while most have a human right to live and thrive in a community of their choice, just like anyone else.

When the Mount Pleasant Mental Health Institute closed in 2015 after its funding was blocked by then-Gov. Terry Branstad, those humanitarian thoughts were his reasoning. Some critiques said there was no adequate replacement in place for about 80 beds at the facility, which included 15 mental health beds. The institute served roughly half of Iowa.

Some said MHI's closure is somewhat responsible for the large uptick in waiver-site homes over the past couple years. Hope Haven's Bartles pointed to it, though he agrees the small homes are a much better concept for their residents' sake. These people should be as "community-orientated as possible," he said.

"The Mount Pleasant facility closed without an infrastructure in place to support the people displaced from the service or who need that service. That's the big rub. I'm not okay with that. Now, they're on the street. They're in jail. They're dead. They are preyed upon by people who prey upon the vulnerable. They're going to go somewhere, if you don't help them."

Another explanation is Iowa's handling of the 2013 Supreme Court decision that allowed states to decide their own fate in regards to the Affordable Care Act's Medicaid Expansion. Iowa was able to get a Medicaid waiver to grant federal money to private health plans, thus opting into the expansion of Medicaid.

That Medicaid privatization has caused problems recently. The Managed Care Organizations, for-profit companies now managing the health care of Iowans on Medicaid, say they are not getting enough money.

Amerihealth Caritas, for instance, is a dominant MCO in Des Moines County. They got a lot of early signups from providers, like Hope Haven and Des Moines County itself, while claiming they wanted to negotiate rates and keep people with their case managers. Now the company said it's cash-strapped, and providers are worried.

Many, including Bartles, feel this money problem between the MCOs and the companies providing services is causing the people who need the most help to get none.

Asked about local jails being affected by mental health needs going unaddressed, Bartles said he has "the belief that they are related."

The Des Moines County jail appears to be struggling with its population. Jail administrator Doug Ervine said he doesn't believe mental illness to be a driving force behind their population problems, because their numbers are similar to other jails nationwide.

The jail's population self-reports mental illness in its in-processing. "Conservatively," 45 percent of its inmates report mental illnesses, Ervine said.

The jail's population was hovering around 95 people this last week. It's maximum capacity is 78, with extras being sent off to neighboring counties' jails.

Generally speaking, the owners behind the waiver home programs think a zoning change would be wrong. Bartles said he trusts nothing will come of it that isn't reasonable.

Insight Partnership's owner Todd Meyers said it has four homes in Burlington with 24-hour supervision. He said any sort of large fire requirement would be a large burden.

"Do they require special things in your house?" Meyers said. "It's just a house that people live in. It would be burdensome for everyone.

"You've got to have management and supervision in there with the proper training of course, but it's just a regular house."

He said they vet people before allowing them into the program to make sure their homes are safe. They can't take everyone, he said, because some of the people simply have too high of costs to serve. They focus on the people they can help assimilate into their community, eventually living on their own.

"That's what makes us happiest," Meyers said.

The provider most people in Burlington are familiar with is Hope Haven, but like other companies, its site homes aren't well known. It has about 10 in town, with a few more in the surrounding area.

Hope Haven usually own the homes, which are unidentifiable from the outside. Being a nonprofit with a knack for grant-writing, it tends to pour a lot of money into its properties.

One houses two young women, with a third moving in this weekend. It's a clean home with cute decorations. Chore lists hang on a bulletin board, and the week's dining schedule in on the refrigerator. One of the women has a big bookcase full of stuffed animals.

The manager has an office downstairs. She splits her time between it and one other home. It's a 40-hour work week, but she usually spends more than 40 hours on the job.

Throughout the home, and at other waiver homes, Hope Haven has a floor plan posted throughout the building with a map of ways to exit in case of emergency. The homes have smoke alarms. Stoves have protective shields to help keep arms away.

Their residents aren't there all the time. Most work jobs in town to pay. But when they are home, they have televisions to watch and yards to enjoy. One home for four older men has a basement man-cave with a pool table and nice couches. Some residents of that home gathered Friday for the Cubs and Cardinals game. They have a guardian supervisor there at all times.

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(c)2017 The Hawk Eye (Burlington, Iowa)

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