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A win for people with mental disabilities
Judge rules 'adult homes' in NYC unjustifiably prevent their
integration into society

OPINION
The National Law Journal
November 2, 2005

pproximately 4,300 people live in "impacted" adult homes in New York City; these are facilities in which at least 25 residents (or, if fewer than 25 residents, 25%) suffer from mental disabilities. In 2003, Disability Advocates Inc. (DAI) sued the New York State Office of Mental Health (OMH) and the Department of Health on behalf of dwellers in the 21 largest homes, seeking an order requiring defendants to move its constituents to supported housing in the community.

The plaintiff claimed that the homes in question — privately owned and run for profit but heavily dependent on government aid — violated the so-called integration mandate of the Americans With Disabilities Act. This provision calls for qualified individuals to be accommodated in the most integrated setting appropriate to their needs, one that enables people with disabilities "to interact with non-disabled persons to the fullest extent possible." The rule was designed to combat institutional placement of people who do not require it, which both improperly constrains their freedom and "perpetuates unwarranted assumptions that persons so isolated are incapable of or unworthy of participating in community life." Olmstead v. L.C., 527 U.S. 581, 597, 600 (1999).

On Sept. 8, Judge Nicholas G. Garaufis of the U.S. District Court for the Eastern District of New York upheld DAI's claim. DAI v. Paterson, 598 F. Supp. 2d 289. In a landmark 210-page opinion, he held that the use of adult homes unjustifiably prevented integration of the mentally ill into society. "Scattered site" supported housing, by contrast, provides a normal residential experience, while permitting tenants to receive any necessary services for their illness. As noted by the court, OMH's current focus on this type of dwelling indicates that the state itself recognizes its superiority to the adult-home alternative.

The judge gave the defendants until Oct. 23 to propose a remedial plan, and the plaintiff until Nov. 8 to respond. On the 23d, the United States moved to intervene in the action, citing the "significance and scope" of the remedial decision, "which will help transform the lives of individuals with mental illness...living in segregated communities." Among other things, its memorandum of law noted, the court's final judgment "will likely implicate the United States' interests in the recently signed U.N. Convention on the Rights of Persons With Disabilities," which is pending ratification in the Senate.

The state may well appeal, ­however. Thus it is not clear when, or even whether, this long-awaited declaration of emancipation for the mentally disabled will take effect.

Indeed, the checkered history of attempts to reform treatment of the mentally ill gives ample basis for skepticism: One era's purported improvement morphed into its successor's embarrassment — or even scandal. When revulsion against nightmarish psychiatric hospitals, improvements in medication and a stress on cost containment combined to produce deinstitutionalization in the early 1970s, adult homes initially provided a refuge for discharged inmates. Yet over time, the solution itself became a problem.

Various reports, culminating in a series of New York Times articles in 2002, publicized the horrific squalor and abuses prevalent in these facilities: negligent or nonexistent care, filthy conditions, haphazard distribution of medication, physical mistreatment of vulnerable residents by co-dwellers and employees and unexplained deaths, as well as financial fraud by the owners.

In the wake of these exposés, inspections and enforcement increased for a while; a few of the worst homes were closed, and responsible parties barred from the industry or even, occasionally, prosecuted. But the fundamental problem remained: Even if cleaner and better run, such facilities remain homes in name only.

In reality, the judge found, they are institutions — "psychiat­ric ghettos," to quote even one defense witness — sharing many negative features of the hospitals they replaced. Highly regimented, with roommates and dining room seats assigned, inflexible meal times and other routines, minimal privacy, poor accommodation for visitors, few appropriate leisure activities and little opportunity for residents to care for their own needs themselves or to venture into the neighborhood, the homes may cause occupants to lose skills they previously possessed. Many also receive medical and psychiatric treatment in-house; the homes select the health care providers, often choosing (and overusing) those that will generate the most revenue for the owners. Simply put, the clients' whole lives revolve around their housing.

By contrast, supported-housing residents "are not defined by the setting in which they receive services." Like nonmentally disabled people, with whom they live in close proximity, they can come and go as they please. One witness, a former adult-home dweller, testified poignantly: "It's freedom. It's being able to actually live like a human being again."

Now, one can only hope that the DAI decision remains good law and culminates in a viable plan to transfer adult-home occupants to integrated dwellings — a plan realized through necessary funding and provision of beds. Absent follow-up, it will join the crowded ranks of previous promises made to the mentally ill but broken. The U.S. government's intervention may be just the spur required to ensure that words are transformed into action.