The chairman of a legislative oversight committee looking into assisted-living facilities said the state may need to consider going back to regional center-type settings for some people with persistent mental illness.
The oversight committee, created during the 2018 lawmaking session, is studying the lack of adequate conditions of state-licensed care facilities where many of the residents are diagnosed with a mental illness, the treatment of clients residing in such facilities, and the effectiveness of regulation and licensure by the state Division of Public Health in providing oversight.
It is also looking at how the Department of Health and Human Services implements and administers its behavioral health services through the behavioral health regions to address the needs of that vulnerable population.
A law passed in 2004 resulted in a shift in mental health services from three psychiatric hospitals to community-based care. That eliminated hundreds of inpatient mental health beds, and more people with mental illness ending up in jails and prisons, or assisted-living facilities.
Sen. Curt Friesen, chairman of the Legislature's State-Licensed Care Facilities Oversight Committee, told senators during a legislative retreat that law enforcement has complained there's no safe place to take people with serious mental illness when they have issues that require police or sheriff's department intervention.
When the Hastings and Norfolk regional centers were closed, no solid plan was developed on where residents who left the centers would go, Friesen said.
Certain clients just do not fit in an open-campus setting that some community housing units have. "They need a more structured environment like Norfolk or Hastings."
With the high level of care they need, they are never going to transition to independent living, he said.
Sen. Lou Ann Linehan said the federal government forced the change from regional center settings, rather than have mental health patients being warehoused. The state then created six behavioral health regions.
"I think we need to go back to behavioral health regions and say, 'What are you doing for this subgroup of people that are falling into law enforcement?'" she said.
The resolution (LR296) that authorized the oversight committee was introduced last session by Sen. Lynne Walz of Fremont. It was born out of an incident at a Palmer assisted-living facility, in Friesen's district. A resident of the Life Quest facility, which had a history of complaints and violations, died Sept. 3, 2017.
The HHS report on that death has not yet been completed, Friesen said.
The HHS revoked the license of the Palmer facility to operate as a mental health center a month after the death. In February, Life Quest in Blue Hill closed its doors, related to a bed bug issue that could not be resolved, Friesen said.
During its investigation, the oversight committee has held discussions with HHS, the Lincoln Police Department, the state ombudsman's office, disability rights advocates and industry experts.
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HHS is required to survey these facilities at least once every five years, so it is assumed that about 20 percent of them are inspected in any given year, Friesen said.
"But there was at least one year that there were absolutely no inspections done," he said. "There are only two surveyors in charge of all these facilities."
The committee wanted to have a surveyor come and talk to the committee, but HHS would not allow it, he said. The committee also has not received some information it has asked for, including the number of complaints facilities have received, how many of those complaints resulted in deficiencies, and how many were violations of life and safety issues.
Some members of the committee did get permission to follow a surveyor on several unannounced official inspections of facilities, he said.
The surveyors are busy, Friesen said, and although they triage the complaints they get, they get overloaded. When they go to a facility on a complaint, they look only at that complaint and don't do an inspection of the entire facility.
In addition to requesting information from HHS, members have visited 13 facilities, in Ashland, Central City, Hastings, Inavale, Lincoln and Omaha. Several more visits are planned.
The facilities house as few as four or five clients or as many as 20 to 30. The clients there are not placed by the state, but rather opt to live there or are placed by guardians or family members.
The facilities vary in condition, he said, and although many of their owners and managers have good intentions, they may not have the proper resources to care for this vulnerable population.
The state may need to increase the number of inspections it conducts, Friesen said.
Lincoln Sen. Anna Wishart, also a member of the committee, told senators Friday the committee saw a few facilities that were out-of-compliance with state licensing regulations. During some visits, they saw toilets that were black, bedrooms that were filled with flies, black mold and smoke detectors without batteries.
"It was startling that these are places that are still licensed by the state," she said.
"This is an issue that we're going to have to confront in the session."
The committee will submit its final report in December.