November 17, 2002
New York Exports Mentally Ill, Shifting Burden to Other States
By CLIFFORD J. LEVY
LINCOLN PARK, N.J. ?A few miles off the highway in this secluded town stands a sprawling nursing home that has become a virtual annex to New York State's psychiatric system. Confined on the third floor of the home, which has no mental health credentials and has been admonished by New Jersey officials for providing inadequate care, are more than 125 people who were sent here by state psychiatric hospitals in New York.
Locked away at a similarly checkered nursing home near a cornfield in Andover Township, N.J., about 50 miles from Manhattan, are more than 200 other former New York psychiatric patients. Still others just like them have been sent by New York officials to problem-plagued nursing homes and adult homes as far-flung as the Boston area, including several deemed so violent and disastrous that Massachusetts officials threatened to close them down. At one last year, a resident from New York gouged out the eye of another resident with his bare hands, the officials said.
Over the past eight years, the Pataki administration has been essentially exporting hundreds of its most troubled psychiatric patients to other states, turning over responsibility for their care to homes there that have little if any expertise and often have tarnished histories, according to interviews with officials, visits to the facilities and an analysis of Medicaid and other state records.
Many of those patients had been institutionalized for decades and were among the most difficult and costly to treat. As a result, they had frequently been rejected by private facilities in New York because of the level of care that they need, records and interviews show. By using homes outside its borders, New York officials have effectively shifted the burden of overseeing their care to other states. Further, interviews show, they have then made it difficult for some of their own residents to re-enter New York's mental health network.
"The point was to clear beds and to get even these chronic patients out who had been taking up beds for 10 or 15 or 20 years," said Dr. Alvin Pam, who was director of psychology at Bronx Psychiatric Center until the end of 2000. "Patients might be turned down by 15 residences in New York ?which could raise serious questions about whether they should be discharged at all. And if the hospital would find someplace to take the patients outside the state, they would go."
The patients have been sent by state hospitals across the region, records show, from Bronx Psychiatric Center and South Beach Psychiatric Center in Staten Island to Hudson River Psychiatric Center in Dutchess County and Rockland Psychiatric Center. The out-of-state homes, in turn, have reaped hundreds of millions of dollars from the New York Medicaid program, which typically pays for the residents' care.
A spokesman for the New Jersey Department of Human Services said the department's mental health director had complained to officials in Albany this year that New York psychiatric patients were being discharged to nursing and adult homes in South Jersey, deteriorating and then ending up in a New Jersey state hospital.
Roger F. Klingman, a spokesman for New York's Office of Mental Health, which operates the state psychiatric hospitals, called sending the patients out of state proper.
"Discharge decisions are made on a case-by-case basis," Mr. Klingman said. "It's a clinical decision made by the discharge team at each state hospital. Different facilities offer different kinds of programs. Obviously, the discharge planners believe that these out-of-state facilities offer the kind of programs that the patients needed."
He added that state hospitals discharged thousands of patients a year, and only a fraction of them went outside New York.
Several facilities outside New York were also used by previous administrations in Albany, though to a lesser extent, according to state records and interviews. Lincoln Park, for example, had only a handful of New York residents before Gov. George E. Pataki took office in 1995.
The practice is just one way his administration has been able to shrink the state's costly psychiatric hospital system. The state hospitals now have 4,300 beds, down from 9,000 in 1995. At the same time, a chronic shortage of housing for the mentally ill has persisted.
Other former patients have gone to adult homes in New York. The administration has proposed a sweeping overhaul of the adult homes in response to a series of articles in The New York Times earlier this year that described extensive neglect and malfeasance in the system. Still others have been released to locked units in nursing homes in New York, under a policy adopted by the Pataki administration in 1996. The policy was halted at some state hospitals after an article about the units appeared in The Times last month.
A Goal of Self-Sufficiency
Some of the out-of-state homes, including Lincoln Park and Andover, keep mentally ill residents in similar conditions ?locked away on isolated floors and barred from going outside on their own. They have little ability to contest their confinement, though they have not been legally committed.
Officials at Hudson River Psychiatric Center in Poughkeepsie, N.Y., told Susan Meyer that the Andover nursing home in rural Sussex County would be wonderful for her sister, Marcia Berger, who suffers from schizophrenia, Ms. Meyer said. Instead, Ms. Meyer said she found that her sister had been all but ignored at Andover.
Ms. Meyer, who is trained as a nurse, said scores of mentally ill residents wandered the locked floor at Andover, some screaming at one another, while workers provided little supervision. "The surroundings are utter chaos," Ms. Meyer said.
Many other residents from New York, who have spent much of their lives in institutions and are accustomed to being told what to do, often have no idea how they ended up far from their homes ?or even where they actually are. Some, like Gregory Posey, 40, and Carmen Shields, 62, who went to Lincoln Park this year after lengthy stays at Bronx Psychiatric Center, could recall being told only that there was no longer room for them at the hospital.
"I don't want to be in this place ?it's too far away," Ms. Shields said. "They keep you locked up here on this floor, and you don't go anywhere or do anything."
Both Ms. Shields and Mr. Posey have schizophrenia, and Bronx officials had tried for years to discharge them, according to interviews and records. In the last year alone, more than a dozen nursing homes in New York had refused to accept Mr. Posey.
Mr. Posey also said there was not much to do at Lincoln Park, besides go on smoking breaks. The home is in a woodsy area of eastern Morris County, about 30 miles from his family's apartment in Harlem.
Like the other mentally ill residents, he can leave the floor only when escorted by workers. He was found in his room shortly before noon the other day, half asleep on his bed while fully clothed and wearing sneakers and a wool ski hat. His two roommates were asleep in their clothes as well.
"I wish they would let us out more," said Mr. Posey, who is physically healthy.
While New York's own files show that mentally ill patients have been consistently sent out of state since Mr. Pataki took office, the governor and his aides maintain that they have in fact done the opposite.
On the campaign trail in recent weeks, Mr. Pataki said his administration had brought back 5,000 mentally ill patients. "That is an important, positive thing for them and for their families," Mr. Pataki said during a debate after his policies on mental health were criticized by one of his opponents, H. Carl McCall.
The governor's assertion could not be substantiated by New York Medicaid records. Asked about it, neither Mr. Klingman nor John Signor, a spokesman for the state Health Department, could offer any evidence to support it. They would not identify which facilities had been caring for the mentally ill outside the state, nor where they had been returned to in New York.
Mr. Pataki would not comment for this article. Several mental health experts in New York, along with groups that represent housing providers for the mentally ill, said they had never heard of an effort by the administration to bring back mentally ill patients.
At the same time, Mr. Signor maintained that the administration had sent fewer than 50 people annually to facilities outside New York. In fact, Medicaid records show that since 1995, more than 725 New Yorkers have gone to the Lincoln Park and Andover nursing homes alone, an average of more than 90 a year. Some have not remained there, but it is unclear what happened to them because the administration does not track their treatment after they leave New York, officials said. There are now at least 425 New Yorkers at both homes, including some sent by psychiatric wards of general hospitals with the administration's approval.
While New York typically continues to pay the Medicaid fees for New Yorkers in facilities outside the state, the Pataki administration still realizes substantial savings because the federal government heavily subsidizes Medicaid. If the patients were to remain in a state psychiatric hospital, Washington would not cover any of the cost.
Andy Williams, a spokesman for the New Jersey Department of Human Services, said the department was not aware that New York was sending large numbers of patients to Lincoln Park and Andover, in the northern part of the state. But Mr. Williams said the department's mental health director, Alan G. Kaufman, had complained to New York officials about the patients being sent to homes in South Jersey and then ending up at a New Jersey state hospital.
"He was concerned about it, and he did call his counterpart in Albany," Mr. Williams said. "We were of the understanding that they were not doing it anymore."
Mr. Klingman, the spokesman for the New York State Office of Mental Health, acknowledged that the office was called. He said the office had not changed any policies in response, but had directed one hospital, Bronx Psychiatric Center, to stop sending patients to adult homes in South Jersey.
For the facilities, accepting such patients can be a lucrative business. Medicaid has paid Lincoln Park and Andover $82 million to care for New Yorkers since 1995, according to Medicaid records. It has paid more than $260 million to the deeply troubled SunBridge chain of facilities in Massachusetts, which at the beginning of this year cared for 400 New Yorkers in at least four homes, according to Medicaid records.
Massachusetts regulators say the SunBridge facilities have deteriorated markedly in recent years, repeatedly criticizing them for mismanagement, shoddy care, sexual assaults and other violence among residents, including the resident's eye gouging last year. Yet New York officials continued to send patients there, records show.
Late last year, the Massachusetts regulators threatened to effectively shut down three of the homes if improvements were not made. In March 2002, SunBridge closed one of them, in East Boston. SunBridge said a new management team was improving the facilities.
The movement of residents outside New York is apparent from an examination of the discharge records of Bronx Psychiatric Center. Since 1998, it has sent at least 75 patients to New Jersey facilities. In addition to numerous placements at Lincoln Park and Andover, at least 25 patients went to adult homes in Toms River, Glassboro, Camden and Lakewood ?facilities that are as much as a two-hour drive from the Bronx.
Alarming Inspection Reports
The New Jersey facilities have all been criticized by their state's Department of Health and Senior Services. Inspectors found that Lincoln Park had failed to provide "any meaningful activities" for mentally ill residents, according to an August 2002 inspection report. They cited the Andover nursing home for making residents sleep on filthy and threadbare sheets.
Mimi Feliciano, the chief executive at the Lincoln Park home, said the home had responded to the inspectors' concerns. She said the home provided excellent care that was intended to help the mentally ill "improve their functional ability and promote the acquisition of leisure-related skills."
"One of our goals is to promote the reintegration of these people back into the community," she said.
Asked how keeping residents on a locked floor in a New Jersey suburb accomplished that, she said: "Yes, they are in the facility, and yes, they are in an institution, but we do think that we do a good job doing what we can with them. Some of them are very limited."
Administrators at the Andover nursing home did not respond to three messages seeking comment.
New Jersey inspectors also cited problems at the New Lexington Manor adult home in Lakewood, in Ocean County, which has accepted about 15 patients from Bronx Psychiatric Center in the last few years. Medication and record-keeping practices were poor, and workers were "disrespectful and demeaning" to residents, a March 2002 report said.
New Lexington recently decided to stop accepting patients from New York psychiatric hospitals because they were too unstable.
"I got the sense that they were dumping patients on us," said Lynda Crooks, New Lexington's manager. "Why couldn't these people be placed in New York? They claimed that they had no placements for them up there."
Some of the Bronx patients now in New Jersey adult homes said they saw little choice but to go.
"They were having difficulty getting me into residences in New York, and this place was presented to me as a quick way out of Bronx State," said Phillip Rosenstein, 51, who was sent to the Dayton Manor adult home in Camden, outside Philadelphia.
Mr. Rosenstein said he had no complaints about the home. Other former patients and their relatives said they felt deceived by both the psychiatric hospitals and the facilities outside New York.
Sarah Thomas, the mother of Mr. Posey, who was sent to Lincoln Park from Bronx Psychiatric Center, said she had been worried that the home was far away, but at least it was closer than the only other choice offered by the hospital, the Andover nursing home. She said Lincoln Park had promised that Mr. Posey would live in a stimulating environment, and even be taken on trips. But the reality, she said, is that he has little to do.
"I was getting a lot pressure from Bronx State to discharge him," Ms. Thomas said. "They said Greg was at that point that they couldn't do anything else for him. And they said that the nursing home would be a better place for him. And the home said they had all these activities planned for him. They misled me, definitely. All these good things that they said would happen, they really didn't happen."
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