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Hundreds of group homes - for adults, youth, mental health - in Alamance County

Times-News - 4/15/2018

April 15--You have probably passed by one when going to the store or a friend's house. They are all around, but it is hard to tell unless a sign is up in the front yard. Whether or not you are aware, there are hundreds of different types of group homes in Alamance County.

While the term "group home" is broad and vague, it can be broken down into several different categories: youth group homes, mental group homes, family care group homes and homes for the aged. They can take in people of all ages and ethnicities.

However, understanding how a group home functions can be tricky, since it is not immediately transparent which organization oversees the specific types of group homes.

The Department of Social Services in Alamance County, for example, only monitors two types of group homes -- family care homes and homes for the aged, of which there are a total of 59 homes in Alamance County. The North Carolina Department of Health and Human Services covers group homes for the mentally ill, whether they are children, adolescents or adults. There are around 95 mental group homes within the county.

Even though the groups homes are monitored by different agencies and have different ways of allowing residents, they have the same goal in mind: to provide care and help for citizens.

Going into a group home

The Department of Social Services (DSS) and Department of Health and Human Services (DHHS) have specific requirements for residents who want to live at a group home. At DSS, the first step is determining what type of group home would be best -- family care or aged.

"For your family care homes, those are our facilities that are two to six beds, that is, how many residents that they can actually have," said Latawnya Hall, the Adult and Family Services Program Manager with DSS. "For those, that is more of the person that requires a little bit of assistance with their activities of daily living, like medication management and feeding."

"Your homes for the aged, those are the ones that are a little larger," continued Hall. "They can go up to 100 beds. For those, they actually do the same thing as your family care home but they could also have a doctor on site but not 24 hours."

Hall explained that most of the family care group homes are hard to determine as a group home because they blend in so well to the surrounding environment.

"You wouldn't be able to tell your family care homes without them having a sign out there," said Hall. "It looks like a typical house."

Some of the larger facilities can stick out more simply because they are bigger in size.

DHHS, on the other hand, has a whole process they must undergo before deciding to place a person at a mental group home.

DHHS first looks at whether or not the individual in question is Medicaid-eligible or if they are a recipient of state-funded services. That person can then enter the system once they contact the Local Management Entities Managed Care Organization, or LMEMCO, which is Cardinal Innovations Health Care for Alamance County.

"That is sometimes facilitated in a process with DSS where DSS may have a person who they are working with that may need some of those services," said Dr. Jason E. Vogler, the Senior Director of Mental Health, Developmental Disabilities and Substance Abuse Services with DHHS. "Then what happens is there is an assessment that is done to determine that person's clinical needs."

This assessment, called a biopsychosocial assessment, is a comprehensive assessment of that person's needs that confirms what their diagnoses or diagnosis is as well as their eligibility in terms of the insurance.

"If for some reason the person has a private insurance equivalence to a Blue Cross Blue Shield-type of insurance, then they would be referred over to that insurer, but if the person has Medicaid or is eligible for Medicaid or non-Medicaid services, then Cardinal determines what the person's needs are," Vogler said.

Vogler went on to explain that while the person in question could be referenced to a group home, DHHS's first preference is that the person is able to receive their mental health services at home.

"We always want to try to keep the person in their home when that is feasible," Vogler said. "If determined that clinically that person needs group-living type of service, then Cardinal would work with that individual or his or her family to determine what the best type of residential setting may be for that person."

One difference between the two organizations it that DSS considers anyone age 18 and older as an adult while DHHS makes a clear distinction between child, adolescent and adult when putting people in mental group homes.

"Different facilities are licensed to take different ages," Vogler said. "There are child and adolescent group homes which focus on mental illness. There are child and adolescent group homes which focus on IDD (intellectual or development disabilities) service and ones that focus on substance abuse and then there are separate licensed facilities for adults. The adults and children are not treated in the same facility unless the facility has a certain type of setup and operates under a dual license."

Inside the group home

Once a resident is placed in a group home, their needs are met and they are helped with the problems they have. For example, Hall explained that some residents simply need help taking their medicine and that they are attending their doctor's appointments as needed.

"They basically need a caregiver to assist them with some of those things," said Hall. "The family care homes, they usually have an administrator and a staff person. They can't be left alone. They have to be supervised the entire time."

Homes for the aged, on the other hand, typically will have a nurse or doctor that will come and give on-site care. Both types of group homes monitored by DSS must meet specific licensure requirements, such as being handicap-accessible, making sure each resident has their own bed and locking the medications up so residents can't get to them.

The family care and aged group homes are also responsible for providing activities for the residents, based upon the administrator or owner's preference.

"They should have an activity scheduled or calendar where they list what the activities are for those residents," said Hall. "We don't, of course, encourage things like watching TV as an activity, but an actual activity. It varies based upon the different facilities."

Over at DHHS, the mental group homes undergo the same basic needs: making sure their medicine is taken and that they get to their doctor's appointments on time. They also rely on the resident's inner plan to determine what their preferences and needs are.

"That can range from anything that includes things like individual therapy, medication, recreational needs," said Vogler. "It is a custom-tailored plan to that individual designed to meet whatever needs that that person has had that have been assessed through a clinical assessment."

The group homes are also open to family and friends visiting, though they may face visiting hours to ensure residents are not disturbed at all hours of the night.

"Typically, you will see that a group home has established visiting hours, much like hospitals or other types of settings," said Vogler. "A person is able to have visitors of their choice unless for some reason there is a court order or some other legal document that limits who can visit them."

DSS also determines if the visitor in question is causing safety concerns to the residents.

"Anyone can visit unless the administrator or the owner of the facility feels as though they are posing a safety risk to that particular individual or any other residents in the facility," Hall said.

Potential problems

While group homes are designed to help residents and meet their needs, that doesn't mean there are never problems. Some residents find that they do not like the home they are living in and want to move to a different home.

DSS and DHHS treats these instances on a case-by-case basis. Hall explained DSS has to make sure that the resident in question does not have family that have to first be notified before placing them in a different facility. They also have to call in an ombudsman to determine that the resident's rights are not being violated.

"The resident could contact them and say 'This is going on in this facility and I no longer want to live here,'" Hall said. "They may assist them with looking for somewhere else to stay."

DSS then provides the resident a list of other facilities that can meet their needs.

DHHS operates under much of the same mentality.

"As we are all human, we change our mind or we have things that come up that we don't like," said Vogler. "What happens in that circumstance is then the consumer works with Cardinal to try to find alternative placement that may be available. They have to work to find a facility that has an open bed, that is appropriately license and that also meets their medical needs. All those things have to be taken into account."

Another problem that group homes can face are when a resident runs away or leaves the home. Here, DSS and DHHS differ on how they handle these type of situations.

DSS first check to make sure the facility's policies and procedures say that residents are allowed to sign themselves out. If the resident is allowed, DSS will check the log and make sure they did sign out. After that, there is not much DSS can do.

"We, of course, encourage the administrators and the staff to make sure that that person is actually capable of signing themselves out and being able to come back to the facility without needing assistance from law enforcement or anyone else," said Hall. "That is based upon the individual's capabilities."

DSS will offer a corrective action plan to the facility if a resident did not sign themselves out. The plan has DSS write down the licensure rule that was violated and ask the facility how they would like to fix the problem.

"We allow them to submit a plan. We also submit a plan in regards to what should be done to correct it. Based upon the severity of that plan or the severity of the violation, sometime there is an actual monetary fine and then sometimes it is 'we fixed it' and we kind of move on," said Hall.

DHHS explained that when someone elopes from the group home, they take it case-by-case and first determine if the person in question was a minor or legally incompetent.

"Then they have to notify the guardian or whoever it is that is their legally responsible person and the LMEMCO are also required to enter an incident report into the state's incident reporting system," Vogler said.

He explained that most of these cases will end with Amber Alerts or Silver Alerts.

When it comes to an adult that is legally competent, the only time police would be involved is if the person in question is believed to be a danger to him or herself or others.

"In those cases, then the same procedures would apply," Vogler said. "Then the LMEMCO has to work with that individual as well as the provider to determine what happened and what led to this incident."

Vogler said this can end with the resident either going back to the group home or going to a different type of living setting.

Monitoring homes

While the two agencies are in charge of different types of group homes and residents, the homes have to meet specific rules and expectations.

DSS has three social workers called adult home specialists that visit facilities once every other month to determine if the facility in question is following the licensure rules.

"We go out and we monitor things such as the environment, medication, staffing and residents' rights," Hall said. "What we do is we make sure that based upon the state licensure rules, they are following those rules."

DHHS, however, does not have social workers to send to sites. Instead, the division of DHHS responsible for investigating complaints and for routine inspections is called the Division of Health Service Regulations. They are also in charge of licensing the facilities.

"They are the entity responsible for following up on investigations and routine inspections," Vogler said. "The LMEMCO (Local Management Entities Managed Care Organization) also has a responsibility for monitoring the clinical care that goes on within their providers."

Vogler's division specifically looks at the safety and welfare that occurs within the facilities as well as following up on complaints that are filed and responding to any issues there.

"Our responsibility is to ensure that LMEMCO are working to meet the needs of their consumers in the least restrictive way possible and that they are contracting with providers, like group home providers, whenever consumers are in need of services so that they can make sure that those are being delivered."


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