New York Announces New Initiatives to Further Protect Adult Home Residents, Mentally Ill

State's Initiatives Include Assessments, Improved Case Management and Medication System

Albany, November 26, 2002 – Building on New York State's unprecedented surveillance initiatives, State Health Commissioner Antonia C. Novello, M.D., M.P.H., Dr.P.H. was joined today by State Office of Mental Health (OMH) Commissioner James L. Stone, Commission on Quality of Care for the Mentally Disabled (CQC) Chairman Gary O'Brien and Office for the Aging (SOFA) Director Patricia Pine to announce new initiatives to improve the quality of life and safety for adult home residents in New York State.

The extensive State actions announced today are based on recommendations developed by an adult home workgroup established by Dr. Novello in May 2002 at the direction of Governor Pataki. The new State initiatives to improve the lives of adult home residents include:

  • Clinical, psychiatric and functional assessments by highly qualified and trained health and mental health care providers;
  • Improved case management and coordination to assure that appropriate care and services are delivered;
  • Enhanced Medication management system which better ensures that medication is being administered by qualified personnel;
  • Improved social and recreational services; and
  • Increased advocacy and legal support.

Dr. Novello said, "No Governor has done more in New York State history to protect adult home residents than Governor Pataki. These new initiatives build on the State's sweeping changes to further strengthen the oversight of adult homes in New York. I would like to thank all of the members of the workgroup, my colleagues, Commissioner Stone, Chairman O'Brien, and Dr. Pine, as well as all State agency staff for their commitment and hard work in this endeavor."

"New York State's new strategy will result in substantially improved conditions in adult homes, as well as increase the opportunities for rehabilitation and recovery for residents with mental illness," said Commissioner Stone. "The initiatives announced today build upon actions already taken by the State to strengthen regulatory oversight; quality improvement; information sharing; and enhanced consumer participation. These actions further ensure that residents of adult homes will receive appropriate services and, when appropriate, high quality mental health care in a safe, clean environment."

Chairman O'Brien said, "The State initiatives reflect and affirm the values and guiding principles established by the shareholders. I sincerely appreciate the efforts which this workgroup, my colleagues, Dr. Novello, Commissioner Stone, Dr. Pine, and our staff have devoted to this issue. I would like to thank the Governor for his tremendous leadership, support and commitment to improving the quality of life for all adult home residents."

Dr. Pine said, "I am pleased with the results of the workgroup's efforts to improve care and quality of life for adult home residents. Thanks to the Governor's support, these far–reaching initiatives will improve conditions and the quality of services provided to all residents of adult homes, including many seniors."

Dr. Novello announced the creation of a new adult home toll–free centralized complaint "hotline" (1–866–893–6772) for consumers, families and advocates to contact with concerns about the conditions or services in specific homes. The State Health Department has mailed posters with the new "hotline" number to all adult homes operators in New York State with instructions to prominently display them in common areas of the homes.

Dr. Novello has also asked members of the workgroup to continue in their current capacity as the State moves forward with efforts to overhaul the current adult home and mental health systems.

The adult home workgroup was formed in May 2002 to examine key issues related to adult homes, especially those related to the needs of individuals with mental illness, as well as the frail and elderly. The workgroup's primary focus was in the areas of resident assessments, including health and mental health evaluations, resident rights, case management, medication management, personal care, coordination of services (with a particular interest on outside provider services), resident support groups, personal needs allowances and the feasibility of alternative housing options beyond the current adult home setting.

The adult home workgroup members include: Harvey Rosenthal (New York Association of Psychiatric Rehabilitation Services), Karen Schimke (Schuyler Center for Analysis and Advocacy), Geoff Lieberman (Coalition for Institutionalized and Disabled ), David Rosen (Medisys, Jamaica Hospital), Dr. Neal Cohen (psychiatrist), Alfred Brandon (adult home resident), Dr. Richard Milone (psychiatrist, PMC board member), Rosa Gill (social worker), Florence Weil (NAMI), Robert Butler, M.D. (International Longevity Center), Kathleen McArdle, R.D. (NY United Hospital Medical Center, Skilled Nursing Pavilion), Pearl Granat (SEIU New York State Council), Susan Reagan (Visiting Nurse Service of New York), Azzy Reckess (adult home operator), and Leon Hoffman, (adult home operator).

What New York State is doing to strengthen oversight of adult homes:

Multi–State Agency Oversight of Adult Care Facilities

  • The State's latest actions include: reinforcement of mandatory death reporting by homes and immediate investigations of such reports; multi–agency created profile of deaths at the homes to identify patterns; and increased surveillance, including multi–agency teams comprised of inspectors from DOH, OMH and CQC to complete focused surveys. These strong actions will not only serve to further protect adult home residents when fully implemented, but will also serve to make homes more accountable for the care they provide.
  • The State has also taken additional steps to clamp down on Medicaid fraud by conducting audits of services provided by outside health and mental health care providers, as well as requiring homes to provide additional audited financial information for State review. This heightened review of Medicaid expenditures will help the State better identify where services are being duplicated, as well as where they are inappropriate or unnecessary.

Adult Home Inspection Sweeps

  • New survey teams of inspectors from CQC, OMH and DOH completed 27 adult home inspections this year. The new multi–agency survey teams are focusing on death reporting, medication management, the appropriateness of services, annual mental health and health assessments, case management and the conditions of the homes. In addition, the Department of Health is expediting enforcement actions against adult homes that are found to be providing insufficient care.
  • To date, the surveillance teams have found violations in 26 of the 27 homes inspected in New York City and other regions of the State, referring 11 of the homes for enforcement action (proposed fines). The fines ranged from $1,000 to $56,500 in the 11 enforcement cases. Additional focused surveys are underway.
  • The State Health Department, at the Governor's direction, committed $1 million in funding to add approximately 12 new surveyors (representing a 35 percent workforce increase) to conduct additional surveys involving resident deaths and other serious incident report investigations. As a result, the current number of adult home inspectors totals 46, including 26 in New York City.
  • DOH, OMH and CQC are now developing "Priority Investigative Teams" that will be charged with conducting expeditious inspections of adult homes with problems that pose an imminent risk to the welfare and safety of residents.

Death Reporting and Investigations

  • A letter was sent on April 30, 2002 to all adult homes from the Commissioner of Health reminding homes of their statutory responsibility to report all resident deaths and attempted suicides within 24 hours to the Department of Health. The letter also indicated that felony crimes against residents must be reported to an appropriate law enforcement authority as soon as possible and no later than 48 hours after the event. Reporting of these events to CQC for residents receiving mental health services was noted as well. The letter indicates that failure to report will result in a citation and an immediate enforcement action.
  • A second, follow up letter was sent to all adult homes on May 3rd notifying homes of the increased penalties for failure to report all resident deaths and attempted suicides.
  • The State's investigation of reported deaths is a priority. In addition, death report profiles or patterns for each adult home are now being reviewed by a multi–agency review team to determine the need for further surveillance action.
  • The State has developed and distributed a consolidated death reporting form for adult homes in place of individual agency reporting forms.

Financial Accountability and Medicaid Fraud Activities

  • Profiles on Medicaid providers servicing adult home residents have been developed to identify potential patterns of overuse and abuse. The State will conduct follow–up surveys and audits with regard to Medicaid billings and refer any physicians found to be a party to violations to the Department's Office of Professional Medical (OPMC) Conduct for investigation.
  • Increased targeted Medicaid audit activities are now being conducted based on reviews of unusual service and billing patterns, as well as in response to facility specific inspection results.
  • Adult home cost reports are being revised by CQC to better identify and disclose adult home financial relationships with mental health and health care providers, as well as related party transactions. Audits will be conducted to assess the accuracy of the cost report information.
  • Medicaid reimbursement regulation will be amended by redefining a clinic threshold visit to eliminate visits made solely for podiatric purposes.

Temperature Control Regulations

  • In August 2002, the State Health Department (the Department) referred three homes for enforcement action for non–compliance with heat–related directives issued by the Department in a June 28 letter to all ACF operators statewide. The Suffolk County homes cited for violations were Inver Adult Home, Montauk Manor and Holiday Manor.
  • The June 28 letter contained detailed information regarding steps that ACF operators must follow to ensure the comfort, health and safety of residents, medications that may cause residents to become more susceptible to heat, rebate options available from NYSERDA in the purchasing of air conditioners, and, the signs and symptoms of heat illness. The Commissioner's June 28 directive also required adult homes that have air conditioning to turn those systems on to ensure comfortable temperatures for residents.
  • In addition to Commissioner Novello's June 28 letter, to further ensure the safety of residents, the Department has directed all adult homes identified with temperature control violations to provide fans in every resident bedroom and, where necessary, install air–conditioning to cool common areas of the home. ACF operators who fail to comply with State temperature control regulations may face enforcement action for endangering the welfare and safety of residents.
  • In addition to the focus surveys now being conducted, State Health Department inspectors routinely conduct a review of the temperatures in adult care facilities and determine whether the operators are taking necessary precautions to ensure that residents at risk for heat–related illnesses are appropriately cared for and provided plenty of fluids to prevent dehydration and other health–related complications. The homes must provide all residents with access to common areas of the home where temperatures have been cooled to comfortable levels.
  • With the cold winter months approaching, Commissioner Novello will issue a temperature control advisory in the coming weeks to all adult home operators statewide reminding them of their obligations and responsibilities to ensure that resident bedrooms and common areas of the home maintain temperatures of 68 degrees Fahrenheit. Operators are required to purchase additional heaters to ensure compliance with such temperature control regulations if the current heating system in the home is not adequate.

Consumer Information

  • Quarterly press releases are now being issued identifying recent adult home inspections and the results of those inspections.
  • In addition, the most recent surveillance history of adult care facilities will soon be available on the Department's website by both by facility name and geographic region.

11/26/02 –129 OPA