HD4 - Services for Mentally Disabled Residents of Adult Care Residences


Executive Summary:
The 1996 General Assembly passed two resolutions directing the Joint Legislative Audit and Review Commission (JLARC) to examine and recommend the best methods for providing mental health, mental retardation, and substance abuse services to persons residing in adult care residences. As part of the review, JLARC was also directed to make recommendations about funding services for these residents. The mandate for this study was thus focused on services to mentally disabled residents of adult care residences (ACRs).

JLARC has conducted two previous studies of adult care residences, formerly known as homes for adults. A 1979 evaluation addressed issues related to the health and safety of residents, and identified significant deficiencies. A 1990 follow-up study found that the basic health and safety measures to protect residents appeared to have improved in the homes, although JLARC found that the regulatory framework did not adequately protect residents with serious mental health or medical needs.

The current study takes place against a background of recent and substantial change in Virginia's ACR industry. Many of these Changes address key concerns of the prior JLARC reports.

• Major legislation established two levels of licensed care in which ACR residents were to be placed, required that placements be based on assessments conducted by outside parties, mandated involvement by the Department of Medical Assistance Services in funding services for ACR residents, and directed that ACRs have adequate and sufficient staff to provide the care determined by the assessments.

• Revised and expanded ACR regulations took effect in February 1996. All ACRs were subsequently inspected for compliance with the new standards.

• A higher funding level for ACRs of $695 per month per resident took effect in 1996; funding for two higher levels of care- regular assisted living and intensive assisted living-was implemented in August 1996.

• Uniform assessment instruments, required for all auxiliary grant recipients, were completed in 1996. Data from these instruments provide, for the first time, statewide information about many ACR residents.

The combined effect of these recent State actions is helping move ACRs beyond providing just board and care, as was sometimes the case in the past. Some ACRS are model service providers, and are cost-effective alternatives to other more costly forms of residential care for the mentally disabled. As the ACR system moves toward providing services for residents with more complex medical and mental health needs, further steps need to be taken to improve services, standards, enforcement, and payment mechanisms.