For every bed lost a person is displaced: California’s continuing board & care crisis

The CORO Fellowship program is a 79-year old,  highly respected nine-month public affairs leadership training boot-camp based in five cities across the US, including Los Angeles.  When CORO’s executive director reached out to me in September asking if Heart Forward LA would host a Fellow for their four-week nonprofit placement, at first I balked, because taking on an intern can often mean doubling one’s own work.  However, she indicated that they specifically wanted this Fellow to work on a project  related to housing and the light-bulb snapped for me. 

Advisory Panel that contributed to this report: Lynda Kaufmann, Director of Government and Public Affairs, Psynergy; Dr. Susan Partovi, Clinic Physician, Homeless Healthcare LA; Paul Webster, Director, Hope Street Coalition; Maxwell Hellmann, MD/PhD Candidate, UCLA; Lauren Rettagliata, Advocate, Co-Author “Housing that Heals;” Teresa Pasquini, Advocate, Co-Author “Housing that Heals;” Brittney Weissman, Executive Director, Hollywood 4WRD; Barbara B Wilson, LCSW, Mental Health Hookup.

“Yes, I’ll host a Fellow,” I acceded.  “And I would like the Fellow to shed light on the continuing crisis we see unfolding in our system of board and care homes in L.A. County where some of our most vulnerable community members are living in congregate settings.”   This is a type of housing that is rarely discussed in the continuum of homeless housing – yet it is a critical, albeit shrinking, component of our housing infrastructure for people with serious mental health conditions.  (I have written about this before –  Taking Care of People for $35/day.  And, I’ve celebrated the advocacy of Lauren Rettagliata and Teresa Pasquini who have given us new language for what this state needs – Housing That Heals.)

Coro Fellow Jonathan Wisner joined us on September 20 and I assembled an Advisory Panel to help guide his journey over four weeks.  (See sidebar.)  In addition to researching any and all reports, articles and data sets on “Adult Residential Facilities” in California (this is the formal name associated with the licensing category), he also had the opportunity to do site visits to several board and care facilities, a supportive housing community and Skid Row. 

No Time to Waste

His report was issued this week.  He aptly titles it: “No Time to Waste: An Imminent Housing Crisis for People with Serious Mental Illness Living in Adult Residential Facilities.”

As he suggests in the introduction to his report:

An exploration of three critical emerging themes guides this report’s finding. Through the lens of accountability, it is concluded that a lack of central responsibility alongside extreme data gaps have essentially separated ARFs and their residents from the collective public and institutional support. When examining the market conditions of ARFs, this lack of central accountability has contributed to static funding structures that have made ARFs financially nonviable for decades, disincentivizing quality care and new market entry. This has led to a continued closure of facilities that has only worsened with time. Further, there is a lack of equitable access to quality care due to funding structures and a central lack of care standardization.  The current system disadvantages those without personal or familial resources as well as those living in California counties with limited or no care options. In addition, existing state funding structures of care facilities for other populations, such as those with Intellectual or Developmental Disabilities (IDD), are more financially lucrative and discourage the operation and opening of care facilities for those with SMIs.


Zoom call between Coro Fellow Jonathan Wisner and Advisory Panel

His report outlines three main recommendations that can only be led by the state and cannot be delegated to the counties:  (1)  Centralized statewide data collection; (2) an immediate statewide infusion of interim funds (a “patch” ranging from $65 to $125 per resident per day) to stem the tide of facility closures; and (3) the creation of a state-wide advisory group to oversee the research and prioritize solutions that lead to a system of “housing that heals.”

 Bravo to Jonathan Wisner for capturing in just a four-week internship the severity of this crisis and the “grave human injustices that are looming as this industry collapses.”   Please be informed – read this report, and share widely with policy makers, advocates, the media and elected officials at the local and state level.

As he so eloquently concludes his report:  “The best time to act on this issue was when it surfaced decades ago.  The second-best time to act is now.”

Exploring how lessons learned from the Trieste, Italy mental health system could be transformative in the US




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