NC has a plan to support people with disabilities living outside institutions. Does it do enough?

A 2021 assessment of living arrangements and community support for North Carolinians with developmental disabilities or severe mental illnesses reinforced what’s become a truism in the state: it spends a disproportionate amount of public money on institutional living that keeps people segregated from larger communities.

The state Department of Health and Human Services released a plan in January that it intends to use as a guide toward keeping people from entering institutions and helping those who want to leave, in keeping with the U.S. Supreme Court’s 1999 Olmstead decision that services should be available to allow  people to live and work in their communities.

The two-year plan lays out 11 priorities that include closing gaps in community services, making it easier for people to live in communities, and finding ways to hire and keep the frontline support staff who help people with disabilities live outside institutions.

Corye Dunn, public policy director at Disability Rights North Carolina, said the state plan doesn’t do enough.

“The state characterized as a final plan and a living document,” she said.  “We see it as too far from where we need to be to be considered final.  We’re treating it as the next of what may be many drafts.”

For example, under a 2012 court settlement, North Carolina is required to move people with mental illnesses out of adult care homes and into communities. The Olmstead plan says the state will find homes for an additional 750 people under its Transitions to Community Living program, including 450 who will move from adult care homes, by the middle of this year.

That sounds like a lot, Dunn said, but only a fraction will likely end up staying in their own homes.

“I want to see actual investments and commitments to change,” she said.

The Technical Assistance Collaborative and the Human Services Research Institute defined the state’s challenges in its 2021 assessment. The state doesn’t have enough affordable housing or support services. In 2019, North Carolinians used community mental health services far less than the national average. That year, 14,000 people with mental illnesses lived in places like assisted living facilities or group homes. That’s not counting those who live in adult care homes.

Staff turnover is high in low-paying, community-based support jobs.

There’s limited state funding to cover community services for low-income, uninsured adults. State facilities are the back up.

DHHS has lots of data, but it’s not organized. The agency hasn’t been able to use its data to improve services and can’t say how the mental health system is performing.

Vicki Smith, Alliance of Disability Advocates executive director, said she knows something that does work – helping people figure out how to do things they want to do when they’ve moved to community living.

Helping people figure out how to make community connections – to figure out how to get to church, for example – cuts down on loneliness and isolation and keeps people from wanting to move back to institutions, she said.

Alliance of Disability Advocates is doing that kind of work.

“You can’t put people in an apartment and think you’ve addressed the Olmstead plan,” she said.” If you’re connected to a community, you’re engaged, probably happier than you would be just sitting by yourself.”

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NC has a plan to support people with disabilities living outside institutions. Does it do enough?