Out of sight

The photos of the moldy food, the filthy walls and the broken furniture were disgusting, but it was the picture of the bed made up with a blue tarp instead of a sheet that broke my heart. I imagined a tortured soul, lost in a confused mind, crawling into bed every night, trying to find a few hours of rest on that hard crackling fabric when a church or charity thrift store would have gladly donated a set of clean sheets if they had just been asked. I was overcome with sadness that anyone would run a group home for severely mentally ill people without making sure there were sheets for the beds, decent food in a functioning refrigerator, and more than a candle on the floor for lighting regardless of what they were being paid to provide meals and shelter, if not comfort and companionship.

The Nevada Legislature received the first of three reports on the state’s Community-Based Living Arrangement homes for people living with severe mental illness from the Audit Division last month. The audit’s findings were devastating, even for Nevada, where we’re currently ranked dead last at 51st in the country for mental health care.

Auditors inspected 37 of the 105 homes providing care to this vulnerable population and found “serious, deficient conditions” at every one, including 10 homes located in Northern Nevada. The deficiencies, backed up by 2000 photographs, included unsanitary conditions such as excessively dirty floors and walls, mold and mildew, human waste, and rodent and insect infestations. The inspections turned up spoiled food, broken doors, missing smoke detectors and inaccessible fire extinguishers. Medications were not properly stored and sometimes co-mingled and unsecured. All of those serious problems were then compounded by the bleak living conditions the auditors documented—insufficient quantities of food, insufficient bedding, inadequate lighting, and non-functioning or damaged appliances.

Unbelievably, at one location, auditors found a three-year-old child running around a filthy home, being supervised by the mentally ill clients while the mother, a live-in caretaker, was working a second job away from the home.

The for-profit providers were paid an average of $1,450 each month for every client they housed and supposedly assisted with activities of daily living. Clients also contributed their own meager incomes from social security or disability, a financial system future audits will cover.

How have we come to this place where people living with a severe mental illness live in such squalor? Nevada’s dark history of providing care for the mentally ill goes back decades as the state budget is often balanced by reducing services for people who don’t or can’t complain. The public has long turned a blind eye to the hidden suffering of people we’d rather not think about at all.

The Legislature and the governor would do well to focus on practical solutions for those who can’t care for themselves. To start, the responsibility for oversight of the homes must be removed from case workers who are desperate to find placements for their clients, some of whom display difficult behaviors and habits. A full continuum of housing options is needed, preferably run by the non-profit sector or through public/private partnerships

No one should have to live in these deplorable conditions, but it’s going to take some work to develop more suitable housing options in this time of decidedly unaffordable housing. But the only housing choice cannot be a filthy, substandard home focused on profit instead of people.

Non-profit agencies, churches and advocacy groups must also step up to share the responsibility and find solutions. Legislators must do more than express outrage and blame; they must find the money needed to make the change happen.

This one is on all of us to solve.