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3 staff (mental health workers III, IV and/or V and licensed practical nurse) at $6,400..
25 percent time..
Occupational, physical, corrective and/or recreational therapist etc., at $10 per
hour, for 50 hrs. y-time secretary... Audio-visual equipment (see attached). Training (including travel, books, journals). Local mileage.... Miscellaneous: Part time space rental and phone; typewriter, stationery, printing, et cetera.
500 1, 375 2, 839 2,500
1,200 2,500 1,500
Income.-Consideration, but no estimate, may be given to reimbursement for approved psychiatric/psychological treatment during part of the project period. It is also suggested that consideration be given to the possible realization of one of the objectives of the project, i.e., supplemental support to boarding home operators by the health and social services department or the department of hospitals and institutions. As such, reimbursement for operator training may be obtained, during the 3d project year.
Operations assistant (B.A. to M.A. level).
Possible income.- 12 residents receiving SSI: $140-20 for personal use = $120 per month program timetable: 6th-8th month: progressive enrollment of residents; 8th-12th months full enrollment. 12 residents X $i 20 per mor $1,400 per mo. $1,400 per month X 5 mo = $7,200. Plus $1,400 from initial 2 mo = $8,640. Unknown amount generated through possible psychiatric services. Possible budget: $67.655 - 8,640 = $59,015.
Possible income.-12 residents receiving SSI of $120 per months x 12 month= $17,280. Plus unknown SSI increase. Plus unknown reimbursement for psychiatric services. Possible budget: $67,596–17,280 = $50,316.
Possible income.--Ist 6 mo. similar to last 6 mo. of project year. Possible budget: $75,063 – 8,640 = $66,423.
Possible income. It is suggested that consideration be given to the possible realization of one of the objectives of the project, i.e. supplemental support to boarding home operators by the health and social services department or the department of hospitals and institutions. As such, reimbursement for operator training may be obtained during the 4th project year.
INTRODUCTION During the preparation of the final draft of this proposal, the following story appeared in the APA Monitor (The American Psychological Association, March, 1974):
NEW YORK TOWN BANS MENTAL PATIENTS Long Beach, New York ... passed an ordinance . that bans anybody requiring "continuous" psychiatric, medical or nursing care, or medication from being registered in any of the city's facilities . . . Carried to its logical conclusion, the .. i law would treat former mental patients (and present mildly or moderately disabled individuals, ed.) as permanent lepers and would cripple the progressive movement toward community-based outpatient care. (The rate of admissions to New Mexico State Hospital from Bernalillo County has decreased from 27% prior to the development of a community based program to 4%, while the number of applicants for service has tripled, ed.)
The article points out that the city's intention is not to ban mental patients but to regulate and superyise the city's 30 odd hotels and rooming houses which were never intended to be health care facilities and many of which are substandard. Apparently, however, the city is regulating people and not substandard facilities as no positive support or closing of substandard facilities is indicated. Proponents of the law reportedly also represent some senior citizen groups who shouldn't be forced to live with mental patients. The point is elaborated on in the article with the consideration, would any one put his mother in the same room with a mental patient. Obviously not; but, perhaps as equally important and in reference to this proposal, would anyone put their mother in a substandard rooming house or "hotel" or situation which does not consider the more intangible aspects of quality living-social stimulation, opportunities for a sense of self worth and competence. (The complete text of the article is an addendum to the proposal.)
At another level, consideration should be given to reference in the 1970 U.S. Government Census Report regarding persons in group living situations. One reference, listed along with prisons, is to inmates of homes for the aged-lacking further definition, it is assumed reference is to nursing homes as rooming houses are also listed. Nonetheless, it is felt that the use of the term inmate carries a popular negative connotation although the denotative reference is also not necessarily complimentary: one of a group occupying a single residence; especially a person confined in an asylum, prison or poorhouse. (Today's nursing homes are indeed costly and the poorhouse can be where you “end up" after being in one; "confined” implies, as against one's will which is not necessarily true of a person who voluntarily uses a nursing home facility.)
More specifically in regard to the project, it is assumed that any agency providing human services develop their intervention plan with due regard for both the figure and background aspects of the client. As an example, it would be foolhardy for a client to be prescribed a medication and have no financial means of obtaining it, i.e. the agency would refer or assist the client to or with resources, eg. an HSSD application. Similarly, agencies such as mental health, various medical programs and rehabilitation programs develop intervention plans, but unintentionally may overlook a possible variable which can seriously jeopardize the plan (or even limit potential clients from seeking services). This variable is the client's psychological and physical residence which, for many, is a boarding home. With due respect to the fine boarding home operators, general public opinion appears to be pessimistic about the quality of living provided and negativistic about the intentions of operators. No known local project has existed which attempts to offer positive consideration of operators' "side of the story." The proposed project is such an attempt: Project staff will be trained ; work in boarding homes or operate one for a specified period; provide psycho/social services; gather management and other data ; analyze data and develop a Boarding Home Operations Training Package for statewide use that focuses on fiscal/physical management and Physical/Psychological Care Development. If, as indicated by the data, further positive support is necessary, the data will be presented to possible resources, e.g., the Health & Social Services Department and/or the Department of Hospitals and Institutions.
Many boarding homes contain a mixture of older and younger residents. The Project will : 1) Focus on this typical boarding home resident pattern as best as possible and 2) Be considered as part of the development of a comprehensive (mental health) program on aging.
As a final introductory comment, it may be argued that the proposal focus, boarding homes and their operation, fall beyond the realm of sponsorship by a mental health facility. However, it is suggested that this is a service gap area and that the Mental Health Care/Department of Psychiatry play only a leadership and stimulation role that will eventually bring forth a, perhaps, more appropriate sponsoring agency or the development of a private organization of boarding (and perhaps nursing) home operators. In addition, the two alternative methods for obtaining the objectives of the Project are time limited.
Boarding homes are not to be confused with skilled or intermediate care nursing homes. The latter provides a residential situation with trained nursing personnel. The former is not required to provide in-house nursing care. A boarding home is a group residence which provides sleeping facilities and meals. In those instances where some physical assistance is provided, e.g. dressing, bathing, feeding and where certain physical plant requirements are met, e.g. crash bars on the doors, the home may be designated a sheltered home. Few homes are so designated because of the financial expense of meeting the physical plant requirements. (Often a room and board operator may assist with feeding, bathing, etc. because of his own personality style.) An individual who seeks to board more than two individuals in his home, must meet license requirements (primarily related to the physical plant) of the New Mexico Health & Social Services Department.
At present, there are thirty-nine licensed facilities in Bernalillo County and fifty-five in the remainder of the state with many in Las Vegas where the State Psychiatric Hospital is located. Four facilities in Bernalillo County will be excluded from statistical presentation; (three related to drug rehabilitation programs and one sponsored by the Albuquerque Association for Retarded Children). Thus, the licensed capacity of the remaining thirty-five homes is approximately 350. For the rest of the state, it is 485. In addition to licensed facilities, it is estimated by HSSD personnel that there are 700 unlicensed facilities locally creating a potential capacity of 1,400. Little supervision or knowledge of these homes is available. Expanding further on the spectrum of "living' facilities are the many less expensive motels and hotels in the core city where elder or the younger disabled may reside.
Who live in boarding homes? No concrete "diagnostic" or descriptive material is available. However, as community based mental health staff have occasion to consult or work with residents over the past five years, one might characterize a majority of the residents as the infirmed elderly, the young and older adult retarded and the young and older adult marginal functioning individual, oftentimes ex-state hospital patient.
Why a concern for boarding homes as they are a private, profit making business? As, it is believed, Mark Twain once said about the weather, everybody talks about it, but nobody ever does anything about it. Refer to any agency personnel that has contact with boarding homes—Visiting Nursing Service, Office of Economic Opportunity, Family Health Center, Mental Health Center, Coordinated Action for Senior Adults, Albuquerque Community Council, Mid-Rio Grande Health Planning Council, Community Services Office of New Mexico State Ilospital, Health & Social Services Department, Environmental Health-and question the quality of living aspects of many boarding homes. Over a year ago, community concern, that periodically waxes and wanes resulted in the closing of a few facilities for fire-safety violations, e.g. insulation of heating equipment, too many residents, including one blind person living in a basement bedroom, etc. The concern, however, that stifles many more closings is where are the residents to be "sbifted." Indeed, it should be up to the individual to move if he is not satisfied, however, because of lack of cognitive/emotional capacity or the limited financial resources of many, the number of choice alternatives is limited. Further, speaking recently to a senior resident who was exploring her plight of being physically mishandled, she at the time was reluctant to be placed elsewhere as she had established friends in the home and was also fearful she would no longer be able to visit with relatives in the general neighborhood.
For at least the last five years, the general attitude regarding boarding homes has been a negativism mixed with outrageous indignation and a sense of punitiveness. The general solutions offered are for tougher regulations, enforcement and closing. Several other "input” variables need to be considered : (1) Several states