In 2016, Anjeanette Damon wrote a series for the Reno Gazette-Journal exposing some harrowing conditions in group homes for people with mental illness.
These are outsourced homes the state pays for and is supposed to oversee.
That series got the attention of Governor Brian Sandoval and legislators, who passed a law in 2017 requiring better oversight by October 1 of last year.
A new audit by the Legislative Counsel Bureau concludes that that oversight has not happened.
And people are still living in the filthy conditions Damon found nearly two years ago.
“If you talk to the director of the Health and Human Services, he says, ‘we received all the tools we needed to make sure this wouldn’t happen again and for some reason it did.’ They are still investigating to find out exactly where the breakdown happened,” Damon said.
The homes cost the state of Nevada $134 million a year. Providers get paid $1,450 per month per client.
And that's part of the problem, according to auditor Todd C. Peterson. He told the Audit Committee of the state legislature:
"Without a strong inspection and certification process, we have serious concerns with the current model for funding CBLA [Community-Based Living Arrangements] provider homes. Providers operate a business that inherently is driven by a profit motive. In the absence of adequate inspection and certification activities, providers may limit their level of care to maximize profit at the detriment of client services."
State Senator Ben Kieckhefer and Assemblywoman Maggie Carlton expressed concern in the audit meeting that the private funding model may need to be changed. Carlton said simply, "Privatization sucks!"
Kieckhefer didn't agree with that the idea that privatization is the problem when he spoke KNPR's State of Nevada, but there are a lot of issues that need to be addressed.
“The state can oversee this," he said, "The problem is the structure that was in place failed to do so in the very recent past”
Audit committee chair, Assemblywoman Teresa Benitez-Thompson says the focus now is on fixing the problem.
"It’s not just about money," she said "Group homes can be operated safely and at great quality. It really is about the person operating the group home and the amount of pressure coming from the state and from the department to make sure the quality does exist.”
Benitez-Thompson said there are group homes around the state for people with disabilities and the elderly that run well.
One of her biggest concerns with the audit was not the broken glass or dirty floors but with lack of oversight for medications. The audit found there was often no accurate record keeping of medications and the staff at many homes weren't properly trained when it came to medications.
“The staff have in no way the training the experience or the language abilities to be communicating effectively with this population about their medication management and that right off the bat is one of the most concerning things,” she said.
State Sen. Kieckhefer said part of the problem is how these homes are inspected. Most homes for the elderly or disabled are inspected by the same state regulators that oversee hospitals and other medical facilities.
Since these homes are not listed as "medical facilities" they are not inspected the same way.
“What we’ve had in some ways is the fox watching the henhouse," he said, "We need to bifurcate these functions so that service delivery professionals are separated from the individuals who are charged with overseeing these facilities from a regulatory perspective.”
Improving the inspection is part of the issue and being able to clawback state funds if a contracted company cannot properly show where that money went is another part.
He believes inspectors should be able to move people or cancel contracts if they find a home that is not following the rules.
The head of the Division of Public and Behavioral Health resigned just two days after her testimony to the committee, but Benitez-Thompson doesn't think that's enough.
She believes that in a way the state has created a "paper tiger" in that there are enough laws, rules, regulations and money but still nothing has changed.
Benitez-Thompson believes the people in the division overseeing the problem need to be passionate about their jobs and she feels society's attitude around people with mental illnesses needs to change.
“This is worth the work. This is worth the investment. Ultimately, our community is a better place if we can take care of these people”
And Damon pointed out that Governor Brian Sandoval - while expressing disgust at the conditions - has not made mental health funding a priority.
Anjeanette Damon, reporter, Reno Gazette-Journal; Assemblywoman Teresa Benitez-Thompson, D-District 27, State Senator Ben Kieckhefer, R-District 16
