As Dallas Boarding Homes Struggle, City Hall Sits on its Hands

Texas lawmakers gave cities the power to regulate homes for the mentally ill -- but so far, Dallas hasn't used it.

"Boarding homes aren't a bad thing," says Dave Hogan, a licensed social worker who's also the head of the Dallas Police Department's Crisis Intervention Unit. "But there needs to be oversight." In 2007, the city didn't even know where the boarding homes in Dallas were located, much less which ones were good or bad. Hogan was part of an interdepartmental city task force that took a few older lists of possible boarding homes and set out to find out where the homes were and to ensure they were safe. It was the second time Dallas had convened city entities to look at boarding homes. The first effort was in 2004, and it didn't seem to have much impact.

What the 2007 task force found was often alarming. "There were terrible living conditions," Hogan says. "Places that were dirty, kind of crowded, the beds pushed together," at times cramming eight or more people in a single bedroom. In some homes, a slightly more competent resident was acting as the house manager. In one place, Hogan says, he asked that resident where everyone's medications were kept. The man thought deeply for a moment, then retreated into his bedroom. Hogan followed. "He was looking around like he can't remember where it is," Hogan says. Then the man brightened and reached under his mattress, pulling out a plastic bag filled with a jumble of pill bottles.

Over 15 months, the team visited 345 properties, where caseworkers interviewed 883 residents. Of those, 276 — nearly one in three — were found to be "at risk and in need of crisis assistance," in the words of a report the team put together.

The Pleasant Grove boarding home where Boulware and seven others live.
Nomi Vaughan
The Pleasant Grove boarding home where Boulware and seven others live.
Janie Metzinger, public policy director at Mental Health America of Greater Dallas. "The problem we see with some boarding homes is that they mitigate against recovery."
Naomi Vaughan
Janie Metzinger, public policy director at Mental Health America of Greater Dallas. "The problem we see with some boarding homes is that they mitigate against recovery."

"It really worked great," Hogan says. He's a small man with neat white hair in a Mister Rogers side-part. He swims slightly in the black DPD jacket he wears for work. Over time the team pared the list down and discovered which homes were still operating and which had vanished; many homes, especially in poorer parts of southern Dallas, seem to pop up and disappear overnight. "Some had gone back to single-family homes, with a tricycle in the front yard. One of them, it had gone and turned into a little mini city park. We had a good laugh at that. A good number of 'em were boarded up like haunted houses." With the intensive inspection, he says, "We got a good handle on generic problems and specific problems to some of these houses."

As Hogan points out, not all boarding homes are dangerous or overcrowded. In Texas, they've become an increasingly large part of the thin safety net that keeps the mentally ill, just barely, from falling through the cracks.

The number of beds in state-run psychiatric facilities here shrank by 30 percent between 1993 and 2010, according to Health Management Associates, which owns hospitals in 10 states. Among states, Texas also doles out the least money in mental health funding. In 2009, economist Ray Perryman found that Texas spent $34.57 per day per patient on mental health services, when the national average was $103.53. The same year, the state's mental health system received a "D" grade from the National Alliance on Mental Illness.

Outpatient treatment is just as strapped. NorthSTAR, the behavioral health program that provides services to many North Texas residents, lost around $23.7 million in funding during the last legislative session. Since 2008, the number of people who lost health insurance as a result of the economic crisis and have needed public mental healthcare has skyrocketed.

Dr. James Baker is the president of Dallas Metrocare Services, one of the largest nonprofit mental healthcare providers here. The upshot for his clinics, he says, is that "we're serving twice as many people as we served in 2004 for the same amount of dollars."

For all these reasons — the shortage of state beds and state money, poverty, lack of family willing or able to care for them — for many people in Texas and elsewhere, a boarding home is the only option after leaving a hospital or homeless shelter.

Boarding homes aren't medical facilities, and an operator isn't required to have any special training or license. "All we're required to do is provide three meals a day, one of them hot, and a roof over their heads," Donaldson says.

It's better than homelessness. But for years, mental health advocates throughout the state have been telling their cities that no one is really watching these places the way that they should be. The homes aren't overseen by the Department of Aging and Disability Services (DADS), the state agency that regulates places like nursing homes. And although a state law passed in 2009 gave Texas cities the authority to regulate these homes, only El Paso has chosen to do so.

A 2009 report to the Legislature estimated that about 845 boarding houses operate throughout Texas, many of them clustered in Houston, El Paso, Dallas, San Antonio and Austin. People who live in them are often mentally ill, elderly, disabled, recovering from addiction, or some combination of all those conditions. Most of those clients have an income of less than $650 a month, which they tend to get from federal Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) checks. An average of $21 a day is expected to pay for a person's room, board and personal needs; Texas is one of a handful of states that doesn't subsidize SSI. "Boarding houses are very much a stopgap between some basic level of shelter and food and outright homelessness," the report says. It found that most people receiving SSI would have to spend 109 percent of their monthly income to rent an apartment at regular market rate in most Texas cities.

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1 comments
357 Armadillo
357 Armadillo

This article and the Observer's earlier articles illustrate the dark side of the body business, where people take control of other people's lives, patient recruiters are given access to captive populations, and the rules are made by groups like Mental Health America who get money from the drug industry. It is an environment ripe for fraud, kickbacks, and other forms of corruption. Getting people off the street when they have no where to go is a laudible goal. But only if it is done without violating people's safety and their basic rights.

 
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